Background Competitive anxiety is a common psychological challenge among athletes and can negatively affect sports performance. Although several psychological interventions have been shown to reduce competitive anxiety, their relative effectiveness has not been well established. This study aimed to compare the effectiveness of different psychological interventions in reducing competitive anxiety in athletes. Methods We searched the Cochrane Library, Embase, PubMed, Scopus, and Web of Science from inception to March 2025, with additional screening of Google Scholar and reference lists. Randomized controlled trials published in English were eligible. Risk of bias was evaluated using the revised Cochrane Risk of Bias Tool. A Bayesian random-effects network meta-analysis was conducted using the `multinma` package. Subgroup analyses examined anxiety dimensions and competitive level. Effects were expressed as standardized mean differences (SMDs) with 95% credible intervals (CrIs). Results A total of 46 trials involving 2,049 participants were included. Mindfulness-Acceptance-Commitment (MAC) showed the largest overall point estimate for reducing competitive anxiety (SMD = - 1.33; 95% CrI: -2.31 to - 0.43). Across anxiety dimensions, relaxation was associated with the largest point estimate for reductions in cognitive anxiety (SMD = - 1.54, 95% CrI: -3.31 to 0.21), while MAC showed the largest estimated effect on somatic anxiety (SMD = - 1.24, 95% CrI: -1.57 to - 0.90). Intervention effects appeared to vary by competitive level: imagery showed the largest point estimate among elite athletes (SMD = - 0.88, 95% CrI: -1.84 to 0.14), MAC among semi-elite athletes (SMD = - 1.37, 95% CrI: -3.11 to - 0.17), and biofeedback among junior athletes (SMD = - 1.07, 95% CrI: -2.26 to 0). Exploratory study-level mediation analyses suggested that reductions in competitive anxiety were associated with improvements in sports performance. Conclusions MAC showed the highest estimated effects overall; however, uncertainty remains substantial given the wide credible intervals and limited data for several intervention nodes. Psychological interventions were associated with improved sport performance, and changes in competitive anxiety may be one contributing factor. These findings support the potential value of tailored psychological training approaches for athletes, while underscoring the need for more robust comparative evidence. Key Points Mindfulness-Acceptance-Commitment tended to show relatively larger effect estimates than several other interventions, although optimal approaches differed depending on anxiety type and competitive level. Basic single-skill interventions may show larger point estimates than multi-component packages; however, credible intervals are wide and direct head-to-head evidence remains limited. This study preliminarily examined whether reductions in competitive anxiety were associated with improvements in sports performance at the study level.
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