How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review
Open accessAbstract
This study aimed to systematically review studies which conducted a controlled mediation analysis in order to examine the potential mechanisms which underlie mindfulness-based programme’s (MBPs) effects on anxiety, depression and psychological distress in any health or mental health population. Searches of six databases (Medline (Ovid), PsycINFO, Cochrane Central Register of Controlled Trials, EMBASE, Cinahal Plus and Cochrane Reviews) were undertaken in September 2020. After removing duplicates, 2052 records were screened, of these 1822 were excluded based on the abstract and 230 were further assessed for eligibility against the full study inclusion criteria. Full texts were acquired for the 11 studies which met the inclusion criteria. The quality of the methodologies of each of these 11 studies were assessed using the Cochrane risk of bias tool (Higgins et al., 2011). The quality of the findings from each study relating to the hypothesised mechanisms of action of the MBP reviewed were evaluated using Alsubaie et al. (2017)’s framework for abstracting and interpreting mechanistic study quality, derived from recommendations made by Kazdin (2007, 2009). We found preliminary evidence that MBCT/MBSR treatment effects on anxiety and depression may be mediated by hypothesised mechanisms, such as mindfulness, rumination, worry, self-compassion, cognitive reactivity, aversion, attention regulation skills and positive affect. An overall lack of methodological rigour does preclude us from making any definitive conclusions on causality. The results from this study do however provide some insights into what the potential causal pathways connecting MBPs with improved anxiety and depression might be.
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It is currently unclear how MBSWSC improved stress and burnout outcomes.
“It is currently unclear how MBSWSC improved these outcomes, and over the last two decades, the scientific mindfulness literature has consistently highlighted the need to verify the most important mechanisms of MBPs, which influence changes in mental health and well-being outcomes, such as stress and burnout (Gu et al., 2015; Maddock & Blair, 2023; Van der Velden et al., 2015).”
From Testing Mindfulness Mechanisms of Action on the Stress and Burnout of Social Workers (2024) · cites this paper as Maddock & Blair, 2023
The paper's Abstract says it remains unclear which mechanisms of mindfulness-based programmes produce changes in anxiety, depression and psychological distress, and its Mechanistic Study Quality section describes limitations in testing those mechanisms (page numbers unavailable). That supports the general need to clarify mechanisms, but the paper does not establish how MBSWSC specifically improved stress and burnout outcomes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThese significant findings are in line with systematic reviews highlighting complex direct and mediated change processes in outcomes following MBP participation.
“These significant findings are in line with the results of several systematic reviews (Alsubaie et al., 2017; Maddock & Blair, 2023; Van der Velden et al., 2015), which have highlighted the potentially complex direct and mediated change processes in outcomes such as stress, emotional exhaustion, depersonalisation, and personal accomplishment following MBP participation.”
From Testing Mindfulness Mechanisms of Action on the Stress and Burnout of Social Workers (2024) · cites this paper as Maddock & Blair, 2023
The Discussion (page unavailable) reports preliminary evidence that mindfulness-based programmes may affect anxiety and depression directly and through multiple mediated pathways, supporting the claim about complex change processes. The review does not establish those processes for the citing sentence’s specified outcomes of stress, emotional exhaustion, depersonalisation, or personal accomplishment. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe scientific mindfulness literature has consistently highlighted the need to verify the most important mechanisms of MBPs.
“It is currently unclear how MBSWSC improved these outcomes, and over the last two decades, the scientific mindfulness literature has consistently highlighted the need to verify the most important mechanisms of MBPs, which influence changes in mental health and well-being outcomes, such as stress and burnout (Gu et al., 2015; Maddock & Blair, 2023; Van der Velden et al., 2015).”
From Testing Mindfulness Mechanisms of Action on the Stress and Burnout of Social Workers (2024) · cites this paper as Maddock & Blair, 2023
Systematic reviews and meta-analyses have provided support for the central concept of mindfulness along with overlapping yet distinct processes (e.g., self-compassion and decentering) as candidate mechanisms underlying MBCT and other MBPs.
“Systematic reviews and meta-analyses have provided support for the central concept of mindfulness along with overlapping yet distinct processes (e.g., self-compassion and decentering) as candidate mechanisms underlying MBCT and other MBPs (Alsubaie et al., 2017; Gu et al., 2015; Maddock & Blair, 2023; van der Velden et al., 2015).”
From The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies (2023) · cites this paper as Maddock & Blair, 2023
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“Use of MBPs in patient and professional populations have evidenced positive outcomes including improved physical and psychological well-being, reduced stress, and burnout (Goodman & Schorling, 2012; Maddock & Blair, 2021; Maddock et al., 2019).”
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“…have provided support for the central concept of mindfulness along with overlapping yet distinct processes (e.g., self-compassion and decenter-ing) as candidate mechanisms underlying MBCT and other MBPs (Alsubaie et al., 2017; Gu et al., 2015; Maddock & Blair, 2023; van der Velden et al., 2015).”
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- Authors
- Maddock, A., & Blair, C.
- Affiliations
- Queen's University Belfast (GB)
- Corresponding author
- Maddock, Alan
- Venue
- Current Psychology
- Published
- 2021-09-22
- Volume
- 42
- Issue
- 12
- Pages
- 10200-10222
- ISSN
- 1046-1310 (ISSN-L)
- 1936-4733
- OpenAlex
- W3200306843
- Cited by
- 68
- References
- 82
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 20 · 2023: 12 · 2022: 5 · 2021: 1
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Current Psychology (publishedVersion, cc-by)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mindfulness-based cognitive therapy, mindfulness-based stress reduction, anxiety, depression, psychological distress, mediation analysis, mechanisms of change, rumination, worry, self-compassion, cognitive reactivity, attentional control, positive affect
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