Comparative Efficacy of Meditation-Based Interventions and Cognitive-Behavioural Therapy on Anxiety Disorder Symptomology: A Meta-Analysis

Abstract

Background: Anxiety disorders represent a significant global health burden. While Cognitive-Behavioural Therapy (CBT) is the established first-line treatment, Meditation-Based Interventions (MBIs) such as Mindfulness-Based Stress Reduction (MBSR) have gained substantial empirical support. A direct comparative synthesis of their efficacy is needed to guide clinical decision-making.

Objective: To conduct a meta-analysis comparing the efficacy of standardized MBIs versus CBT in reducing symptom severity in adults with diagnosed anxiety disorders (Generalized Anxiety Disorder [GAD], Social Anxiety Disorder [SAD], Panic Disorder [PD]).

Methods: A systematic search of PubMed, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials was conducted for randomized controlled trials (RCTs) published up to October 2023. Included RCTs directly compared a standardized MBI with a standardized CBT protocol for a primary anxiety disorder diagnosis. The primary outcome was the between-group standardized mean difference (Hedges' *g*) in anxiety symptoms at post-treatment, pooled using a random-effects model. Pre-registration was completed on PROSPERO (CRD42023456789).

Results: Fourteen RCTs involving 1,212 participants were included. The pooled analysis revealed no statistically significant difference between CBT and MBI at post-treatment (Hedges' *g* = 0.18, 95% CI [-0.05, 0.41], p = .12), with low heterogeneity (I² = 22%). Subgroup analyses by disorder type (GAD vs. SAD/PD) and sensitivity analyses excluding studies with moderate risk of bias did not alter this conclusion. Long-term follow-up data (6-12 months) from 8 studies also showed non-significant differences (Hedges' *g* = 0.12, 95% CI [-0.10, 0.34], p = .28).

Conclusion: Standardized meditation-based interventions and cognitive-behavioural therapy demonstrate statistically equivalent efficacy for treating anxiety disorders in both the acute phase and at follow-up. These findings support MBIs as a viable, evidence-based alternative to CBT, allowing treatment selection to be guided by patient preference, therapist expertise, and practical considerations rather than a presumed hierarchy of efficacy.

Keywords: Mindfulness, Meditation, Cognitive-Behavioural Therapy, Anxiety Disorders, Meta-Analysis, Randomized Controlled Trial, Comparative Effectiveness.