Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial
Open accessAbstract
Background: Individual-based cognitive–behavioural therapy (CBT) is in short supply and expensive. Aims: The aim of this randomised controlled trial (RCT) was to compare mindfulness-based group therapy with treatment as usual (primarily individual-based CBT) in primary care patients with depressive, anxiety or stress and adjustment disorders. Method: This 8-week RCT (ClinicalTrials.gov ID: NCT01476371) was conducted during spring 2012 at 16 general practices in Southern Sweden. Eligible patients (aged 20–64 years) scored $10 on the Patient Health Questionnaire-9, $7 on the Hospital Anxiety and Depression Scale or 13–34 on the Montgomery–åsberg Depression Rating Scale (self-rated version). The power calculations were based on non-inferiority. In total, 215 patients were randomised. Ordinal mixed models were used for the analysis. Results: For all scales and in both groups, the scores decreased significantly. There were no significant differences between the mindfulness and control groups. Conclusions: Mindfulness-based group therapy was non-inferior to treatment as usual for patients with depressive, anxiety or stress and adjustment disorders.
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Our findings correspond with other studies that found independent associations among anxiety symptoms, quality of life, and mindfulness, and extend this knowledge to individuals with heart failure.
“While the direction of the relationships cannot be established in the present investigation, our findings correspond with other studies that found independent associations among anxiety symptoms, QOL and mindfulness 23,24,27,46 and it extends this knowledge to individuals living with HF.”
From Mindfulness, Anxiety Symptoms, and Quality of Life in Heart Failure. (2020) · cites this paper as [46]
The Results (page unavailable) report reduced anxiety symptoms after mindfulness group therapy, and the ‘Main findings and comparison with findings from other studies’ section (page unavailable) describes a prior study linking mindfulness treatment with reduced social anxiety and increased subjective well-being. This paper does not establish independent associations among anxiety symptoms, quality of life, and mindfulness; its reported outcomes do not include a quality-of-life measure. The extension to people with heart failure is the citing authors’ own finding, not a claim attributed to this source. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMBSR has demonstrated significant benefits in stress, anxiety, depression, and chronic pain and is recommended in several guidelines.
“the extensively researched MBSR program, has demonstrated significant benefits in these areas [16–23], and are recommended in several guidelines [22, 24, 25].”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [25]
The Results report significant decreases in depression and anxiety scores among patients receiving mindfulness group therapy, and the discussion reports prior MBSR studies with benefits for anxiety and depression. The paper mentions effects of mindfulness on pain, but does not establish a significant benefit of MBSR for chronic pain; it also does not say that guidelines recommend MBSR. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIntegration of mindfulness into mainstream healthcare is lacking due to structural and organizational barriers, not lack of efficacy.
“integration into mainstream healthcare is lacking – not due to lack of efficacy, but rather structural and organizational barriers [24, 25, 28–31].”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [25]
The Main findings section reports that mindfulness group therapy in general practice was non-inferior to individual therapy, including CBT, supporting the efficacy portion of the claim. The Implications section mentions limited resources and a shortage of CBT therapists, but does not establish that structural or organizational barriers explain a lack of mindfulness integration into mainstream healthcare. Page numbers are unavailable in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredMBSR is taught in groups up to thirty or more participants if necessary, making the intervention notably cost-effective as its effect on mental health issues has been proven equal to cognitive therapy in many studies.
“As MBSR is taught in groups up to thirty or more participants if necessary [37, 55] the intervention is notably cost-effective as the effect on mental health issues has been proven equal to e.g. cognitive therapy in many studies [18, 25, 26].”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [25]
The 'Main findings and comparison with findings from other studies' section reports that mindfulness group therapy was non-inferior to individual-based therapy, including CBT, for primary-care patients with depression, anxiety, and stress or adjustment disorders. It does not establish equivalence across many studies; the paper calls its trial the first comparison with an active control group in general practice and says RCT evidence was scarce. The separate claim about groups of thirty is attached to other citations in the citing sentence. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSundquist et al. found improvements within groups but no significant differences between groups.
“A few studies, such as Sundquist et al., found improvements within groups but no significant differences between groups [47].”
From The Effects of Mindfulness Techniques on Anxiety, Depression, and Stress, with an Emphasis on Gratitude: A Systematic Review and Meta-Analysis (2026) · cites this paper as [47]
In a study of 215 eligible patients, the mindfulness group protocols were equally effective to regular treatment, with non-significant variability between mindfulness and control groups.
“Variability between the mindfulness and control groups was non-significant and the mindfulness group protocols were found to be equally effective to regular treatment.”
From Mindfulness in mood and anxiety disorders: A review of the literature (2017) · cites this paper as [9]
Another limitation of the study was its inclusion of patients with depressive and anxiety disorders.
“Another limitation of the study was its inclusion of patients with depressive and anxiety disorders.9”
From Mindfulness in mood and anxiety disorders: A review of the literature (2017) · cites this paper as [9]
One limitation of the study was the inclusion of immigrants in the randomized controlled trial, but those who could not speak Swedish fluently were disqualified from participation.
“One limitation of this study was the inclusion of immigrants in the randomized controlled trial, but those who could not speak Swedish fluently were disqualified from participation.”
From Mindfulness in mood and anxiety disorders: A review of the literature (2017) · cites this paper as [9]
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“While most studies mitigated this limitation by standardizing procedures and training facilitators, moderate risk was identified in several trials [46,47] 2023), primarily due to incomplete follow-up reporting or lack of imputation strategies [50,52].”
- Authors
- Sundquist, J., Lilja, Å., Palmér, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K.
- Affiliations
- Lund University (SE)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2015-02
- Volume
- 206
- Issue
- 2
- Pages
- 128-135
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2144005534
- Semantic Scholar
- 8448da501379e1c16063c3093f3e342388f98366
- Cited by
- 123
- References
- 44
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 8 · 2021: 21 · 2020: 8 · 2019: 13 · 2018: 17 · 2017: 21 · 2016: 10 · 2015: 5
- FWCI
- 14.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Vetenskapsrådet
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd
- 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 › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- mindfulness-based group therapy, depression, anxiety, stress, adjustment disorder, primary care, cognitive behavioral therapy, non-inferiority, general practice, psychotherapy
- MeSH terms
- Adjustment Disorders, Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Psychotherapy, Group, Stress, Psychological, Cognitive Behavioral Therapy, Young Adult, Mindfulness
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