Comparative Effectiveness of Resilience-Focused Psychological Interventions on Resilience, Anxiety, and Depression in...

Patients with cancer often experience psychological distress, which can reduce resilience, increase anxiety, and depression. Resilience-focused psychological interventions have been increasingly implemented; however, their comparative effectiveness remains unclear, as existing evidence is largely limited to pairwise comparisons. This study aimed to compare and rank the effectiveness of resilience-focused psychological interventions on resilience, anxiety, and depression among adults with cancer using a network meta analysis of randomized controlled trials.

A systematic search of seven databases (CINAHL, Embase, MEDLINE Ovid, PubMed, Scopus, Web of Science, and Cochrane) was conducted from inception to December 2025. A frequentist random-effects network meta-analysis was performed using the netmeta package in R. Effectiveness was evaluated using standardized mean differences (SMDs) with 95% confidence intervals (CIs), prediction intervals, P-scores, and certainty of evidence.

Twenty-six randomized controlled trials involving 2159 adults with cancer were included. Cognitive behavioral therapy (CBT) demonstrated the largest improvement in resilience (SMD = 1.14; 95% CI: 0.80, 1.48), followed by positive psychology interventions (SMD = 0.79; 95% CI: 0.56, 1.03) and Acceptance and Commitment Therapy (ACT) (SMD = 0.70; 95% CI: 0.04, 1.35). For anxiety, ACT (SMD = -0.97; 95% CI: -1.85, -0.10) and CBT (SMD = -0.73; 95% CI: -1.19, -0.27) showed the largest average reductions. For depression, CBT (SMD = -0.61; 95% CI: -0.97, -0.25) and positive psychology (SMD = -0.55; 95% CI: -0.89 to -0.20) were significant symptom reductions.

Resilience-focused psychological interventions were effective, with CBT showing the most consistent benefits, followed by positive psychology interventions and ACT. These findings support integrating resilience-based interventions into oncology care to improve psychological well-being.