Impacts of digital third-wave interventions for adults on wellbeing and mental health outcomes: A systematic review and meta-analysis of randomized controlled trials

Tom C Gordon, Andrew H Kemp, Josh Hope-Bell and Darren J Edwards

PLOS Digital Health, 2026, vol. 5, issue 10, 1-23

Abstract: To synthesise the efficacy of digital third-wave process-based interventions (e.g., ACT, Mindfulness, Compassion) for improving wellbeing and ameliorating mental health symptoms in adults. A prospectively registered systematic review (OSF: 10.17605/OSF.IO/5RMU2) and random-effects meta-analysis of randomised controlled trials (RCTs) was conducted across six databases through January 2026. Certainty of evidence was assessed using the GRADE framework. Interventions (k = 147; N = 26,391) yielded small-to-moderate immediate post-intervention improvements in wellbeing (k = 46, g = 0.36), depression (k = 110, g = 0.44), anxiety (k = 93, g = 0.40), stress (k = 66, g = 0.46), quality of life (k = 32, g = 0.30), and psychological flexibility (k = 51, g = 0.41). Heterogeneity was substantial across most outcomes (I2 > 75%). Benefits were observed across healthy (61 trials; n = 15,770), mental health (41 trials; n = 6,130), and medical samples (46 trials; n = 4,491), with population type not significantly moderating immediate post-intervention effects. Comparator type significantly moderated several analyses, with smaller effects against active than inactive controls. Guidance did not significantly moderate immediate post-intervention effects, although it predicted larger short-term depression effects (QM = 4.17, p = .048). At short-term follow-up, effects remained statistically supported across all outcomes, while only depression, anxiety, and stress remained statistically supported at medium-term follow-up. GRADE certainty was moderate for most immediate post-intervention outcomes and low for quality of life. Digital third-wave interventions produced small-to-moderate average benefits across symptom-focused, wellbeing-focused, and process outcomes. Effects were smaller against active comparators, indicating that pooled benefits should be interpreted in relation to comparator intensity. Future research should prioritise rigorous active controls, longer follow-up, and direct tests of whether changes in psychological flexibility mediate improvements in symptoms and wellbeing.Author summary: Digital programmes based on acceptance, mindfulness, compassion, and related approaches are increasingly used to support adult mental health, but their overall benefits and durability remain uncertain. We brought together evidence from 147 randomised controlled trials involving 26,391 participants. We found that these programmes produced small-to-moderate average improvements in wellbeing, depression, anxiety, stress, quality of life, and people’s ability to respond flexibly to difficult thoughts and emotions immediately after the intervention. Benefits were observed among healthy adults and people with mental or physical health conditions. However, effects were generally smaller when programmes were compared with active alternatives, such as structured psychological support, rather than inactive controls such as waiting lists. Improvements in depression, anxiety, and stress were maintained over the short term, but longer-term evidence was limited and less consistent. Results also varied substantially between studies, and most trials had some methodological concerns, meaning that the precise size of benefit remains uncertain. Our findings suggest that these digital programmes can provide useful mental health support, but future trials should compare them with credible active treatments and establish how benefits can be maintained over time.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pdig00:0001764

DOI: 10.1371/journal.pdig.0001764

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