A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders

Heidemarie Haller,Holger Cramer,Marleen Schröter,Gustav Dobos,Pascal Breilmann

doi:10.1038/s41598-021-99882-w

Heidemarie Haller, Holger Cramer + Show 3 more

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https://doi.org/10.1038/s41598-021-99882-w

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Abstract

This meta-analysis systematically reviewed the evidence on standardized acceptance-/mindfulness-based interventions in DSM-5 anxiety disorders. Randomized controlled trials examining Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), and Mindfulness-Based Stress Reduction (MBSR) were searched via PubMed, Central, PsycInfo, and Scopus until June 2021. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for primary outcomes (anxiety) and secondary ones (depression and quality of life). Risk of bias was assessed using the Cochrane tool. We found 23 studies, mostly of unclear risk of bias, including 1815 adults with different DSM-5 anxiety disorders. ACT, MBCT and MBSR led to short-term effects on clinician- and patient-rated anxiety in addition to treatment as usual (TAU) versus TAU alone. In comparison to Cognitive Behavioral Therapy (CBT), ACT and MBCT showed comparable effects on both anxiety outcomes, while MBSR showed significantly lower effects. Analyses up to 6 and 12 months did not reveal significant differences compared to TAU or CBT. Effects on depression and quality of life showed similar trends. Statistical heterogeneity was moderate to considerable. Adverse events were reported insufficiently. The evidence suggests short-term anxiolytic effects of acceptance- and mindfulness-based interventions. Specific treatment effects exceeding those of placebo mechanisms remain unclear. Protocol registry: Registered at Prospero on November 3rd, 2017 (CRD42017076810).

Highlights

Anxiety disorders differ from normative fear or anxiety by featuring exaggerated symptoms lasting persistently over a prolonged period of time that interfere with daily activities
Types of patients: Eligible samples included adults diagnosed with an anxiety disorder as defined by DSM-51 including: Separation Anxiety Disorder (DSM-5: 309.21/ICD-10: F93.0), Selective Mutism (DSM-5: 321.23/ICD-10: F94.0), Specific Phobias (DSM-5: 300.29/ICD-10: F40.218, F40.228, F40.23x, F40.248, F40.298), Social Anxiety Disorder (DSM-5: 300.23/ICD-10: F40.10), Panic Disorder (DSM-5: 300.01/ICD-10: F41.0), Agoraphobia (DSM-5: 300.22/ICD-10: F40.00), Generalized Anxiety Disorder (DSM-5: 300.02/ICD-10: F41.1), Other Specified (DSM-5: 300.09/ICD-10: F41.8), and Unspecified Anxiety Disorder (DSM-5: 300.00/ICD-10: F41.9)
23 Randomized controlled trials (RCTs) published between 2007 and 2021 including 1815 patients were included in the metaanalysis[59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81]

Summary

Introduction

Anxiety disorders differ from normative fear or anxiety by featuring exaggerated symptoms lasting persistently over a prolonged period of time that interfere with daily activities. As the first-line treatment of anxiety disorders, clinical practice guidelines recommend psychological therapies, Cognitive Behavioral Therapy (CBT) in preference to or in combination with pharmacotherapy[10,11,12]. Another treatment option with promising evidence for alleviating anxiety symptoms in non-psychiatric samples[13,14,15,16,17] are mindfulness-based interventions such as Mindfulness-based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), and Acceptance Commitment Therapy (ACT). There is no comprehensive meta-analysis that assesses and compares the effectiveness and safety of standardized MBSR, MBCT, and ACT in the management of adult patients with DSM-5 anxiety disorders

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