Comparative effects of different sport psychology interventions on anxiety in competitive athletes: a Bayesian network meta-analysis.

BACKGROUND: Anxiety is a prominent psychological factor that can impair both training adaptation and competitive performance in athletes. Although sport psychology interventions are generally considered beneficial for anxiety reduction, the comparative effectiveness of different intervention approaches remains unclear. OBJECTIVE: To systematically evaluate the effects of sport psychology interventions on anxiety in competitive athletes and to compare their relative efficacy using Bayesian network meta-analysis. METHODS: Randomized controlled trials (RCTs) examining sport psychology interventions for anxiety reduction in competitive athletes were systematically identified. Pairwise meta-analysis was conducted to estimate the overall effect, with sensitivity analysis, subgroup analysis, and meta-regression performed to explore the robustness of findings and potential sources of heterogeneity. Bayesian network meta-analysis was then used to compare and rank the relative effects of different interventions. RESULTS: Twenty-four studies were included. Pairwise meta-analysis showed that sport psychology interventions significantly reduced anxiety in competitive athletes compared with control conditions (SMD = -0.74, 95% CI: -1.05 to -0.43; p < 0.0001), and sensitivity analyses supported the robustness of this finding. Subgroup analyses suggested that both individual and group-based interventions were effective, with generally consistent effects across competitive levels. Intervention timing emerged as the only significant subgroup factor, with interventions delivered during the regular training period showing the largest effect (SMD = -0.94, 95% CI: -1.43 to -0.45), while immediate pre-competition interventions also showed a stable benefit (SMD = -0.46, 95% CI: -0.58 to -0.33). Meta-regression did not identify significant linear associations between the examined covariates and effect sizes. In the Bayesian network meta-analysis, arousal regulation interventions (AR), cognitive-behavioral therapy (CBT), and mindfulness/acceptance/meditation-based interventions (MAM) showed significant advantages over passive control (PC), and CBT had the highest probability of being ranked first (86.14%). CONCLUSION: Sport psychology interventions appear effective overall for reducing anxiety in competitive athletes. Different intervention approaches may vary in relative efficacy, with CBT, AR, and MAM emerging as the most promising options and CBT showing the greatest likelihood of relative advantage within the current evidence base. Intervention timing may also be an important factor influencing treatment effects. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261347470, identifier CRD420261347470.