Mindfulness-Based Interventions for Anxiety and Depression

May combine two claims.

MBIs are effective for anxiety, depression relapse risk, current depressive symptoms, stress, chronic pain, quality of life, and psychological or emotional distress.

“These outcomes include clinical disorders and symptoms such as anxiety,8,12,13 risk of relapse for depression,14,15 current depressive symptoms,9 stress,16–18 medical and well-being outcomes such as chronic pain,19 quality of life,14,20 and psychological or emotional distress.21,22”

• cites [8] Hofmann, 2010, The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review, J Consult Clin Psychol sourceSupported
• cites [12] Green SM, Bieling PJ. Expanding the scope of mindfulness-based cognitive therapy: evidence for effectiveness in a heterogeneous psychiatric sample. Cogn Behav Pract. http://dx.doi.org/10.1016/j.cbpra.2011.02.006. sourceNot checked — no full text of the source
• cites [13] Hinton, 2013, Acceptance and mindfulness techniques as applied to refugee and ethnic minority populations with PTSD: examples from “culturally adapted CBT”, Cogn Behav Pract sourceNot checked — no full text of the source
• cites [14] Kuyken, 2008, Mindfulness-based cognitive therapy to prevent relapse in recurrent depression, J Consult Clin Psychol sourceNot checked — no full text of the source
• cites [15] Teasdale, 2000, Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy, J Consult Clin Psychol sourceNot checked — no full text of the source
• cites [9] Strauss, 2014, Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials, PLoS One sourceSupported

May combine two claims.

ACT does not include meditation and rarely uses the term 'mindfulness', but its therapeutic strategies are practically identical to mindfulness skills as described in this review.

“ACT does not include meditation practices, and rarely uses the term ‘mindfulness’ in its treatment protocol, but the therapeutic strategies of ACT are practically identical to mindfulness skills as described in this review.”

• cites [26] Hayes, 1994, Acceptance and commitment therapy: altering the verbal support for experiential avoidance, Behav Anal sourcePartly supported

  The sections on establishing self as context and letting go of the struggle describe observing thoughts and experiencing feelings without trying to change or escape them, supporting a resemblance to mindfulness skills. But the paper does not compare ACT with the skills in the citing review, establish that its strategies are practically identical to them, or substantiate claims about meditation and use of the word ‘mindfulness’ in the full treatment protocol. The Examples of Specific ACT Techniques section says that protocol is a book-length document and offers only a sample of its procedures (page numbers unavailable). (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [45] Baer, 2003, Mindfulness training as a clinical intervention: a conceptual and empirical review, Clin Psychol Sci Pract sourceNot checked — no full text of the source

May combine two claims.

MBCT may be most effective for preventing relapse in those at greatest risk, including people with four or more prior major depressive episodes (Cohen's h = 0.88) and those who experienced childhood maltreatment.

“Furthermore, studies looking at individual moderators of treatment outcomes have found that MBCT may be most effective in preventing relapse among individuals with the greatest risk of relapse. These high-risk individuals include those with four or more previous major depressive episodes (Cohen’s h = 0.88),53 and those who suffered from maltreatment during childhood.53,54”

• cites [53] Ma, 2004, Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects, J Consult Clin Psychol sourceNot checked — no full text of the source
• cites [54] Williams, 2014, Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial, J Consult Clin Psychol sourcePartly supported

  The Results and Discussion report that childhood trauma moderated MBCT’s effect on relapse, with benefit among participants reporting more childhood trauma. The paper also discusses greater benefit in vulnerable patients with three or more prior episodes, but our copy does not support the specific threshold of four or more episodes or Cohen’s h = 0.88. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

The MBSR group had a pre-post treatment effect size (Cohen's d) of 1.06, similar to effect sizes for CBT for anxiety.

“The MBSR group demonstrated a pre-post treatment effect size (Cohen’s d) of 1.06, which is comparable to the effect sizes seen in CBT for anxiety.”

• cites [46] Hoge, 2013, Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity, J Clin Psychiatry sourceSupported

May combine two claims.

Preliminary evidence suggests that abbreviated 2-3-week mindfulness programs can improve compassion and working memory capacity.

“These programs have not been examined as thoroughly as the standard 8-week interventions; however, preliminary evidence indicates that these modest interventions can have beneficial effects on a variety of symptoms, including compassion58 and working memory capacity.59”

• cites [58] Lim, 2015, Mindfulness and compassion: an examination of mechanism and scalability, PLoS One sourceSupported
• cites [59] Mrazek, 2013, Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering, Psychol Sci sourceNot checked — no full text of the source

May combine two claims.

Meta-analyses show MBSR is superior to heterogeneous controls for reducing anxiety and stress, with pre-post effect sizes in the moderate-to-large range (Hedge's g 0.24-1.54).

“These results are supported by select meta-analyses that have demonstrated superiority of MBSR in reducing anxiety and stress relative to heterogenous control conditions.8,47,48 Pre-post treatment effect sizes for these meta-analyses all fall in the moderate-large range (Hedge’s g ranging from 0.24 – 1.54).”

• cites [8] Hofmann, 2010, The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review, J Consult Clin Psychol sourcePartly supported

  The Results report a moderate pre–post reduction in anxiety for MBSR (Hedges’ g = 0.55) and significant anxiety effects for mindfulness-based therapy against several types of control. But the controlled analyses pool mindfulness-based therapies rather than isolate MBSR, the measured outcomes are anxiety and depression rather than stress, and this paper does not report 0.24–1.54 as its range of pooled pre–post effects. The Discussion also cautions that most controlled-effect estimates were unreliable. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [47] Bohlmeijer, 2010, The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis, J Psychosom Res sourceNot checked — no full text of the source
• cites [48] Fjorback, 2011, Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials, Acta Psychiatr Scand sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The field has been limited by methodological gaps that restrict the reach and relevance of conclusions from the current literature.

“However, as noted by Dimidjian and Segal, 65 the field has been limited by a number of methodological gaps that restrict both the reach and relevance of the conclusions that can be drawn from the current literature.”

• cites [65] Dimidjian, 2015, Prospects for a clinical science of mindfulness-based intervention, Am Psychol sourceSupported

May combine two claims.

A recent meta-analysis of 15 RCTs found that technology-delivered MBIs significantly improved depression, anxiety, stress, well-being, and mindfulness compared with control or waitlist conditions (Hedge's g 0.22 for anxiety to 0.51 for stress).

“Though these technology-delivered interventions are still in their infancy, a recent meta-analysis of 15 RCTs found that, relative to control or waitlist conditions, technology-delivered MBIs had a significant beneficial impact on depression, anxiety, stress, well-being, and mindfulness (Hedge’s g ranging from 0.22 for anxiety to 0.51 for stress).64”

• cites [64] Spijkerman, 2016, Effectiveness of online mindfulness-based interventions in improving mental health: a review and meta-analysis of randomised controlled trials, Clin Psychol Rev sourceSupported
  Experimental — accuracy not yet measured

May combine two claims.

Mindfulness-based treatments and traditional CBT share many features: both aim to reduce psychopathological suffering, use cognitive and behavioral exercises, desensitize conditioned fear responses, and direct patients to view internal phenomena as temporary and without inherent worth.

“Mindfulness-based treatments and traditional (Beckian) CBT share many similar characteristics.45 Both aim to reduce psychopathological suffering, and approach this goal with a combination of cognitive and behavioral therapeutic exercises. Both involve a desensitization of conditioned fear responses, though MBIs approach this effect through sustained attention, while traditional CBT directly focus”

• cites [45] Baer, 2003, Mindfulness training as a clinical intervention: a conceptual and empirical review, Clin Psychol Sci Pract sourceNot checked — no full text of the source
• cites [66] Hofmann, 2008, Cognitive processes during fear acquisition and extinction in animals and humans: implications for exposure therapy of anxiety disorders, Clin Psychol Rev sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [67] Longmore, 2007, Do we need to challenge thoughts in cognitive behavior therapy?, Clin Psychol Rev sourceNot checked — no full text of the source

May combine two claims.

Brief 3- or 4-day lab-based mindfulness training can have immediate effects on psychological and neuroendocrine responses to social stress and on perceived pain severity from noxious heat.

“Though these mindfulness interventions are too truncated to expect any long-term effects, studies indicate that they can have immediate effects on psychological and neuroendocrine responses to social stress,60 and perceived pain severity in response to noxious heat stimulation.61”

• cites [60] Creswell, 2014, Brief mindfulness meditation training alters psychological and neuroendocrine responses to social evaluative stress, Psychoneuroendocrinology sourceNot checked — no full text of the source
• cites [61] Zeidan, 2011, Brain mechanisms supporting the modulation of pain by mindfulness meditation, J Neurosci sourceSupported

May combine two claims.

A large ecological momentary assessment study found that about 47% of waking hours were spent mind wandering, and that mind wandering predicts later unhappiness.

“In a large study using ecological momentary assessment data, 37 it was found that approximately 47% of subjects’ waking hours were spent in a state of mind wandering; furthermore, the authors demonstrated that mind wandering predicts subsequent unhappiness.”

• cites [37] Killingsworth, 2010, A wandering mind is an unhappy mind, Science sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Mindfulness targets a core process that has shown efficacy in reducing anxiety and depression symptom severity, both as the main treatment ingredient and when integrated into other treatments.

“As we will discuss throughout this review, mindfulness targets one such core processes that has demonstrated efficacy in reducing anxiety and depression symptom severity, both as the core treatment ingredient, as well as when integrated into other treatments.”

May combine two claims.

The evidence base for mindfulness-based interventions is incomplete, partly because the literature contains many cross-sectional studies, waitlist-controlled trials, and other methodological weaknesses that limit conclusions.

“Despite the popularity of these interventions, the evidence base is still not fully established, in part because this literature is oversaturated with cross-sectional studies, waitlist-controlled trials, and other methodological shortcomings that limit the strength of conclusions that can be drawn from these studies.”

• cites [1] Gu, 2015, How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies, Clin Psychol Rev sourceNot checked — no full text of the source

May combine two claims.

Both MBIs and CBT involve relaxation and improved self-modulation, though it is unclear whether these effects come from a specific treatment component or simply from engaging in therapy.

“Lastly, both treatments involve relaxation and improvements in self-modulatory efforts,45 though it is unclear whether these effects are attributable to a specific treatment component, or simply engaging in a therapeutic process.”

• cites [45] Baer, 2003, Mindfulness training as a clinical intervention: a conceptual and empirical review, Clin Psychol Sci Pract sourceNot checked — no full text of the source

May combine two claims.

Mindfulness meditation retreats are a relatively cost-effective way to deliver intensive, well-controlled mindfulness doses, and recent trials show promising effects on anxiety, stress, and other psychosocial well-being and health measures.

“Nevertheless, these retreats are a relatively cost-effective way of delivering intensive and well-controlled doses of a mindfulness intervention, and recent trials have demonstrated promising effects on anxiety, stress, and other measures of psychosocial well-being and health.56,57”

• cites [56] Cohen, 2017, The immediate and long-term effects of an intensive meditation retreat, Mindfulness sourceNot checked — no full text of the source
• cites [57] Rosenberg, 2015, Intensive meditation training influences emotional responses to suffering, Emotion sourceNot checked — no full text of the source

May combine two claims.

Post-treatment effect sizes were largest for psychological outcomes, with the strongest effects for anxiety, then depression.

“Post-treatment effect sizes were largest for psychological outcomes, relative to physical or medical outcomes, with the strongest effects found for anxiety, followed by depression.”

• cites [6] Khoury, 2013, Mindfulness-based therapy: a comprehensive meta-analysis, Clin Psychol Rev sourceNot checked — no full text of the source

May combine two claims.

Beneficial effects remained relatively stable after follow-up periods (3 weeks to 3 years, median 28 weeks), though comparative effect sizes for MBI versus control decreased at follow-up.

“These beneficial effects remained relatively stable after follow-up periods (ranging from 3 weeks to 3 years, with a median of 28 weeks), though the comparative effect sizes for MBI versus control treatment conditions diminished at follow-up.6”

• cites [6] Khoury, 2013, Mindfulness-based therapy: a comprehensive meta-analysis, Clin Psychol Rev sourceNot checked — no full text of the source

May combine two claims.

Until recent years, most trials compared MBIs with waitlist controls, which introduce many confounders that weaken conclusions.

“Until recent years, most trials compared MBIs to waitlist controls, which introduce a multitude of confounding factors that limit the strength of conclusions that can be drawn from these trials.”

May combine two claims.

MBSR appears safe and effective for reducing emotional dysregulation.

“MBSR appears to be a safe and effective treatment for the reduction of emotional dysregulation.”

Probably not a substantial claim: may not pass S4 (based).

Mindfulness practices seem to have therapeutic effects on emotional well-being.

“Whichever mechanisms truly underlie mindfulness (see below for a review of key mechanisms), mindfulness practices appear to demonstrate therapeutic effects on emotional well-being, and thus continue to capture the interest of myriad clients, practitioners, and researchers.”

May combine two claims.

In DBT and ACT, mindfulness is only one component, while it is the central skill in mindfulness-based treatments.

“The use of mindfulness in these treatment protocols is markedly different from MBSR and MBCT, in that mindfulness is merely a component of these interventions, whereas it is the core skill taught in mindfulness-based treatments.”

• cites [1] Gu, 2015, How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies, Clin Psychol Rev sourceNot checked — no full text of the source
• cites [28] Chiesa, 2011, Mindfulness-based approaches: are they all the same?, J Clin Psychol sourceNot checked — no full text of the source

May combine two claims.

The central theoretical premise of MBIs is that practicing mindfulness makes people less reactive to unpleasant internal experiences and more reflective, which leads to positive psychological outcomes.

“The overarching theoretical premise of MBIs is that, by practicing mindfulness (e.g. through sitting meditation, yoga, or other mindfulness exercises), individuals will become less reactive to unpleasant internal phenomena but more reflective, which in turn will lead to positive psychological outcomes.3,33”

• cites [3] Segal, 2002Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [33] Kabat-Zinn, 1992, Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders, Am J Psychiatry sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Mindfulness and acceptance strategies fit general CBT principles because they address core processes like emotional awareness and regulation, cognitive flexibility, and goals-based behaviors.

“Mindfulness and acceptance strategies are consistent with general CBT principles, because they target core processes, such as increased emotional awareness and regulation, cognitive flexibility, and goals-based behaviors.31,32”

• cites [31] Hayes SC, Hofmann SG. The third wave of CBT and the rise of process-based care. World Psychiatry, in press.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [32] Hofmann, 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The more one can adopt a mindful state through life's ups and downs, the less suffering one experiences.

“The stronger one’s ability to adopt a mindful state throughout the perpetual ups and downs of life, the less suffering one will experience. This basic premise remains the foundation of mindful practices, as it has for centuries;42”

• cites [42] Bodhi, 2011, What does mindfulness really mean? A canonical perspective, Contemporary Buddhism sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The similarities between mindfulness and cognitive-behavioral treatments may explain their compatibility.

“As we will now discuss, these similarities may perhaps be responsible for the compatibility of mindfulness and cognitive-behavioral treatments.”

May combine two claims.

Despite differences, both approaches ultimately produce a similar result: by changing one's perspective on unpleasant thoughts, feelings, or sensations, the person realizes these internal phenomena are not as dangerous or powerful as believed, and the cycle of maladaptive cognitions, emotions, and behaviors gradually weakens.

“Despite these differences, the result of both approaches is ultimately quite similar: By changing one’s perspective on unpleasant thoughts, feelings, or sensations, the individual comes to realize that these internal phenomena are not as dangerous or powerful as previously believed, and the cycle of maladaptive cognitions, emotions, and behaviors gradually weakens.”

May combine two claims.

Mindfulness is hard to achieve but ultimately beneficial.

“Taken together, these findings suggest that mindfulness is a difficult state to achieve, but is ultimately beneficial.”

May combine two claims.

Mindfulness skills in DBT resemble those in MBSR, especially nonjudgmental observation of internal phenomena, but the teaching format differs considerably.

“Mindfulness skills taught in DBT are similar to those in MBSR, particularly the nonjudgmental observation of internal phenomena; however, the format in which these skills are taught differs considerably.”

• cites [25] Linehan, 1993 sourceNot checked — no full text of the source
• cites [45] Baer, 2003, Mindfulness training as a clinical intervention: a conceptual and empirical review, Clin Psychol Sci Pract sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Mindfulness- and acceptance-based interventions including DBT, ACT, MBSR, and MBCT are examples of the "third-wave" of cognitive-behavioral therapies.

“Mindfulness- and acceptance-based interventions – including DBT, ACT, MBSR, and MBCT – are examples of the so-called “third-wave” of cognitive-behavioral therapies.70”

• cites [70] 2004Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Mindfulness-based interventions target a core process that is the focus of a call to redirect clinical practice away from treating medical syndromes and toward processes and core competencies.

“The result is a call to redirect clinical practice away from treating medical syndromes and toward focusing on processes and core competencies. Mindfulness-based interventions target one such process.”

• cites [31] Hayes SC, Hofmann SG. The third wave of CBT and the rise of process-based care. World Psychiatry, in press.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [32] Hofmann, 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In DBT, clients can choose which mindfulness exercises to practice and when, allowing all individuals to benefit regardless of severity or willingness to meditate.

“Clients may choose which mindfulness exercises they wish to practice and when, which allows all individuals to benefit from mindfulness training regardless of their severity or willingness to meditate.45”

• cites [45] Baer, 2003, Mindfulness training as a clinical intervention: a conceptual and empirical review, Clin Psychol Sci Pract sourceNot checked — no full text of the source