Mindfulness-based cognitive therapy for generalized anxiety disorder (2022)

Table of Contents
Journal of Anxiety Disorders Abstract Method Results Conclusion Introduction Section snippets Participants Demographic characteristics Discussion References (29) Behavior Therapy General Hospital Psychiatry Behaviour Research and Therapy Journal of Behavior Therapy and Experimental Psychiatry Stress reduction through mindfulness meditation: effects on psychological symptomatology, sense of control and spiritual experiences Psychotherapy and Psychosomatics Beck anxiety inventory manual Comparison of the Beck Depression Inventories-IA and II in psychiatric outpatients Journal of Personality Assessment Psychotherapy for generalized anxiety disorder Journal of Clinical Psychiatry A component analysis of cognitive behavioral therapy for generalized anxiety disorder and the role of interpersonal problems Journal of Consulting and Clinical Psychology Comorbidity among anxiety disorders: implications for treatment and DSM-IV Journal of Consulting and Clinical Psychology The benefits of being present: the role of mindfulness in psychological well-being Journal of Personality and Social Psychology The empirical basis of generalized anxiety disorder American Journal of Psychiatry Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder Journal of Consulting and Clinical Psychology Structured clinical interview for DSM-IV Axis I Disorder (SCID-I) Cited by (337) Effects of group mindfulness-based cognitive therapy and group cognitive behavioural therapy on symptomatic generalized anxiety disorder: a randomized controlled noninferiority trial Mindfulness-Based Cognitive Therapy: A Preliminary Examination of the (Event-Related) Potential for Modifying Threat-Related Attentional Bias in Anxiety Recommended articles (6) FAQs Videos
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Journal of Anxiety Disorders

Volume 22, Issue 4,

May 2008

, Pages 716-721

Abstract

While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program. MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression (Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 6, 615–623).

Method

Eligible subjects recruited to a major academic medical center participated in the group MBCT course and completed measures of anxiety, worry, depressive symptoms, mood states and mindful awareness in everyday life at baseline and end of treatment.

Results

Eleven subjects (six female and five male) with a mean age of 49 (range=36–72) met criteria and completed the study. There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment.

Conclusion

MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD. Future directions include development of a randomized clinical trial of MBCT for GAD.

(Video) Mindfulness-based therapy for Generalized Anxiety Disorder online

Introduction

Generalized anxiety disorder (GAD), characterized by long-term, intense, and excessive worry, is a chronic, relatively common disorder with high rates of co-morbidity (Brown & Barlow, 1992). The estimated lifetime prevalence rate for GAD is 5.7% (Kessler, Berglund, Demler, Jin, & Walters, 2005), and the diagnosis is associated with considerable distress and impairment in social and occupational functioning (Maier et al., 2000).

Cognitive behavior therapy (CBT) has been found to be efficacious in the treatment of GAD (Borkovec & Ruscio, 2001; Borkovec, Newman, Lytle, & Pincus, 2002; Butler, Fennell, Robson, & Gelder, 1991; Ladouceur et al., 2000). Borkovec and Ruscio (2001) point out the typical CBT approach for GAD involves training clients to detect internal and external anxiety cues and to employ strategies to manage the psychological and somatic symptoms. While CBT is effective in treating the disorder, GAD nonetheless remains the least successfully treated of the anxiety disorders (Brown, Barlow, & Liebowitz, 1994). Ninan (2001) points out that nearly twice as many patients in treatment for GAD achieve partial remission as those who achieve full remission and indicates the persistence of residual symptoms in many who respond to treatment.

Roemer and Orsillo (2002) provide a conceptual understanding of integrating mindfulness and acceptance-based perspectives to the extant models and treatment of GAD. Mindfulness, moment-to-moment non-judgmental awareness, is cultivated through the regular practice of mindfulness meditation and emphasizes an open awareness to the contents of the mind. Roemer and Orsillo (2002) point out that since the nature of worry is future directed, training in present-moment mindful awareness may provide a useful alternative way of responding for individuals with GAD. Astin (1997) suggests that the techniques of mindfulness meditation help the person to develop a stance of detached observation towards the contents of consciousness and may be a useful cognitive behavioral coping strategy.

The mindfulness-based stress reduction (MBSR) program developed by Jon Kabat-Zinn and his colleagues (Kabat-Zinn, 1990) at the University of Massachusetts Medical School helps individuals develop mindfulness through intensive training in mindfulness meditation. MBSR is an intensive, structured, client-centered approach that has been used successfully in a range of clinical settings, hospitals and schools. MBSR is integral to mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002) which has been found useful for the prevention of relapse in depression (Teasdale et al., 2000). Some other cognitive behavioral psychotherapies, such as dialectal behavior therapy (Linehan, 1993) and acceptance and commitment therapy (Hayes, Strosahl, & Wilson, 1999), include mindfulness and acceptance strategies. Currently, there are a few non-randomized trials of MBSR for anxiety disorders (Kabat-Zinn et al., 1992; Miller, Fletcher, & Kabat-Zinn, 1995) that suggest intensive training in mindfulness meditation may be helpful in reducing anxiety. In a recent open trial of acceptance-based behavior therapy for GAD, Roemer and Orsillo (2007) found that patients who received a treatment combining CBT and learning and practicing mindfulness and acceptance-based strategies experienced significant reductions in symptoms and improvement in quality of life.

However, a recent report published by the Cochrane Collaboration (Krisanaprakornkit, Krisanaprakornkit, Piyavhatkul, & Laopaiboon, 2006) raises a question as to the feasibility and acceptability of meditation based treatments for GAD. This report focused only on randomized clinical trials investigating the effectiveness of meditation for anxiety disorders. Only 2 of 50 studies, one involving transcendental meditation and the other utilizing kundalini yoga, met the rigorous inclusion criteria. Drop out rate was quite high in both studies and could suggest that the intensity and adherence to practicing regular meditation in individuals suffering from anxiety disorders may be of significant consideration. The authors concluded that the small number of studies did not permit conclusions to be drawn on the effectiveness of meditation for anxiety disorders and suggested that more trials are needed.

One rationale for testing new treatments for GAD is related to the fact that despite effective therapies, the persistence of residual GAD symptoms in treatment responders is a problem. Conceptually, it makes sense that the development of mindfulness in individuals with GAD would be beneficial since a mindful state of being captures a quality of consciousness that is characterized by a clarity and vividness of current experience (Brown & Ryan, 2003). Nonetheless, practice of mindfulness meditation is demanding for anyone and may present particular challenges to individuals with GAD whose contents of mental consciousness are for most of the time oriented away from present moment to moment awareness.

The purpose of the study was to investigate whether an open trial of an 8-week group mindfulness-based cognitive therapy program that focused on intensive training in mindfulness meditation and integrated principles of cognitive behavior therapy would be an acceptable and effective treatment for patients suffering from GAD.

Section snippets

Participants

Participants were recruited to this academic medical institution via posted notices around the hospital and letters sent to the faculty. A clinical psychologist or psychiatrist screened interested subjects for inclusion and exclusion criteria. Inclusion criteria were (a) 18–80 years of age, (b) English speaking, (c) medically stable, (d) met criteria for GAD determined by the modified version of the Structured Clinical Interview for DSM IV (First, Spitzer, Gibbon, & Williams, 1997). Since the

Demographic characteristics

Of 36 subjects who were screened for the study, 12 met inclusion criteria and participated in the study. Eight patients were excluded due to co-morbid major depression. Several patients screened either did not meet criteria for GAD or were no longer able to commit to the 8-week program once the group was scheduled. One subject was excluded from the final data analysis because of the onset of a medical problem during the 8-week trial. Results are reported on the 11 subjects (6 female and 5 male)

Discussion

Results from this small open trial of MBCT for GAD demonstrate that subjects in the study, as a group, experienced a significant decrease in their anxiety, tension, worry and depressive symptoms following an 8-week group mindfulness based course. Also, patients who exhibited clinically significant symptoms of measures of anxiety, worry and depressive symptomatology experienced a drop in their symptoms comparable to those of a non-clinical population. While there was a mean increase in mindful

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      Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.

      Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).

      Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.

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      2022, Behavior Therapy

      Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.

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      This study investigated effects of mindfulness training on resilience, self-confidence and emotion regulation of elite football players as well as mediating role of locus of control. The study recruited 34 participants which were assigned into experimental (n=17) and control (n=17) groups. Age ranged between 16 and 32years (M age=22.6years, SD=1.47). The experimental group received 8 weeks mindfulness acceptance commitment (MAC) intervention program, while control group received no intervention. Participants completed Five Facet Mindfulness Questionnaire (FFMQ), The Connor-Davidson Resilience scale (CD-RISC), Trait Sport Confidence Inventory (TSCI), Emotion Regulation Questionnaire (ERQ) and Adapted Levenson Multidimensional Locus of control scales (ALMLC). Both groups completed the questionnaire at pre-test and post-test evaluation. Descriptive data employed mean and standard deviation, while Structural Equation Modelling (SEM) of Sӧrbom's method (alternative to analysis of covariance) was used for analysis of hypothesis. Finding of the study showed that there is significant direct and indirect effect of mindfulness acceptance commitment on resilience, self-confidence and emotion regulation on elite football players. The findings further showed that there is significant difference between the pre-test scores and post-test scores of intervention group and control group. The intervention group mean scores on resilience, self-confidence and emotion regulation are higher than the control group counterparts. This shows that MAC program is effective in increasing resilience, self-confidence and emotion regulation of elite football players concurrently which in turn could improve performance and attain success.

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      Les recherches sur la méditation dans le champ des thérapies complémentaires et alternatives sont de plus en plus importantes. En effet, beaucoup de travaux soulignent les effets bénéfiques en termes de santé physique et psychique de la méditation. Dans le cadre des deux grandes orientations de techniques de méditation (concentration et pleine conscience), nous allons nous concentrer dans cette étude sur la méditation de concentration (méditation mantra et transcendantale). Après avoir encadré la notion à un niveau théorique, nous développerons une revue de la littérature (randomisés, comparaison avant/après) sur cette forme de pratique en ciblant précisément la méditation transcendante et de mantra ainsi que d’autres formes utilisant uniquement la concentration afin de mettre en lumière les effets thérapeutiques de cette approche sur la santé mentale et de souligner son efficacité. Cependant, nous resterons prudents quant à émettre des conclusions hâtives sur les effets bénéfiques systématiques de cette pratique en mettant en lumière l’importance des limites méthodologiques que l’on retrouve dans ces travaux depuis les quarante dernières années en proposant des pistes d’amélioration.

      Research on meditation in the field of complementary and alternative therapies is increasingly important. Indeed, many works highlight the beneficial effects in terms of physical and mental health of meditation. Within the framework of the two main directions of meditation techniques (concentration and mindfulness), we will focus in this study on concentration meditation (mantra and transcendental meditation). After having framed the notion at a theoretical level, we will develop a review of the literature (randomized, before/after comparison) on this form of practice by precisely targeting transcendent and mantra meditation as well as other forms using only concentration in order to highlight the therapeutic effects of this approach on mental health and to emphasize its effectiveness. However, we will remain cautious about issuing hasty conclusions on the systematic beneficial effects of this practice by highlighting the importance of the methodological limitations that we find in this work for the past 40years by proposing avenues for improvement.

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    FAQs

    What is mindfulness-based cognitive therapy for anxiety? ›

    Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness.

    How effective is mindfulness-based cognitive therapy? ›

    Study shows that MBCT has the high percentage in reducing depressive symptoms than psycho-education. MBCT significantly decrease depression severity and improved treatment response rate but not remission. MBCT shows significant decrease in depressive symptoms and improve the mindfulness skill.

    What are some of the major purposes of mindfulness-based cognitive therapy? ›

    The core aim of MBCT is to increase psychological health by increasing mindfulness, which can be characterized by the following skills: (1) acceptance of thoughts and feelings without judgment, and, (2) focusing fully on the present moment (Allen et al. 2006; Baer et al.

    How do you practice mindfulness-based cognitive therapy? ›

    Other MBCT techniques include walking and sitting meditations, sitting with thoughts, and sitting with sounds.
    ...
    1. Observing your experience (How are you doing right now?)
    2. Focusing on your breath.
    3. Attending to your body and physical sensations.
    14 Jul 2021

    How long does MBCT last? ›

    The course includes eight sessions lasting two and a quarter hours and one longer session. Sessions normally take place over consecutive weeks. In the sessions you will learn and practice some fairly simple meditations, for example focusing attention on your breathing for periods of time.

    Is MBCT good for anxiety? ›

    In conclusion, the findings from the current study suggest that both MBCT and CFT are effective at enhancing mindfulness and self-compassion and at reducing depression, anxiety, stress, and rumination in clients with anxiety, depression, and stress difficulties.

    Is MBCT better than CBT? ›

    Both MBCT and CBT work to help patients better control their thoughts, emotions, and responses to these factors. But MBCT differs from CBT by incorporating elements of mindfulness to additionally control the body's automatic responses to the stresses associated with many negative thoughts or feelings.

    What is the difference between CBT and mindfulness? ›

    Thus mindfulness can alter one's attitude or relation to thoughts, such that they are less likely to influence subsequent feelings and behaviors. In contrast, CBT involves the restructuring and disputation of cognitions and beliefs toward acquiring more functional ways of viewing the world (18).

    What are the strengths of the mindfulness-based treatments? ›

    If you are struggling, mindfulness-based cognitive therapy, also known as MBCT, may help. MBCT and other meditative practices have been shown to reduce anxiety, depression, post-traumatic stress disorder, lower stress and cortisol levels, and are beneficial for all ages.

    What is one possible adverse effect of mindfulness-based interventions? ›

    The study found that mindfulness meditators had worse physical and mental health than non-meditators, including higher levels of pain, headaches, stress, depression, anxiety, insomnia and acute illness.

    Is mindfulness a DBT or CBT? ›

    A big difference in DBT vs CBT is how they approach the patient. DBT is mostly focused on how a person interacts with others and themselves. It tends to use mindfulness philosophies to help patients accept themselves and their environment. Meanwhile, CBT tends to be more logic-focused.

    What happens in mindfulness therapy? ›

    Mindfulness meditation involves sitting silently and paying attention to thoughts, sounds, the sensations of breathing or parts of the body, bringing your attention back whenever the mind starts to wander. Yoga and tai-chi can also help with developing awareness of your breathing.

    When was mindfulness-based cognitive therapy developed? ›

    Mindfulness-based cognitive therapy (MBCT) was developed by Segal, Williams, and Teasdale (2002) as a therapy for relapse prevention of major depression.

    Is mindfulness therapy evidence-based? ›

    Is MBSR evidence based? In summary, yes. Mindfulness-Based Stress Reduction (MBSR) is based on a framework of psychological science. It was developed for use in a medical setting to help patients cope better and to decrease pain and stress they were experiencing.

    Who invented mindfulness cognitive therapy? ›

    WHAT IS MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)? MBCT is based on the Mindfulness-Based Stress Reduction (MBSR) eight-week program, developed by Jon Kabat-Zinn.

    Why is mindfulness used in the treatment of anxiety disorders? ›

    The basic premise underlying mindfulness practices is that experiencing the present moment nonjudgmentally and openly can effectively counter the effects of stressors, because excessive orientation toward the past or future when dealing with stressors can be related to feelings of depression and anxiety (e.g., Kabat- ...

    What is the difference between MBSR and MBCT? ›

    The key differences between MBSR and MBCT

    MBCT tends to target specific conditions or vulnerabilities where as MBSR has a more generic application and is applied to stress arising from a variety of life events including physical or mental illness.

    What theory is mindfulness based on? ›

    In brief, the Mindfulness-to-Meaning Theory asserts that mindfulness allows one to decenter from stress appraisals into a metacognitive state of awareness that broadens attention to previously unnoticed pieces of information about one's life, accommodating a reappraisal (i.e., a reframing) of adverse circumstances that ...

    How much does MBCT cost? ›

    From a healthcare perspective, MBCT costs an average of $4,590.79 per patient for 1.18 QALYs while ADM costs $5,591.32 per patient for 1.10 QALYs. The incremental cost difference was $1,000.53 for 0.08 additional QALY gain over 24 months.

    Does metacognitive therapy work? ›

    Conclusions: Our findings indicate that MCT is an effective treatment for a range of psychological complaints. To date, strongest evidence exists for anxiety and depression. Current results suggest that MCT may be superior to other psychotherapies, including cognitive behavioral interventions.

    Is mindfulness a holistic therapy? ›

    At its core, cognitive behavioral therapy is traditional psychotherapy. However, mindfulness therapy often uses holistic healing practices. Meditation therapy and yoga therapy, which are a big part of mindfulness therapy, are holistic services.

    What is MBCT NHS? ›

    Mindfulness-based cognitive therapy (MBCT)

    MBCT combines mindfulness techniques like meditation and breathing exercises with cognitive therapy, which is about learning how to manage your thoughts and how they make you feel.

    Videos

    1. CBT Generalized Anxiety Disorder (3 Tools To Reclaim Your Life!)
    (Barbara Heffernan)
    2. Fabrizio Didonna on Mindfulness-Based Cognitive Therapy for OCD | Noble Mind Ep 28
    (Noble Mind Podcast)
    3. What a Cognitive Behavioral Therapy (CBT) Session Looks Like
    (MedCircle)
    4. Generalized Anxiety Disorder- Mindfulness
    (Mareena Vivas)
    5. Mindfulness for Anxiety 💓 A Beginner's Guide 21/30
    (Therapy in a Nutshell)
    6. Fabrizio Didonna on Mindfulness Based Cognitive Therapy for OCD
    (Noble Mind Podcast)

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