Online and traditional mindfulness-based interventions for stress in university students: a systematic review and meta-analysis versus control conditions

Objective Empirical evidence verifies the efficacy of mindfulness interventions in addressing heterogeneous stress forms across clinical and non-clinical populations. However, online mindfulness is increasingly emerging in diverse modalities across online platforms, propelled by ongoing technological advancements. This study aims to conduct a systematic analysis of the intervention effects of online versus traditional mindfulness in alleviating stress among university students. It is important to note that this review compares online and traditional formats indirectly, by synthesizing trials that separately compare each format against a control condition, as head-to-head RCTs directly comparing both formats were not eligible for inclusion. Methods Four databases were selected as data sources: Web of Science, Embase, Medline and PsycINFO. A total of 4,387 articles were included based on the PICOS framework established a priori , and 16 articles were ultimately incorporated into the meta-analysis. During data analysis, article quality was appraised utilizing the Cochrane Risk of Bias Tool, with data extraction performed in Microsoft Excel and statistical analyses conducted in Stata. Results Analysis of the included studies indicated that online mindfulness interventions (SMD = −0.56; 95% CI: −0.76 to −0.36) effectively reduced stress in university students, with traditional mindfulness interventions (SMD = −0.64; 95% CI: −0.83 to −0.46) demonstrating comparable results. For improving mindfulness among university students, both online mindfulness (SMD = 0.52; 95% CI: 0.28 to 0.76) and traditional mindfulness (SMD = 0.42; 95% CI: 0.24 to 0.59) yield positive outcomes. Conclusion The results demonstrated that both online and traditional mindfulness effectively reduce university students’ stress and enhance their mindfulness levels. And the effects of these two intervention methods are comparable. Therefore, online mindfulness may serve as a viable and similarly effective alternative to traditional mindfulness for stress reduction among college students. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251025123 , CRD420251025123.