Mindfulness Cognitive Behavioral Therapy Shows Promise for

Cognitive Behavioral Therapy (CBT) and medication are considered first-line treatments for anxiety disorders. However, only about 60% of patients respond well to these treatments. With anxiety disorders on the rise, the need for alternatives for patients who don’t respond to first-line treatments or who have residual symptoms is imperative.

A recent clinical trial explored mindfulness-based CBT (MBCT) as an effective option for patients with treatment-refractory anxiety disorders. The researchers published their findings in the Journal of Anxiety Disorders. The pragmatic randomized controlled trial compared MBCT to standard psychological relapse prevention treatment for treatment-refractory anxiety disorder (CBT-RP).

The researchers recruited 171 adults aged 18 and over between 2013 and 2018. They conducted the study at PsyQ, a leading mental health center in the Netherlands. Participants had received at least 1 first-line psychological treatment for a diagnosed anxiety disorder and continued to experience symptoms.

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Both the MBCT and CBT-RP groups received weekly 2-hour group sessions for 8 weeks. Groups included 4 to 8 people. Both groups had to complete homework: either 1 hour daily of mindfulness practice and exercises or 1 hour daily of homework related to their relapse prevention plan. Symptoms were measured before, during, and after treatment, as well as during a 6-month follow-up.

“When compared with the CBT-RP group, at post-treatment, the MBCT group showed a significantly larger decrease in self-reported anxiety and avoidance, while changes in depression severity and quality of life were comparable,” the authors reported.

“MBCT may also be effective in patients who responded insufficiently to evidence-based CBT as a first-line treatment provided for at least 20 sessions.” The researchers also found the MBCT group showed greater improvement in emotional regulation compared with the CBT-RP group.

The researchers admit a few study limitations. Treatment-refractory anxiety disorder is poorly defined in literature as it applies to psychological treatment. Also, patients knew during pretreatment which group they would be in, which may have caused attrition bias. Small sample size and the use of “advanced beginner” level therapist may have also affected the results.

However, the study results indicate promise for mindfulness-based CBT in these patients. “Regular booster sessions may be needed to maintain or enlarge short-term treatment effects,” the researchers conclude. “Future research in larger samples assessing long-term effects and using intensive longitudinal designs to identify possible working mechanisms is called for.”


Spinhoven P, Hoogerwerf E, van Giezen A, Greeven A. Mindfulness-based cognitive group therapy for treatment-refractory anxiety disorder: A pragmatic randomized controlled trial. J Anxiety Disord. 2022;90:102599. doi:10.1016/j.janxdis.2022.102599