Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder: Systematic Review and Meta-Analysis
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Objective
To evaluate the efficacy and safety of Mindfulness-Based Stress Reduction (MBSR) for anxiety symptoms in adults with generalized anxiety disorder (GAD).
Design
Systematic review and meta-analysis.
Data Sources
CINAHL, Embase, MEDLINE, PsycINFO, Scopus, SocINDEX, ERIC (EBSCO), and ProQuest Dissertations & Theses Global were searched from inception to October 2025; identified trial protocols were hand-searched for subsequent reports through February 2026.
Eligibility criteria for selecting studies
Randomized, non-randomized, and single-arm trials evaluating the effects of MBSR on anxiety in adults with GAD.
Data extraction and synthesis
Two authors independently screened records, extracted data, and assessed risk of bias. The primary outcome was anxiety symptoms; the secondary outcome was adverse events. Random-effects meta-analyses were conducted, and certainty of evidence was assessed.
Results
Of 19 included reports (16 independent samples), 8 randomized controlled trials ( n =1,012) were included in the primary meta-analysis. MBSR significantly reduced anxiety symptoms vs. waitlist (Hedges’ g =−0.88; 95% CI −1.57 to −0.19) and general active comparators ( g =−0.85; 95% CI −1.15 to −0.54), and showed no significant difference vs. escitalopram in two linked trials ( g =0.09; 95% CI −0.11 to 0.29), with fewer adverse events in the in-person trial, the only one reporting them (15% vs. 79%; number needed to treat to avoid harm=2). GRADE certainty of evidence was high for the escitalopram comparison and very low for waitlist.
Conclusions
MBSR is a well-tolerated, nonpharmacologic treatment option for adults with GAD. Anxiety reductions were similar to escitalopram, with fewer adverse events; independent replication is needed. MBSR may be a viable option for patients who prefer non-pharmacological management or who cannot tolerate medication.
Systematic review registration
PROSPERO CRD420251140213.
SUMMARY BOX
What is already known on this topic
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Generalized anxiety disorder (GAD) is common and disabling, and pharmacotherapy is frequently discontinued because of adverse effects
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Previous reviews of mindfulness-based interventions for anxiety pooled different programs and diagnoses, with inconsistent findings
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Recent noninferiority trials comparing Mindfulness-Based Stress Reduction (MBSR) with escitalopram had not been synthesized
What this study adds
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MBSR reduced anxiety symptoms compared with waitlist and general active comparators, although certainty of evidence for the waitlist comparison was very low
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In two linked trials, anxiety reductions with MBSR were similar to those with escitalopram (high certainty evidence; g=0.09, 95% CI −0.11 to 0.29), with fewer adverse events in the in-person trial (15% v 79%; number needed to treat to avoid harm 2)
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Independent replication and head-to-head trials against cognitive behavioral therapy are needed
