- MBSR significantly reduced anxiety versus waitlist and general active comparators (Hedges' g about -0.85 to -0.88), though certainty versus waitlist was very low.
- Anxiety reductions with MBSR were similar to escitalopram in two linked trials (g = 0.09; high certainty), with fewer adverse events reported.
- MBSR is a well-tolerated, non-pharmacological treatment option for adults with GAD; independent replication and head-to-head trials against CBT are needed.
medRxiv [Preprint]. 2026 Oct 24:2026.10.21.26366048. doi: 10.64898/2026.10.21.26366048.
ABSTRACT
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: Generalized anxiety disorder (GAD) is common and disabling, and pharmacotherapy is frequently discontinued because of adverse effectsPrevious reviews of mindfulness-based interventions for anxiety pooled different programs and diagnoses, with inconsistent findingsRecent noninferiority trials comparing Mindfulness-Based Stress Reduction (MBSR) with escitalopram had not been synthesizedWhat this study adds: MBSR reduced anxiety symptoms compared with waitlist and general active comparators, although certainty of evidence for the waitlist comparison was very lowIn 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)Independent replication and head-to-head trials against cognitive behavioral therapy are needed.
PMID:42996257 | PMC:PMC13738837 | DOI:10.64898/2026.10.21.26366048
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