<p>Although various interventions exist to address adolescent test anxiety, their comparative efficacy remains unclear, creating a gap in evidence-based guidance for researchers, clinicians, and educators. This study aimed to provide the first comprehensive evidence on the comparative efficacy of interventions for test anxiety in adolescents using a Bayesian network meta-analysis, a method that allows for the simultaneous comparison of multiple treatments. A systematic search of eight English and Chinese databases up to June 17, 2025 identified 16 studies (17 randomized controlled trials) involving 1,973 adolescents. The participants were predominantly high school students (11/17 trials), with a majority of studies conducted in China (10/17 trials). The results demonstrated that mindfulness-based interventions, multi-component interventions, and cognitive behavioral therapy were significantly more effective than non-active controls. Mindfulness-based interventions showed the largest effect size (<i>g</i> = -1.82, 95% CrI [-3.02, -0.64]), though this was based on a limited number of trials. Among the interventions with statistically significant effects, mindfulness-based interventions ranked first, followed by multi-component interventions and cognitive behavioral therapy. These findings suggest that mindfulness-based approaches are a particularly promising, though preliminary, first-line treatment for adolescent test anxiety, highlighting the need for more high-quality trials to solidify this preliminary evidence hierarchy.</p>