Supplementary Material for: Efficacy of cognitive behavioral therapy and acceptance- and mindfulness-based treatments in adults with bodily distress – a network-meta-analysis

Introduction: Many physical complaints cause long-term bodily distress. Meta-analyses show that cognitive behavioral therapy (CBT) and acceptance- and mindfulness-based treatments (AMBT) reduce somatic symptom severity, but evidence on differential efficacy is limited. Objective: This study evaluates the efficacy of CBT and AMBT for bodily distress (e.g., somatoform disorders, functional somatic syndromes, and related disorders). Methods: A network meta-analysis of randomized controlled trials on adults with bodily distress compared CBT and AMBT either directly or with non-specific control groups. Cohen’s d based on between-group effect sizes was aggregated using a random effects model. Primary outcome was somatic symptom severity; secondary outcomes included depression, anxiety, and perceived health status. Results: Based on 74 studies (N = 8,277), CBT (d = -0.50, 95%CI -0.70 to -0.29; between-group effect sizes vs. wait-list) and AMBT (d = -0.55, 95%CI -1.06 to -0.23; between-group effect sizes vs. wait-list) were equally effective in reducing somatic symptoms at post-treatment. AMBT were more effective than CBT in reducing depression (d = -0.31, -0.58 to -0.04; between-group effect sizes) and anxiety (d = -0.42, -0.73 to -0.11; between-group effect sizes) post-treatment. At long-term follow-up, effects were partly maintained; AMBT remained more effective than CBT for anxiety, with no differential effects for other outcomes. Conclusions: Both treatments showed benefits compared to various controls. Evidence suggests potential differential treatment effects, indicating some patient groups may benefit more from AMBT. Clinicians should view CBT as foundational but remain open to variations, especially for comorbid pathology.