Transdiagnostic effects of mindfulness-based interventions on emotion regulation and psychopathology in adolescents: A systematic review and meta-analysis.

OBJECTIVES: Emotion dysregulation (ED) is a core transdiagnostic process associated with diverse adolescent mental health problems. This systematic review and meta-analysis evaluated the transdiagnostic effects of mindfulness-based interventions (MBIs) on emotion regulation (ER) and key psychopathology domains in adolescents with ED or elevated emotional difficulties, and explored potential moderators.

METHODS: We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CNKI from inception to December 10, 2025. Individual and cluster randomized controlled trials involving adolescents aged 10-19 years were eligible if they reported at least one ER-related outcome. The primary outcome was ER-related measures (e.g., DERS, ERQ, rumination). Secondary outcomes were depressive symptoms, anxiety symptoms, and internalizing/overall distress. Random-effects models were used to pool standardized mean differences (Hedges' g). Prespecified subgroup analyses examined population type, control type, and setting. Exploratory meta-regressions tested mean age and in-class intervention dose. Publication bias and sensitivity analyses were conducted when appropriate.

RESULTS: Eleven RCTs (INT/CON = 612/634) were included. Compared with controls, MBIs significantly improved ER (Hedges' g = -0.433, 95% CI -0.637 to -0.229; I2 = 62%). MBIs also reduced depressive symptoms (5 studies; SMD = -0.27, 95% CI -0.45 to -0.10; I2 = 0%), anxiety symptoms (4 studies; SMD = -0.57, 95% CI -0.78 to -0.36; I2 = 0%), and internalizing/overall distress (6 studies; SMD = -0.33, 95% CI -0.49 to -0.17; I2 = 19%). Control type significantly moderated ER effects (between-subgroup p = 0.04), with larger effects in the small subset of trials using active controls; however, this comparison was based on only three heterogeneous studies and should be interpreted cautiously. Higher in-class dose was associated with greater ER improvements (β = -0.144, p < 0.05), whereas mean age was not (p = 0.563). Egger's test suggested possible small-study effects (p = 0.037), but trim-and-fill imputed no missing studies and did not materially alter the pooled effect.

CONCLUSIONS: MBIs show small-to-moderate benefits for emotion regulation and a broadly consistent beneficial pattern across depressive, anxiety, and internalizing/overall distress outcomes in adolescents with ED or elevated emotional difficulties. These findings support cautious consideration of ED-focused MBIs in clinical and school settings, while underscoring the need for larger, well-controlled trials to confirm dose-response relationships and clarify comparative efficacy against active controls.