Mindfulness-based cognitive group therapy for treatment-refractory anxiety disorder: A pragmatic randomized controlled trial

Background: This study aimed: (a) to examine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with a treatment-refractory anxiety disorders compared to Relapse Prevention-Cognitive Behavioral Therapy (CBT-RP); and (b) to explore candidate mediating variables. Methods: We conducted a pragmatic randomized controlled trial comparing MBCT with CBT-RP in a group format for 136 outpatients with treatment-refractory DSM-IV defined anxiety disorder, who insufficiently responded to first-line psychological treatment. Results: At post-treatment, the MBCT group showed a significantly larger decrease in self-reported anxiety (Beck Anxiety Inventory), avoidance (Fear Questionnaire), difficulties in emotion regulation (Difficulties in Emotion Regulation Strategies), and worry (Penn State Worry Questionnaire), as well as a significantly larger increase in mindfulness skills (Five Facet Mindfulness Questionnaire). After a 6-month follow-up treatment gains were somewhat diminished. Effects of MBCT on anxiety at post-treatment did not prove to be mediated by mindfulness skills, difficulties in emotion regulation strategies, worry, or rumination (Rumination on Sadness Scales) at midtreatment. Conclusions: MBCT seems to be a promising intervention in routine clinical care for persons with an anxiety disorder who insufficiently responded to first-line psychological treatment. Future research in larger samples assessing long-term effects and using intensive longitudinal designs to identify possible working mechanisms is called for.

Automated summary

This study compares the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) with Relapse Prevention-Cognitive Behavioral Therapy (CBT-RP) for patients with treatment-refractory anxiety disorders. The results show that MBCT can significantly reduce anxiety and other symptoms, and improve mindfulness skills. However, the treatment gains of MBCT were somewhat diminished after a 6-month follow-up. The study also suggests that the effects of MBCT on anxiety may not be mediated by mindfulness skills, difficulties in emotion regulation strategies, worry, or rumination. This indicates the potential application of MBCT in routine clinical care for patients with anxiety disorders who do not respond well to first-line psychological treatment.