Differential Efficacy and Clinical Utility of Mindfulness-Based Adjuncts in Psychotherapy: A Systematic Review and Meta-Analysis

Adjunctive mindfulness-based interventions (MBIs) are widely deployed in psychiatric care, yet comparative efficacy is obscured by heterogeneity in control stringency, endpoints, and follow-up. PRISMA-conformant systematic review and random-effects meta-analysis of 15 RCTs (N = 1,659), pooled separately by effect metric: binary relapse (RR; k = 3), time-to-event relapse (HR; k = 2 independent trial-level estimates), and continuous outcomes (Hedges’ g; k = 5). MBIs favored relapse prevention (RR = 0.63, 95% CI 0.39–1.02; HR = 0.67, 95% CI 0.46–0.98) and suggested a small-to-moderate reduction in symptom severity (g = −0.27, 95% CI −0.55 to 0.02), with substantial heterogeneity for continuous outcomes (I2 = 62.8%). Effects were directionally consistent, strongest for time-to-event relapse, but small-k uncertainty limits precision. This review advances prior syntheses by metric-stratified pooling and by linking estimates to mechanistically informed practice components to improve clinical interpretability.