Advertisement

Mindfulness- and Acceptance-Based Interventions in the Treatment of Anxiety Disorders

  • Jon VøllestadEmail author
Part of the Advances in Mental Health and Addiction book series (AMHA)

Abstract

Anxiety disorders are highly prevalent and costly both to the individual and society. Established treatments are effective, but a number of patients fail to respond optimally. Mindfulness- and acceptance-based interventions (MABIs) constitute a family of treatments emphasising present-centred awareness, a stance of non-judgment, and value-oriented action. Anxiety disorders are instigated and maintained by a set of transdiagnostic processes within the domains of cognition, emotion, behaviour, and self-experience. A conceptual and empirical overview suggests that MABI may impact beneficially on these processes. Clinical trials and meta-analyses provide support for their effectiveness in anxiety disorders, although a pattern of divergent findings emerges. Clinical trials show strongest support for MABIs in the treatment of heterogeneous anxiety disorders and generalised anxiety disorder. Evidence for social anxiety disorder is mixed, and there is at present insufficient evidence to assess the impact of MABIs on panic disorder, PTSD, and OCD. Despite equivalent outcomes to cognitive behavioural therapy (CBT) in most head-to-head comparisons, MABIs have yet to perform as well as CBT at its best. While CBT is still the treatment of choice for most anxiety disorders, MABIs constitute a viable treatment option for CBT nonresponders and may also be preferred by some patients. Further tailoring of MABIs to discrete anxiety disorders may be needed. Clinical implementation is discussed, and recommendations for further research are presented.

Keywords

Mindfulness Acceptance Anxiety disorders Mindfulness-based stress reduction Mindfulness-based cognitive therapy Acceptance and commitment therapy Acceptance-based behaviour therapy 

References

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC: APA.Google Scholar
  2. Amstadter, A. (2008). Emotion regulation and anxiety disorders. Journal of Anxiety Disorders, 22, 211–221.PubMedCentralPubMedGoogle Scholar
  3. Antony, M. M. (2002). Enhancing current treatments for anxiety disorders. Clinical Psychology: Science and Practice, 9, 91–94.Google Scholar
  4. 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.PubMedGoogle Scholar
  5. Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80, 750–765.PubMedGoogle Scholar
  6. Austin, D. W., & Richards, J. C. (2001). The catastrophic misinterpretation model of panic disorder. Behaviour Research and Therapy, 39, 1277–1291.PubMedGoogle Scholar
  7. Avdagic, E., Morrissey, S. A., & Boschen, M. J. (2014). A randomised controlled trial of acceptance and commitment therapy and cognitive-behaviour therapy for generalised anxiety disorder. Behaviour Change, 31, 110–130.Google Scholar
  8. Baer, R. A. (2007). Mindfulness, assessment, and transdiagnostic processes. Psychological Inquiry, 18, 238–271.Google Scholar
  9. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.PubMedGoogle Scholar
  10. Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van Ijzendorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133, 1–24.PubMedGoogle Scholar
  11. Barlow, D. H. (2002). Anxiety and its disorders (2nd ed.). New York: The Guilford Press.Google Scholar
  12. Baumeister, R. F., Heatherton, T. F., & Tice, D. M. (1994). Losing control: How and why people fail at self-regulation. San Diego: Academic.Google Scholar
  13. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.Google Scholar
  14. Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28, 612–624.PubMedGoogle Scholar
  15. Boettcher, J., Åström, V., Påhlsson, D., Schenström, O., Andersson, G., & Carlbring, P. (2014). Internet-based mindfulness treatment for anxiety disorders: A randomized controlled trial. Behavior Therapy, 45, 241–253.PubMedGoogle Scholar
  16. Bögels, S. M., Sijbers, G. F. V., & Voncken, M. (2006). Mindfulness and task concentration training for social phobia: A pilot study. Journal of Cognitive Psychotherapy, 20, 33–44.Google Scholar
  17. Bohlmeijer, E. T., Fledderus, M., Rokx, T. A. J. J., & Pieterse, M. E. (2011). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49, 62–67.Google Scholar
  18. Bolton J. M., Cox, B. J., Afifi, T. O., Enns, M. W., Bienvenu, O. J., & Sareen, J. (2008). Anxiety disorders and risk for suicide attempts: Findings from the Baltimore Epidemiologic Catchment area follow-up study. Depression and Anxiety, 25, 477–481.Google Scholar
  19. Bondolfi, G., Jermann, F., der Linden, M. V., Gex-Fabry, M., Bizzini, L., Rouget, B. W., et al. (2010). Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: Replication and extension in the Swiss health care system. Journal of Affective Disorders, 122, 224–231.Google Scholar
  20. Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). New York: Guilford Press.Google Scholar
  21. Bränström, R., Duncan, L. G., & Moskowitz, J. T. (2011). The association between dispositional mindfulness, psychological well-being, and perceived health in a Swedish population-based sample. British Journal of Health Psychology, 16, 300–316.Google Scholar
  22. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.PubMedGoogle Scholar
  23. 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. American Journal of Psychiatry, 162, 1179–1187.PubMedCentralPubMedGoogle Scholar
  24. Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 542–559). New York: Guilford.Google Scholar
  25. Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006a). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6, 587–595.PubMedGoogle Scholar
  26. Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006b). Effects of suppression and acceptance of emotional responses of individuals with anxiety and mood disorders. Behavior Research and Therapy, 44, 1251–1263.Google Scholar
  27. Carmody, J. (2009). Evolving concepts of mindfulness in clinical settings. Journal of Cognitive Psychotherapy, 23, 270–280.Google Scholar
  28. Cash, M., & Whittingham, K. (2010). What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related symptomatology? Mindfulness, 1, 177–182.Google Scholar
  29. Chan, D., & Woollacott, M. (2007). Effects of level of meditation experience on attentional focus: Is the efficiency of executive or orientation networks improved? The Journal of Alternative and Complementary Medicine, 13, 651–658.PubMedGoogle Scholar
  30. Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67, 1–21.Google Scholar
  31. Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. Journal of Alternative and Complementary Medicine, 15, 593–600.PubMedGoogle Scholar
  32. Clark, D. M. (1999). Anxiety disorders. Why they persist and how to treat them. Behaviour Research and Therapy, 37, 5–27.Google Scholar
  33. Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder: A preliminary evaluation. Behavioral and Cognitive Psychotherapy, 36, 553–568.Google Scholar
  34. Craske, M. G., Rauch, S. L., Ursano, R., Prenoveau, J., Pine, D. S., & Zinbarg, R. E. (2009). What is an anxiety disorder? Depression and Anxiety, 26, 1066–1085.PubMedGoogle Scholar
  35. Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosomatic Medicine, 69, 560–565.PubMedGoogle Scholar
  36. Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for generalized social anxiety disorder – a pilot study. Behavior Modification, 31, 543–568.PubMedGoogle Scholar
  37. Dalrymple, K. L., Morgan, T. A., Lipschitz, J. M., Martinez, J. H., Tepe, E., & Zimmerman, M. (2014). An integrated, acceptance-based behavioral approach for depression with social anxiety - Preliminary results. Behavior Modification, 38, 516–548.PubMedGoogle Scholar
  38. de Vibe, M., Bjørndal, A., Tipton, E., Hammerstrøm, K. T., & Kowalski, K. (2012). Mindfulness based stress reduction (MBSR) for improving health, quality of life, and social functioning in adults. Campbell Systematic Reviews, 8.Google Scholar
  39. Deacon, B., Lickel, J., & Abramowitz, J. S. (2008). Medical utilization across the anxiety disorders. Journal of Anxiety Disorders, 22, 344–350.PubMedGoogle Scholar
  40. Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification, 37, 409–430.PubMedGoogle Scholar
  41. Desrosiers, A., Klemanski, D. H., & Nolen-Hoeksema, S. (2013). Mapping mindfulness facets onto dimensions of anxiety and depression. Behavior Therapy, 44, 373–384.PubMedCentralPubMedGoogle Scholar
  42. Deyo, M., Wilson, K. A., Ong, J., & Koopman, C. (2009). Mindfulness and rumination: Does mindfulness training lead to reductions in the ruminative thinking associated with depression? Patient Education and Counseling, 5, 265–271.Google Scholar
  43. Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in etiology and maintenance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). New York: Guilford Press.Google Scholar
  44. Earley, M. D., Chesney, M. A., Frye, J., Greene, P. A., Berman, B., & Kimbrough, E. (2014). Mindfulness intervention for child abuse survivors: A 2.5-year follow-up. Journal of Clinical Psychology, 70, 933–941.PubMedGoogle Scholar
  45. Ehring, T., & Watkins, E. R. (2009). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192–205.Google Scholar
  46. Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and value-based behavior change strategies. Oakland, CA: New Harbinger Publications.Google Scholar
  47. Eifert, G. H., & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34, 293–312.PubMedGoogle Scholar
  48. Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716–721.PubMedGoogle Scholar
  49. Farb, N. A., Anderson, A. K., & Segal, Z. V. (2012). The mindful brain and emotion regulation in mood disorders. Canadian Journal of Psychiatry, 57, 70–77.Google Scholar
  50. Farb, N. A. S., Segal, Z. V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., et al. (2007). Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, 2, 259–263.Google Scholar
  51. Farb, N. A., Segal, Z. V., & Anderson, A. K. (2012). Mindfulness meditation training alters cortical representations of interoceptive attention. Social Cognitive and Affective Neuroscience, 8, 15–26.PubMedCentralPubMedGoogle Scholar
  52. Finucane, A., & Mercer, S. W. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry, 6, 14.PubMedCentralPubMedGoogle Scholar
  53. Frewen, P. A., Evans, E. M., Maraj, N., Dozois, D. J., & Partridge, K. (2008). Letting go: Mindfulness and negative automatic thinking. Cognitive Therapy and Research, 32, 758–774.Google Scholar
  54. Gloster, A. T., Sonntag, R., Hoyer, J., Meyer, A. H., Heinze, S., Ströhle, A., et al. (2015). Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: A randomized controlled switching trial. Psychotherapy and Psychosomatics, 84, 100–109.PubMedGoogle Scholar
  55. Godfrin, K. A., & van Heeringen, C. (2010). The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study. Behaviour Research and Therapy, 48, 738–746.PubMedGoogle Scholar
  56. Goldin, P. R., Ramel, W., & Gross, J. J. (2009). Mindfulness meditation training and self-referential processing in social anxiety disorders: Behavioral and neural effects. Journal of Cognitive Psychotherapy, 23, 242–257.PubMedCentralPubMedGoogle Scholar
  57. Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., et al. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174, 357–368.PubMedCentralPubMedGoogle Scholar
  58. Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R. T., et al. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60, 427–435.PubMedGoogle Scholar
  59. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291.PubMedGoogle Scholar
  60. Hargus, E., Crane, C., Barnhofer, T., & Williams, J. M. G. (2010). Effects of mindfulness on meta-awareness and specificity of describing prodromal symptoms in suicidal depression. Emotion, 10, 34–42.PubMedCentralPubMedGoogle Scholar
  61. Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 639–665.Google Scholar
  62. Hayes, A. M., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Research and Practice, 11, 255–262.Google Scholar
  63. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1–25.PubMedGoogle Scholar
  64. Hayes, S. A., Orsillo, S. M., & Roemer, L. (2010). Changes in proposed mechanisms of action during an acceptance-based behavior therapy for generalized anxiety disorder. Behaviour Research and Therapy, 48, 238–245.PubMedCentralPubMedGoogle Scholar
  65. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy. An experiential approach to behavior change. New York: The Guilford Press.Google Scholar
  66. Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013). A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81, 761–773.PubMedCentralPubMedGoogle Scholar
  67. Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions. Biological Psychiatry, 51, 101–108.PubMedGoogle Scholar
  68. Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance- and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1–16.PubMedGoogle Scholar
  69. Hofmann, S. G., & Bögels, S. M. (2006). Recent advances in the treatment of social phobia: Introduction to the special issue. Journal of Cognitive Psychotherapy, 20, 3–5.Google Scholar
  70. 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.PubMedCentralPubMedGoogle Scholar
  71. Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632.PubMedCentralPubMedGoogle Scholar
  72. Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., et al. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: Effects on anxiety and stress reactivity. The Journal of Clinical Psychiatry, 74, 786–792.PubMedCentralPubMedGoogle Scholar
  73. Hollon, S. D., & Beck, A. T. (2004). Cognitive and cognitive-behavioral therapies. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 428–466). Oxford: John Wiley & Sons.Google Scholar
  74. Hölzel, B. K., Carmody, J., Evans, K. C., Hoge, E. A., Dusek, J. A., Morgan, L., et al. (2009). Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neuroscience, 5, 11–17.PubMedCentralPubMedGoogle Scholar
  75. Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, K., et al. (2010). Mindfulness practice leads to increases in regional gray matter density. Psychiatry Research: Neuroimaging, 1, 36–43.Google Scholar
  76. Hölzel, B. K., Hoge, E. A., Greve, D. N., Gard, T., Creswell, J. D., Brown, K. W., et al. (2013). Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. NeuroImage: Clinical, 2, 448–458.Google Scholar
  77. Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537–559.PubMedGoogle Scholar
  78. Hölzel, B. K., Ott, U., Gard, T., Hempel, H., Weygandt, M., Morgen, K., et al. (2008). Investigation of mindfulness meditation practitioners with voxel-based morphometry. Social Cognitive and Affective Neuroscience, 3, 55–61.PubMedCentralPubMedGoogle Scholar
  79. Ingram, R. E. (1990). Self-focused attention in clinical disorders: Review and a conceptual model. Psychological Bulletin, 107, 156–176.PubMedGoogle Scholar
  80. Ivanovski, B., & Malhi, G. S. (2007). The psychological and neuropsychological concomitants of mindfulness forms of meditation. Acta Neuropsychiatrica, 19, 76–91.Google Scholar
  81. Jain, S., Shapiro, S. L., Swanwick, S., Roesch, P. J., 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, and distraction. Annals of Behavioral Medicine, 33, 11–21.PubMedGoogle Scholar
  82. 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.PubMedCentralPubMedGoogle Scholar
  83. Jha, A. P., Krompinger, J., & Baime, M. J. (2007). Mindfulness training modifies subsystems of attention. Cognitive Affective and Behavioral Neuroscience, 7, 109–119.Google Scholar
  84. Kabat-Zinn, J. (1990). Full catastrophe living. Using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam.Google Scholar
  85. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Research and Practice, 10, 144–156.Google Scholar
  86. Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L., Fletcher, K. E., Pbert, L., et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936–943.PubMedGoogle Scholar
  87. Kang, H. K., Bullman, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A., & Reger, M. A. (2015). Suicide risk among 1.3 million veterans who were on active duty during the Iraq and Afghanistan wars. Annals of Epidemiology, 25, 96–100.Google Scholar
  88. Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. Journal of Clinical Psychology, 68, 101–116.PubMedGoogle Scholar
  89. Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2013). Effects of participation in a mindfulness program for veterans with posttraumatic stress disorder: A randomized controlled pilot study. Journal of Clinical Psychology, 69, 14–27.PubMedGoogle Scholar
  90. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62, 617–627.PubMedCentralPubMedGoogle Scholar
  91. Kessler, R. C., Ruscio, A. M., Shear, K., & Wittchen, H.-U. (2010). Epidemiology of anxiety disorders. Current Topics in Behavioral Neurosciences, 2, 21–35.PubMedGoogle Scholar
  92. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., et al. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33, 763–771.PubMedGoogle Scholar
  93. Kim, Y. W., Lee, S., Choi, T. K., Young, S. Y., Kim, B., Kim, C. M., et al. (2009). Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder. Depression and Anxiety, 26, 601–606.PubMedGoogle Scholar
  94. Kim, B., Lee, S., Kim, Y. W., Choi, T. K., Yook, K., Suh, S. Y., et al. (2010). Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder. Journal of Anxiety Disorders, 24, 590–595.PubMedGoogle Scholar
  95. Kimbrough, E., Magyari, T., Langenberg, P., Chesney, M., & Berman, B. (2010). Mindfulness intervention for child abuse survivors. Journal of Clinical Psychology, 66, 17–33.PubMedGoogle Scholar
  96. King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., et al. (2013). A pilot study of group Mindfulness-Based Cognitive Therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30, 638–645.PubMedCentralPubMedGoogle Scholar
  97. Kocovski, N. L., Fleming, J. E., Hawley, L. L., Huta, V., & Antony, M. M. (2013). Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: A randomized controlled trial. Behaviour Research and Therapy, 51, 889–898.PubMedGoogle Scholar
  98. Kocovski, N. L., Fleming, J. E., & Rector, N. A. (2009). Mindfulness and acceptance-based group therapy for social anxiety disorder: An open trial. Cognitive and Behavioral Practice, 16, 276–289.Google Scholar
  99. Koszycki, D., Benger, M., Shlik, J., & Bradwejn, J. (2007). Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behavior Research and Therapy, 45, 2518–2526.Google Scholar
  100. Kozasa, E. H., Sato, J. R., Lacerda, S. S., Barreiros, M. A., Radvany, J., Russell, T. A., et al. (2012). Meditation training increases brain efficiency in an attention task. NeuroImage, 59, 745–749.PubMedGoogle Scholar
  101. Kubzansky, L. D., Davidson, K. W., & Rozanski, A. (2005). The clinical impact of negative psychological states: Expanding the spectrum of risk for coronary heart disease. Psychosomatic Medicine, 67, 10–14.Google Scholar
  102. Kumar, S., Feldman, G., & Hayes, A. (2008). Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cognitive Therapy and Research, 32, 734–744.Google Scholar
  103. Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., et al. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76, 966–978.PubMedGoogle Scholar
  104. Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., et al. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48, 1105–1112.PubMedGoogle Scholar
  105. Lee, S. H., Ahn, S. C., Lee, Y. J., Choi, T. K., Yook, K. H., & Suh, S. Y. (2007). 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.PubMedGoogle Scholar
  106. Lépine, J. P. (2002). The epidemiology of anxiety disorders: Prevalence and social costs. Journal of Clinical Psychiatry, 63, 4–8.PubMedGoogle Scholar
  107. Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747–766.Google Scholar
  108. Lovas, D. A., & Barsky, A. J. (2010). Mindfulness-based cognitive therapy for hypochondriasis, or severe health anxiety: A pilot study. Journal of Anxiety Disorders, 24, 931–935.PubMedGoogle Scholar
  109. Lutz, J., Herwig, U., Opialla, S., Hittmeyer, A., Jäncke, L., Rufer, M., et al. (2014). Mindfulness and emotion regulation—An fMRI study. Social Cognitive and Affective Neuroscience, 9, 776–785.PubMedCentralPubMedGoogle Scholar
  110. Lutz, A., Slagter, H. A., Dunne, J. D., & Davidson, R. J. (2008). Attention regulation and monitoring in meditation. Trends in Cognitive Science, 12, 163–169.Google Scholar
  111. Ma, S., & Teasdale, J. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40.PubMedGoogle Scholar
  112. Mansell, W., Harvey, A., Watkins, E., & Shafran, R. (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy, 23, 6–19.Google Scholar
  113. Marchand, W. R. (2014). Neural mechanisms of mindfulness and meditation: Evidence from neuroimaging studies. World Journal of Radiology, 6, 471.PubMedCentralPubMedGoogle Scholar
  114. Marciniak, M., Lage, M. J., Landbloom, R. P., Dunayevich, E., & Bowman, L. (2004). Medical and productivity costs of anxiety disorders: Case control study. Depression and Anxiety, 19, 112–120.PubMedGoogle Scholar
  115. Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1, 167–195.PubMedGoogle Scholar
  116. McKee, L., Zvolensky, M. J., Solomon, S. E., Bernstein, A., & Leen-Feldner, E. (2007). Emotional vulnerability and mindfulness: A preliminary test of associations among negative affectivity, anxiety sensitivity, and mindfulness skills. Cognitive Behaviour Therapy, 36, 91–101.PubMedGoogle Scholar
  117. McManus, F., Grey, N., & Shafran, R. (2008). Cognitive therapy for anxiety disorders: Current status and future challenges. Behavioural and Cognitive Psychotherapy, 36, 695–704.Google Scholar
  118. McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. G. (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80, 817–828.PubMedCentralPubMedGoogle Scholar
  119. Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157, 669–682.Google Scholar
  120. Mennin, D. S., Ellard, K. K., Fresco, D. M., & Gross, J. J. (2013). United we stand: Emphasizing commonalities across cognitive-behavioral therapies. Behavior Therapy, 44, 234–248.PubMedGoogle Scholar
  121. Meuret, A. E., Twohig, M. P., Rosenfield, D., Hayes, S. C., & Craske, M. G. (2012). Brief acceptance and commitment therapy and exposure for panic disorder: A pilot study. Cognitive and Behavioral Practice, 19, 606–618.Google Scholar
  122. Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192–200.PubMedGoogle Scholar
  123. Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128, 638–662.PubMedGoogle Scholar
  124. National Institute for Health and Care Excellence. (2013). Social anxiety disorder: Recognition, assessment and treatment of social anxiety disorder (Clinical guideline 159.) http://guidance.nice.org.uk/CG159
  125. Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–102.Google Scholar
  126. Niles, B. L., Klunk-Gillis, J., Ryngala, D. J., Silberbogen, A. K., Paysnick, A., & Wolf, E. J. (2012). Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 538–547.Google Scholar
  127. Ninan, P. T. (2001). Dissolving the burden of generalized anxiety disorder. Journal of Clinical Psychiatry, 62, 5–10.PubMedGoogle Scholar
  128. Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorder and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.PubMedGoogle Scholar
  129. Norton, A. R., Abbott, M. J., Norberg, M. M., & Hunt, C. (2014). A systematic review of mindfulness and acceptance-based treatments for social anxiety disorder. Journal of Clinical Psychology. doi: 10.1002/jclp.22144.Google Scholar
  130. Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice, Training, 45, 214–226.Google Scholar
  131. Norton, P. J., & Price, E. M. (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. The Journal of Nervous and Mental Disease, 195, 521–531.PubMedGoogle Scholar
  132. Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: A meta-analytic review. Clinical Psychology Review, 27, 572–581.PubMedGoogle Scholar
  133. Ossman, W. A., Wilson, K. G., Storaasli, R. D., & McNeill, J. W. (2006). A preliminary investigation of the use of Acceptance and Commitment Therapy in group treatment for social phobia. International Journal of Psychology and Psychological Therapy, 6, 397–416.Google Scholar
  134. Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2013). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, Retrieved from: http://rsw.sagepub.com/content/early/2013/09/16/1049731513503047
  135. Piet, J., Hougaard, E., Hecksher, M. S., & Rosenberg, N. K. (2010). A randomized pilot study of mindfulness-based cognitive therapy and group cognitive-behavioral therapy for young adults with social phobia. Scandinavian Journal of Psychology, 51. doi: 10.1111/j.1467-9450.2009.00801.x/pdf
  136. Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78, 73–80.PubMedGoogle Scholar
  137. Ramel, W., Goldin, P. R., Carmona, P. E., & McQuaid, J. R. (2004). The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28, 433–455.Google Scholar
  138. Ramsawh, H. J., Raffa, S. D., Edelen, M. O., Rende, R., & Keller, M. B. (2009). Anxiety in middle adulthood: Effects of age and time on the 14-year course of panic disorder, social phobia and generalized anxiety disorder. Psychological Medicine, 39, 615–624.PubMedCentralPubMedGoogle Scholar
  139. Ree, M. J., & Craigie, M. A. (2007). Outcomes following mindfulness-based cognitive therapy in a heterogeneous sample of adult outpatients. Behavior Change, 24, 70–86.Google Scholar
  140. Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24, 883–908.PubMedGoogle Scholar
  141. Roemer, L., Erisman, S. M., & Orsillo, S. M. (2008). Mindfulness and acceptance-based treatments for anxiety disorders. In M. M. Antony & M. B. Stein (Eds.), Oxford handbook of anxiety and related disorders (pp. 476–487). Oxford: Oxford University Press.Google Scholar
  142. Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior Therapy, 40, 142–154.PubMedCentralPubMedGoogle Scholar
  143. Roemer, L., & Orsillo, S. M. (2007). An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy, 38, 72–85.PubMedGoogle Scholar
  144. Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083–1089.PubMedCentralPubMedGoogle Scholar
  145. Roness, A., Mykletun, A., & Dahl, A. A. (2005). Help-seeking behaviour in patients with anxiety disorder and depression. Acta Psychiatrica Scandinavia, 111, 51–58.Google Scholar
  146. Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Panic disorder. Lancet, 368, 1023–1032.PubMedGoogle Scholar
  147. Rubia, K. (2009). The neurobiology of meditation and its clinical effectiveness in psychiatric disorders. Biological Psychology, 82, 1–11.PubMedGoogle Scholar
  148. Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic. Behavioural and Cognitive Psychotherapy, 19, 6–19.Google Scholar
  149. Santorelli, S. (1999). Heal thy self: Lessons on mindfulness in medicine. New York: Bell Tower.Google Scholar
  150. Segal, Z. V., Bieling, P., Young, T., MacQueen, G., Cooke, R., Martin, L., et al. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and Mindfulness-Based Cognitive Therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67, 1256–1264.PubMedCentralPubMedGoogle Scholar
  151. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression. New York: Guilford Press.Google Scholar
  152. Serpa, J. G., Taylor, S. L., & Tillisch, K. (2014). Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans. Medical Care, 52, 19–24.Google Scholar
  153. Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373–386.PubMedGoogle Scholar
  154. Shear, M. K., Bjelland, I., Beesdo, K., Gloster, A. T., & Wittchen, H. (2007). Supplementary dimensional assessment in anxiety disorders. International Journal of Methods in Psychiatric Research, 16, 52–64.Google Scholar
  155. Smith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., et al. (2011). Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters. Journal of Consulting and Clinical Psychology, 79, 613–617.PubMedGoogle Scholar
  156. Stein, D. J. (2002). Obsessive-compulsive disorder. Lancet, 360, 397–405.PubMedGoogle Scholar
  157. Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. Lancet, 371, 1115–1125.PubMedGoogle Scholar
  158. Stopa, L., & Clark, D. M. (2000). Social phobia and interpretation of social events. Behaviour Research and Therapy, 38, 273–283.PubMedGoogle Scholar
  159. 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, e96110.PubMedCentralPubMedGoogle Scholar
  160. Swift, J. K., & Callahan, J. L. (2009). The impact of client treatment preferences on outcome: A meta-analysis. Journal of Clinical Psychology, 65, 368–381.PubMedGoogle Scholar
  161. Taylor, S., Abramowitz, J. S., & McKay, D. (2012). Non-adherence and non-response in the treatment of anxiety disorders. Journal of Anxiety Disorders, 26, 583–589.PubMedGoogle Scholar
  162. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275–287.PubMedGoogle Scholar
  163. Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.PubMedGoogle Scholar
  164. Teasdale, J. D., Segal, Z. V., & Williams, J. M. G. (2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10, 157–160.Google Scholar
  165. Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24, 409–415.PubMedGoogle Scholar
  166. Treanor, M. (2011). The potential impact of mindfulness on exposure and extinction learning in anxiety disorders. Clinical Psychology Review, 31, 617–625.PubMedGoogle Scholar
  167. Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37, 3–13.PubMedGoogle Scholar
  168. Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78, 705–716.Google Scholar
  169. Tyrer, P., & Baldwin, D. (2006). Generalised anxiety disorder. Lancet, 368, 2156–2166.PubMedGoogle Scholar
  170. van den Hurk, P. A., Giommi, F., Gielen, S. C., Speckens, A. E., & Barendregt, H. P. (2010). Greater efficiency in attentional processing related to mindfulness meditation. The Quarterly Journal of Experimental Psychology, 63, 1168–1180.PubMedGoogle Scholar
  171. Vassilopoulos, S. P. (2008). Social anxiety and ruminative self-focus. Journal of Anxiety Disorders, 22, 860–867.PubMedGoogle Scholar
  172. Vassilopoulos, S. P., & Watkins, E. R. (2009). Adaptive and maladaptive self-focus: A pilot extension study with individuals high and low in fear of negative evaluation. Behavior Therapy, 40(2), 181–189.PubMedGoogle Scholar
  173. Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta-analysis. British Journal of Clinical Psychology, 51, 239–260.PubMedGoogle Scholar
  174. Vøllestad, J., Sivertsen, B., & Nielsen, G. H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49, 281–288.PubMedGoogle Scholar
  175. Voncken, M. J., Bögels, S. M., & de Vries, K. (2003). Interpretation and judgmental biases in social phobia. Behaviour Research and Therapy, 41, 1481–1488.PubMedGoogle Scholar
  176. Vujanovic, A. A., Youngwirth, N. E., Johnson, K. A., & Zvolensky, M. J. (2009). Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology. Journal of Anxiety Disorders, 23, 297–303.PubMedCentralPubMedGoogle Scholar
  177. Vujanovic, A. A., Zvolensky, M. J., Bernstein, A., Feldner, M. T., & McLeish, A. C. (2007). A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance. Behaviour Research and Therapy, 45, 1393–1400.PubMedGoogle Scholar
  178. Wadlinger, D. A., & Isaacowitz, D. M. (2010). Fixing our focus: Training attention to regulate emotion. Personality and Social Psychology Review, 20, 1–28.Google Scholar
  179. Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62, 603–613.PubMedGoogle Scholar
  180. Watkins, E., Moberly, N. J., & Moulds, M. L. (2008). Processing mode causally influences emotional reactivity. Distinct effects of abstract versus concrete construal on emotional response. Emotion, 8, 364–378.PubMedCentralPubMedGoogle Scholar
  181. Watts, B. V., Schnurr, P. P., Mayo, L., Young-Xu, Y., Weeks, W. B., & Friedman, M. J. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. The Journal of Clinical Psychiatry, 74, 541–550.Google Scholar
  182. Wegner, D. M., Broome, A., & Blumberg, S. J. (1997). Ironic effects of trying to relax under stress. Behaviour Research and Therapy, 35, 11–21.PubMedGoogle Scholar
  183. Wegner, D. M., & Erber, R. (1992). The hyperaccessibility of suppressed thought. Journal of Personality and Social Psychology, 63, 903–912.Google Scholar
  184. Williams, J. M. G. (2010). Mindfulness and psychological process. Emotion, 10, 1–7.PubMedGoogle Scholar
  185. Wittchen, H.-U., Lieb, R., Pfister, H., & Schuster, P. (2000). The waxing and waning of mental disorders: Evaluating the stability of syndromes of mental disorders in the population. Comprehensive Psychiatry, 41, 122–132.PubMedGoogle Scholar
  186. Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D., & Craske, M. G. (2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80, 786–799.PubMedGoogle Scholar
  187. Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346, 108–114.PubMedGoogle Scholar
  188. Yook, K., Lee, S., Ryu, M., Kim, K., Choi, K. C., Suh, S. Y., et al. (2008). Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders. The Journal of Nervous and Mental Disease, 196, 501–503.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Solli District Psychiatric Centre (DPS)NesttunNorway
  2. 2.Department of Clinical PsychologyUniversity of BergenBergenNorway

Personalised recommendations