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Investigating Effects and Mechanisms of a Mindfulness-Based Stress Reduction Intervention in a Sample of College Students at Risk for Social Anxiety

  • Catrinel A. Ștefan
  • Călin Căpraru
  • Melinda Szilágyi


The aims of this study were two-fold: (1) to investigate the effectiveness of a 6-week mindfulness-based stress reduction (MBSR) program in a sample of college students at risk for social anxiety and (2) to investigate whether emotion regulation strategies and self-compassion act as mechanisms of MBSR effectiveness. Participants in this study were predominantly female college students identified as at risk for social anxiety, who were randomly assigned to either the MBSR intervention or to the wait list control group. The final sample included 22 participants in the MBSR group and 24 in the wait list control group for whom pre-intervention and post-intervention (1 week after the MBSR intervention was finalized) data were gathered on self-report measures. The results showed that MBSR participation lead to significant reductions in social anxiety and perceived stress. Also, significant post-intervention differences in favor of the MBSR group compared to the wait list control group were found for self-compassion and acceptance, but not for positive reinterpretation. Mediation analyses employing a bootstrap procedure with 95% confidence intervals were conducted to test the potential MBSR intervention mechanisms. The results revealed that acceptance and self-compassion mediated the relationship between MBSR participation and social anxiety, as well as MBSR participation and perceived stress. The current findings indicated that mindfulness-based interventions might work by: (1) reducing self-identification with successes and failures in social and stressful situations and (2) deactivating appraisals concerning anxiety provoking situations.


Social anxiety MBSR Effectiveness Mechanisms Positive reinterpretation Acceptance Self-compassion 


Author Contributions

CAȘ designed the study, performed the data analyses, and wrote a large proportion of the manuscript. CC collaborated on the design, wrote parts of the discussion section, and implemented the online homework delivery. MS collaborated on the design and implemented the MBSR training.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849–1858. Scholar
  2. Arch, J. J., Ayers, C. R., Baker, A., Almklov, E., Dean, D. J., & Craske, M. G. (2013). Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behaviour Research and Therapy, 51, 185–196. Scholar
  3. Baer, R., & Krietemeyer, J. (2006). Overview of mindfulness- and acceptance-based treatment approaches. In R. Baer (Ed.), Mindfulness-based treatment approaches: clinician’s guide to evidence base and applications (pp. 3–27). San Diego: Elsevier.CrossRefGoogle Scholar
  4. Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck depression inventories-IA and-II in psychiatric outpatients. Journal of Personality Assessment, 67, 588–597. Scholar
  5. Bergen-Cico, D., & Cheon, S. (2014). The mediating effects of mindfulness and selfcompassion on trait anxiety. Mindfulness, 5, 505–519. Scholar
  6. Bögels, S., & Restifo, K. (2014). Mindful parenting. New York: Springer.CrossRefGoogle Scholar
  7. Bränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients: a randomized study. Annals of Behavioral Medicine, 39, 151–161. Scholar
  8. Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. The American Journal of Psychiatry, 162, 1179–1187. Scholar
  9. Campbell, T. S., Labelle, L. E., Bacon, S. L., Faris, P., & Carlson, L. E. (2012). Impact of Mindfulness-Based Stress Reduction (MBSR) on attention, rumination and resting blood pressure in women with cancer: a waitlist-controlled study. Journal of Behavioral Medicine, 35, 262–271. Scholar
  10. Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6, 587–595. Scholar
  11. Carmody, J., & Baer, R. A. (2008). Relationship between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23–33. Scholar
  12. Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65, 627–638. Scholar
  13. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283. Scholar
  14. Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. The Journal of Alternative and Complementary Medicine, 15, 593–600. Scholar
  15. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford Press.Google Scholar
  16. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396. Scholar
  17. Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. (2001). Coping with stress during childhood and adolescence: progress, problems, and potential. Psychological Bulletin, 127, 87–127. Scholar
  18. Compas, B. E., Jaser, S. S., Dunbar, J. P., Watson, K. H., Bettis, A. H., Gruhn, M. A., & Williams, E. K. (2014). Coping and emotion regulation from childhood to early adulthood: points of convergence and divergence. Australian Journal of Psychology, 66, 71–81. Scholar
  19. Corcoran, K. M., Farb, N., Anderson, A., & Segal, Z. V. (2010). Mindfulness and emotion regulation: outcomes and possible mediating mechanisms. In A. M. Kring & D. M. Sloan (Eds.), Emotion regulation and psychopathology: a transdiagnostic approach to etiology and treatment (pp. 339–355). New York: Guilford Press.Google Scholar
  20. Cox, B. J., Rector, N. A., Bagby, R. M., Swinson, R. P., Levitt, A. J., & Joffe, R. T. (2000). Is self-criticism unique for depression? A comparison with social phobia. Journal of Affective Disorders, 57, 223–228. Scholar
  21. Crașovan, D. I., & Sava, F. A. (2013). Translation, adaptation, and validation on Romanian population of COPE questionnaire for coping mechanisms analysis. Cognition, Brain, Behavior, 17, 61–76.Google Scholar
  22. David, D., & Dobrean, A. (2012). The Beck depression inventory (2nd ed.). Cluj-Napoca: Romanian Testing Services.Google Scholar
  23. de la Fuente, M., Franco, C., & Salvator, M. (2010). Reduction of blood pressure in a group of hypertensive teachers through a program of mindfulness meditation. Behavioral Psychology/Psicología Conductual, 18, 533–552.Google Scholar
  24. Dobkin, P. L., & Zhao, Q. (2011). Increased mindfulness—the active component of the mindfulness-based stress reduction program? Complementary Therapies in Clinical Practice, 17, 22–27. Scholar
  25. Dumitrescu, A., Badia, D., Dogaru, C. B., Toma, C., Perea, G., & Duă, C. (2014). Romanian version of the Perceived Stress Scale: an investigation of its psychometric properties. Procedia–Social and Behavioral Sciences, 159, 561–564. Scholar
  26. Farb, N. A., Segal, Z. V., Mayberg, H., Bean, J., McKeon, D., et al. (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, 2, 313–322. Scholar
  27. Farb, N. A., Anderson, A. K., Mayberg, H., Bean, J., McKeon, D., & Segal, Z. V. (2010). Minding one’s emotions: mindfulness training alters the neural expression of sadness. Emotion, 10, 25–33. Scholar
  28. Finlay-Jones, A. L., Rees, C. S., & Kane, R. T. (2015). Self-compassion, emotional regulation and stress among Australian psychologists: testing an emotion regulation model of self-compassion using structural equation modelling. PLoS One, 10.
  29. Fortune, D. G., Richards, H. L., Main, C. J., & Griffiths, C. E. M. (2002). Patients’strategies for coping with psoriasis. Clinical and Experimental Dermatology, 27, 177–184. Scholar
  30. Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami, S., Stein, M. B., et al. (2001). The Liebowitz social anxiety scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine, 31, 1025–1035. Scholar
  31. Gard, T., Hölzel, B. K., Sack, A. T., Hempel, H., Lazar, S. W., Vaitl, D., et al. (2010). Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cerebral Cortex, 22, 2692–2702. Scholar
  32. Garland, E. L., Gaylord, S. A., & Fredrickson, B. L. (2011). Positive reappraisal mediates the stress-reductive effects of mindfulness: an upward spiral process. Mindfulness, 2, 59–67. Scholar
  33. Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10, 83–91. Scholar
  34. Grant, B., Hasin, D., Blanco, C., Stinson, F., Chou, S., Goldstein, R. B., et al. (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 11, 1351–1361. Scholar
  35. Grant, J. A., Courtemanche, J., & Rainville, P. (2011). A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators. Pain, 152, 150–156. Scholar
  36. Gross, J. J. (2007). The handbook of emotion regulation. New York: Guilford Press.Google Scholar
  37. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362. Scholar
  38. Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (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. Clinical Psychology Review, 37, 1–12. Scholar
  39. Hayes, A. F. (2013). Introduction to mediation, moderation and conditional process analysis. New York: Guilford Press.Google Scholar
  40. Heeren, A., Lievens, L., & Philippot, P. (2011). How does attention training work in social phobia: disengagement from threat or re-engagement to non-threat? Journal of Anxiety Disorders, 25, 1108–1115. Scholar
  41. Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive-behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety: clinical, developmental, and social perspectives (pp. 395–422). New York: Academic Press.CrossRefGoogle Scholar
  42. Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 195–209. Scholar
  43. Hofmann, S. G., & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: new wave or old hat? Clinical Psychology Review, 28, 1–16. Scholar
  44. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183. Scholar
  45. Holzel, B. K., Ott, U., Hempel, H., Hackl, A., Wolf, K., ..., Vaitl, D. (2007). Differential engagement of anterior cingulate and adjacent medial frontal cortez in adapt meditators vs. non-meditators. Neuroscience Letters, 421, 16–21.
  46. Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., et al. (2011a). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research, 191, 36–43. Scholar
  47. Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011b). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537–559. Scholar
  48. Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., et al. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33, 11–21. Scholar
  49. Jazaieri, H., Goldin, P. R., Werner, K., Ziv, M., & Gross, J. J. (2012). A randomized trial of MBSR versus aerobic exercise for social anxiety disorder. Journal of Clinical Psychology, 68, 715–731. Scholar
  50. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33–47. Scholar
  51. Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation in everyday life. New York: Hyperion.Google Scholar
  52. Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163–190. Scholar
  53. Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. Scholar
  54. Keng, S., Smoski, M. J., Robins, C. J., Ekblad, A. G., & Brantley, J. G. (2012). Mechanisms of change in mindfulness-based stress reduction: self-compassion and mindfulness as mediators of intervention outcomes. Journal of Cognitive Psychotherapy, 26, 270–280. Scholar
  55. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H.-U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21, 169–184. Scholar
  56. Kocovski, N. L., Fleming, J. E., & Rector, N. A. (2009). Mindfulness and acceptance-based group therapy for social anxiety disorder: a pilot study. Cognitive and Behavioral Practice, 16, 276–289. Scholar
  57. Krieger, T., Altenstein, D., Baettig, I., Doerig, N., & Holtforth, M. G. (2013). Self-compassion in depression: associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behavior Therapy, 44, 501–513. Scholar
  58. Lazar, S. W., Bush, G., Gollub, R. L., Fricchione, G. L., Khalsa, G., & Benson, H. (2000). Functional brain mapping of the relaxation response and meditation. Neuroreport, 11, 1581–1585. Scholar
  59. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  60. Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887–904. Scholar
  61. Lee, S. H., Ahn, S. C., Lee, Y. J., Choi, T. K., Yook, K. H., & Suh, S. Y. (2006). Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder. Journal of Psychosomatic Research, 62, 189–195. Scholar
  62. Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L. (2008). Emotion regulation in unipolar depression: the effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour Research and Therapy, 46, 1201–1209. Scholar
  63. Lyne, K., & Roger, D. (2000). A psychometric re-assessment of the COPE questionnaire. Personality and Individual Differences, 29, 321–335. Scholar
  64. Miu, A. C., Vulturar, R., Chiş, A., Ungureanu, L., & Gross, J. J. (2013). Reappraisal as a mediator in the link between 5-HTTLPR and social anxiety symptoms. Emotion, 13, 1012–1022. Scholar
  65. Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. Scholar
  66. Neff, K. D., Hsieh, Y. P., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4, 263–287. Scholar
  67. Neff, K. D., Kirkpatrick, K. L., & Rude, S.S. (2007). Self-compassion and adaptive psychosocial functioning. Journal of Research in Personality, 41, 139–154.
  68. Newberg, A., Alavi, A., Baime, M., Pourdehnad, M., Santanna, J., & d’Aquili, E. (2001). The measurement of regional cerebral blood flow during the complex cognitive task of meditation: a preliminary SPECT study. Psychiatry Research, 106, 113–122. Scholar
  69. Newby, J. M., Mckinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110. Scholar
  70. Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64. Scholar
  71. Podina, I., Jucan, A., & David, D. (2015). Self-compassion: a buffer in the pathway from maladaptive beliefs to depression. An exploratory study. Journal of Evidence-Based Psychotherapies, 15, 97–109.Google Scholar
  72. Preacher, K. J., & Kelley, K. (2011). Effect sizes measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 16, 93–115. Scholar
  73. Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology and Psychotherapy, 18, 250–255. Scholar
  74. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. Scholar
  75. Rusch, S., Westermann, S., & Lincoln, T. M. (2012). Specificity of emotion regulation deficits in social anxiety: an internet study. Psychology and Psychotherapy: Theory, Research and Practice, 85, 268–277. Scholar
  76. Rytwinski, N. K., Fresco, D. M., Heimberg, R. G., Coles, M. E., Liebowitz, M. R., Cissell, S., et al. (2009). Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale. Depression and Anxiety, 26, 34–38. Scholar
  77. Schneier, F. R. (2006). Social anxiety disorder. The New England Journal of Medicine, 355, 1029–1036.
  78. Segal, Z. V., Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse (2nd ed.). New York: The Guilford Press.Google Scholar
  79. Shapiro, S. L., Astin, J., Bishop, S., & Cordova, M. (2005). Mindfulness-based stress reduction and health care professionals. International Journal of Stress Management, 12, 164–176. Scholar
  80. Shapiro, S. L., Brown, K., & Biegel, G. (2007). Self-care for health care professionals: effects of MBSR on mental well being of counseling psychology students. Training and Education in Professional Psychology, 1, 105–115. Scholar
  81. Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating mindfulness: effects on well-being. Journal of Clinical Psychology, 64, 840–862. Scholar
  82. Shawyer, F., Meadows, G., Judd, F. K., Martin, P., Segal, Z. V., & Piterman, L. (2012). The DARE study of relapse prevention in depression: design for a phase 1/2 translational randomised controlled trial involving mindfulness-based cognitive therapy and supported self monitoring. BMC Psychiatry, 12(3).
  83. Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (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, 9(4), e96110. Scholar
  84. Voncken, M. J., Dijk, C., de Jong, P. J., & Roelofs, J. (2010). Not self-focused attention but negative beliefs affect poor social performance in social anxiety: an investigation of pathways in the social anxiety–social rejection relationship. Behavior Research and Therapy, 48, 984–991. Scholar
  85. Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43, 374–385. Scholar
  86. Werner, K. H., Jazaieri, H., Goldin, P. R., Ziv, M., Heimberg, R. G., & Gross, J. J. (2012). Self-compassion and social anxiety disorder. Anxiety, Stress, and Coping, 25, 543–558. Scholar
  87. Wolf, C., Serpa, J. G., Kornfield, J., & Goodman, T. (2011). A clinician’s guide to teaching mindfulness. Oakland: New Habinger Publications.Google Scholar
  88. Wolgast, M., Lundh, L., & Viborg, G. (2011). Cognitive reappraisal and acceptance: an experimental comparison of two emotion regulation strategies. Behaviour Research and Therapy, 49, 858–866. Scholar
  89. Ying, Y. W. (2009). Contribution of self-compassion to competence and mental health in social work students. Journal of Social Work Education, 45, 309–323. Scholar
  90. Zeidan, F., Johnson, S. K., Gordon, N. S., & Goolkasian, P. (2010). Effects of brief and sham mindfulness meditation on mood and cardiovascular variables. Journal of Alternative and Complementary Medicine, 16, 867–873. Scholar
  91. Zivin, K., Eisenberg, D., Gollust, S. E., & Golberstein, E. (2009). Persistence of mental health problems and needs in a college student population. Journal of Affective Disorders, 117, 180–185. Scholar

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Authors and Affiliations

  1. 1.Department of PsychologyBabeş-Bolyai UniversityCluj-NapocaRomania

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