Mindfulness-based interventions and cognitive behavioral therapy for depression, anxiety, and stress in adults with chronic conditions: a stratified subgroup meta-analysis

Anxiety, depression, and stress are common in individuals with diabetes and cancer and are associated with poor self-management and well-being. Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) are widely used in nonpharmacological treatments, but their comparative effectiveness remains unclear. We conducted a stratified subgroup meta-analysis to indirectly compare CBT and MBIs in adults with diabetes or cancer, examining moderators including condition, delivery modality, and dose. Following PRISMA guidelines, we searched Scopus, Web of Science, EBSCOhost, and ScienceDirect through October 2025. Randomized trials (N = 107; n = 23,585) reporting validated post-intervention outcomes were pooled using random-effects models, with subgroup and meta-regression analyses performed in RStudio. Overall, CBT and MBIs significantly improved outcomes (SMD = -0.78). CBT showed larger effects, particularly for depression (SMD = -0.95) and diabetes (SMD = -1.21), although comparisons were indirect and heterogeneity was substantial. Stronger effects were observed in group-based interventions lasting ≥8 weeks, providing ≥8 contact hours, and including homework or booster components; higher session frequency was also associated with greater improvement (β = -0.086; p < 0.01). MBIs may offer scalable benefits, particularly in cancer care. These findings support condition-tailored psychosocial strategies, although results should be interpreted cautiously.