Effects of online mindfulness-based interventions (MBIs) on anxiety symptoms in adults: a systematic review and meta-analysis

Background An increasing number of studies have documented the effectiveness on various types of face-to-face and online mindfulness-based interventions (MBIs) in reducing anxiety among general population, but there is a scarcity of systematic reviews evaluating evidence of online MBIs on anxiety in adults. Therefore, we examined the effects of online mindfulness-based interventions (MBIs) on anxiety symptoms in adults and explored the moderating effects of participant, methods, and intervention characteristics. Methods We systematically searched nine databases through May 2022 without date restrictions. Inclusion criteria were primary studies evaluating online mindfulness-based interventions with adults with anxiety measured as an outcome, a comparison group, and written in English. We used random-effects model to compute effect sizes (ESs) using Hedges' g, a forest plot, and Q and I-2 statistics as measures of heterogeneity; we also examined moderator analyses. Results Twenty-six primary studies included 3,246 participants (39.9 +/- 12.9 years old). Overall, online mindfulnessbased interventions showed significantly improved anxiety (g = 0.35, 95%CI 0.09, 0.62, I-2 = 92%) compared to controls. With regards to moderators, researchers reported higher attrition, they reported less beneficial effects on anxiety symptoms (beta=-0.001, Qmodel=4.59, p =.032). No other quality indicators moderated the effects of online mindfulnessbased interventions on anxiety. Conclusion Online mindfulness-based interventions improved anxiety symptoms in adult population. Thus, it might be used as adjunctive or alternative complementary treatment for adults. However, our findings must be interpreted with caution due to the low and unclear power of the sample in primary studies; hence, high-quality studies are needed to confirm our findings.