Comparative efficacy of psychological interventions on immune biomarkers: A systematic review and network meta-analysis (NMA).
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 37187256 · doi:10.1016/j.bbi.2023.05.006
What was done
Authors conducted a systematic review and frequentist random-effects network meta-analysis (PROSPERO: CRD42022325508) of randomized controlled trials (RCTs) searched across PubMed, Scopus, PsycInfo, and Web of Science through October 17, 2022. The review assessed the post-treatment efficacy of 13 types of psychological interventions compared to control conditions on innate and adaptive immune biomarkers in adults. Across 104 included RCTs involving 7,820 participants, effect sizes were calculated as Cohen's d with 95% confidence intervals (CIs).
What was found
Compared to control conditions, post-treatment reductions in proinflammatory cytokines and markers were observed for cognitive therapy (d = -0.95, 95% CI: -1.64 to -0.27), lifestyle interventions (d = -0.51, 95% CI: -0.99 to -0.02), and mindfulness-based interventions (d = -0.38, 95% CI: -0.66 to -0.09). Mindfulness interventions also increased anti-inflammatory cytokines (d = 0.69, 95% CI: 0.09 to 1.30), while cognitive therapy increased white blood cell count (d = 1.89, 95% CI: 0.05 to 3.74). Interventions had no statistically significant effect on natural killer cell activity.
Why it matters
This study provides comparative evidence that specific psychological modalities—most consistently mindfulness, cognitive therapy, and lifestyle strategies—can alter peripheral inflammatory and immune profiles in adults.
Limits
Substantial heterogeneity was detected across most analyses, limiting precision. The GRADE certainty was rated only moderate for mindfulness and low-to-moderate for cognitive therapy and lifestyle interventions. Outcomes reflect immediate post-treatment values, so long-term durability of immune modulation and translation to hard clinical endpoints remain unmeasured.
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