Add-on efficacy of neurofeedback-augmented mindfulness training for stress reduction: a systematic review and meta-analysis of randomized controlled trials

Stress is a psychophysiological response that occurs when environmental demands exceed an individual’s coping capacity, and it is closely linked to many psychosomatic disorders. Mindfulness training can effectively reduce stress, but conventional mindfulness training (CM) places high demands on self-monitoring ability, which limits its effect. Neurofeedback-augmented mindfulness training (NM) provides real-time feedback on brain activity signals and may help address this limitation. However, most existing studies are small-sample RCTs, and their conclusions remain inconsistent. This study used a systematic review and meta-analysis to compare the overall effects of NM and CM on stress reduction and related mental health outcomes, aiming to provide evidence-based guidance for intervention selection in non-clinical young and middle-aged populations with mental health needs. We searched MEDLINE, PubMed, Scopus, CNKI, the Cochrane Library, and the ClinicalTrials registry databases. Publication dates were limited to January 2016 to August 2026. Five randomized controlled trials with 358 participants in total were included, and outcomes included stress, anxiety, depression, sleep quality, phone addiction, no-phone phobia, fatigue, neuroticism, and psychological resilience. Extracted data were pooled using a random-effects model, and sensitivity analyses were performed based on heterogeneity. In terms of stress improvement, NM showed a trend toward superiority over CM (SMD 0.65, P = 0.0009), with robust conclusions. For anxiety, two studies comparing NM with CM consistently supported the superiority of NM (SMD 0.67–0.87, both P < 0.01); however, evidence comparing NM with mental health education was inconsistent. For depression, NM showed a trend toward superiority over mental health education (SMD 0.41, P = 0.04), though the robustness was limited; evidence comparing NM with CM was limited and inconsistent. For sleep quality, no advantage of NM was observed compared with either CM or mental health education (SMD 0.05, P = 0.74), and this negative conclusion was robust. For the remaining outcomes, evidence was insufficient or inconsistent, and no definitive conclusions could be drawn. The preliminary evidence from this study suggests that, among non-clinical young and middle-aged adults, NM demonstrated relatively consistent potential advantages in improving stress, with robust directional findings. For anxiety, NM may offer benefits over CM, although the certainty of evidence is limited; evidence comparing NM with mental health education remains inconsistent. For depression, NM may be superior to mental health education, but the robustness is insufficient, and evidence comparing NM with CM is limited and inconsistent. For sleep quality, no advantage of NM was observed, and this negative finding was robust. For the remaining outcomes, definitive conclusions could not be drawn due to the very small number of studies or inconsistent results. These findings are limited by the small number of included studies, the fact that some outcomes were derived from single studies, and the exclusively non-clinical nature of the samples. Further high-quality randomized controlled trials are warranted to verify these results.