Conventional versus Mindfulness-based Interventions for Anxiety and Worry: A Review and Recommendations

Author(s): Deah Jo Abbott, Caleb Wayne Lack*

Journal Name: Current Psychiatry Research and Reviews
Formerly Current Psychiatry Reviews

Volume 16 , Issue 1 , 2020

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Graphical Abstract:


Anxiety disorders are among the most prevalent and most functionally impairing psychiatric problems experienced by the population. Both pharmacological and psychological evidencebased treatments exist for a number of specific disorders, but may fail to fully relieve symptoms, pointing to the need for additional treatment options. Often considered to be part of the “third wave” of cognitive-behavioral therapies, treatments incorporating mindfulness have emerged in the past two decades as increasingly popular with clinicians and frequently sought out by consumers. The present article reviews the extant literature regarding the efficacy and effectiveness of mindfulnessbased treatments for anxiety, worry, and related problems. Although they have not attained the solid empirical status of CBT or certain pharmacological treatments, the extant research shows mindfulness- based interventions appear to be a promising and useful treatment for people suffering from anxiety and worry. Further work should be done, levels 3-5 of the NIH stage model to determine whether or not they should be further implemented.

Keywords: Mindfulness, mindfulness-based cognitive therapy, third wave, anxiety, pharmacological treatments, conventional.

Van Dam NT, van Vugt MK, Vago DR, et al. Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspect Psychol Sci 2018; 13(1): 36-61.
[] [PMID: 29016274]
Barlow DH. Clinical handbook of psychological disorders: a step-by-step treatment manual. 4th ed. New York: Guilford Press 2008.
Nesse RM, Bhatnagar S, Ellis B. Evolutionary origins and functions of the stress response system. In: Stress: Concepts,Cognition, Emotion, and Behavior, Fink G, Ed San Diego:Academic Press 2016; pp: 95-101.
Barlow DH. Anxiety and its disorders: the nature and treatment of anxiety and panic. 2nd ed. New York: Guilford Press 2002.
Lack CW. Anxiety disorders: an introduction. 1st ed UK. Onus Books 2013.
Craske MG, Rauch SL, Ursano R, Prenoveau J, Pine DS, Zinbarg RE. What is an anxiety disorder? Depress Anxiety 2009; 26(12): 1066-85.
[] [PMID: 19957279]
Borkovec TD. The nature, functions, and origins of worry.In:Worrying: Perspectives on theory, assessment and treatment,Davey G, Tallis F, Eds Oxford: John Wiley & Sons . 1994; pp. 5-33.
Craske MG. Anxiety disorders: psychological approaches to theory and treatment. New York:Basic Books 1999.
Davey GC, Tallis FE. Worrying: Perspectives on theory, assessment and treatment. Chichester:John Wiley & Sons 1994.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association 2013.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62(6): 593-602.
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 2012; 21(3): 169-84.
[] [PMID: 22865617]
Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43(5): 897-910.
Kessler RC, Greenberg PE. The economic burden of anxiety and stress disorders. In: Neuropsychopharmacology:The fifth generation of progress, Davis KL, Charney D, Coyle JT, Nemeroff C, Eds. Philadelphia: Williams and Wilkins. 2002; pp. 982-92.
Barrera TL, Norton PJ. Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder. J Anxiety Disord 2009; 23(8): 1086-90.
[] [PMID: 19640675]
Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev 2007; 27(5): 572-81.
[] [PMID: 17343963]
Fehm L, Beesdo K, Jacobi F, Fiedler A. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Soc Psychiatry Psychiatr Epidemiol 2008; 43(4): 257-65.
[] [PMID: 18084686]
Hazlett-Stevens H, Craske MG, Mayer EA, Chang L, Naliboff BD. Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res 2003; 55(6): 501-5.
[] [PMID: 14642979]
de Graaf R, Tuithof M, van Dorsselaer S, ten Have M. Comparing the effects on work performance of mental and physical disorders. Soc Psychiatry Psychiatr Epidemiol 2012; 47(11): 1873-83.
[] [PMID: 22434047]
Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007; 146(5): 317-25.
[] [PMID: 17339617]
Lucchetti G, Peres MFP, Lucchetti ALG, Mercante JPP, Guendler VZ, Zukerman E. Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache. Psychiatry Clin Neurosci 2013; 67(1): 41-9.
[] [PMID: 23331287]
Lichstein KL, Wilson NM, Johnson CT. Psychological treatment of secondary insomnia. Psychol Aging 2000; 15(2): 232-40.
[] [PMID: 10879578]
Gilmour H. Threshold and subthreshold Generalized Anxiety Disorder (GAD) and suicide ideation. Health Rep 2016; 27(11): 13-21.
[PMID: 27849314]
Haller H, Cramer H, Lauche R, Gass F, Dobos GJ. The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review. BMC Psychiatry 2014; 14: 128.
[] [PMID: 24886240]
Wolitzky-Taylor K, Dour H, Zinbarg R, et al. Experiencing core symptoms of anxiety and unipolar mood disorders in late adolescence predicts disorder onset in early adulthood. Depress Anxiety 2014; 31(3): 207-13.
[] [PMID: 24577995]
Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci 2017; 19(2): 93-107.
[PMID: 28867934]
Olatunji BO, Cisler JM, Deacon BJ. Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings. Psychiatr Clin North Am 2010; 33(3): 557-77.
[] [PMID: 20599133]
Hofmann SG, Smits JAJ. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008; 69(4): 621-32.
[] [PMID: 18363421]
Beck AT, Emery G, Greenberg RL. Anxiety disorders and phobias: a cognitive perspective New York:. Basic Books 2005.
Roness A, Mykletun A, Dahl AA. Help-seeking behaviour in patients with anxiety disorder and depression. Acta Psychiatr Scand 2005; 111(1): 51-8.
[] [PMID: 15636594]
Wang PS, Angermeyer M, Borges G, et al. Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 2007; 6(3): 177-85.
[PMID: 18188443]
Marques L, LeBlanc NJ, Weingarden HM, Timpano KR, Jenike M, Wilhelm S. Barriers to treatment and service utilization in an internet sample of individuals with obsessive-compulsive symptoms. Depress Anxiety 2010; 27(5): 470-5.
[] [PMID: 20455248]
Chartier-Otis M, Perreault M, Bélanger C. Determinants of barriers to treatment for anxiety disorders. Psychiatr Q 2010; 81(2): 127-38.
[] [PMID: 20131095]
Sareen J, Jagdeo A, Cox BJ, et al. Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands. Psychiatr Serv 2007; 58(3): 357-64.
[] [PMID: 17325109]
Coles ME, Coleman SL. Barriers to treatment seeking for anxiety disorders: initial data on the role of mental health literacy. Depress Anxiety 2010; 27(1): 63-71.
[] [PMID: 19960488]
Mojtabai R, Olfson M, Sampson NA, et al. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med 2011; 41(8): 1751-61.
[] [PMID: 21134315]
Williams MT, Domanico J, Marques L, Leblanc NJ, Turkheimer E. Barriers to treatment among African Americans with obsessive-compulsive disorder. J Anxiety Disord 2012; 26(4): 555-63.
[] [PMID: 22410094]
Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010; 10(9): 113.
[] [PMID: 21192795]
Edlund MJ, Unützer J, Curran GM. Perceived need for alcohol, drug, and mental health treatment. Soc Psychiatry Psychiatr Epidemiol 2006; 41(6): 480-7.
[] [PMID: 16565918]
Olfson M, Guardino M, Struening E, Schneier FR, Hellman F, Klein DF. Barriers to the treatment of social anxiety. Am J Psychiatry 2000; 157(4): 521-7.
[] [PMID: 10739410]
Miranda R, Soffer A, Polanco-Roman L, Wheeler A, Moore A. Mental health treatment barriers among racial/ethnic minority versus white young adults 6 months after intake at a college counseling center. J Am Coll Health 2015; 63(5): 291-8.
[] [PMID: 25692661]
Garb HN. Cognitive and social factors influencing clinical judgment in psychiatric practice. World Psychiatry 2013; 12(2): 108-10.
[] [PMID: 23737410]
Kugelmass H. “Sorry, I’m Not Accepting New Patients”: An Audit Study of Access to Mental Health Care. J Health Soc Behav 2016; 57(2): 168-83.
[] [PMID: 27251890]
Bishop SR, Lau M, Shapiro SL, et al. Mindfulness: A proposed operational definition. Clin Psychol Sci Pract 2004; 11: 230-41.
Kabat-Zinn J. Full catastrophe living: using the wisdom of your mind to face stress, pain and illness. New York: Delta 1990.
Teasdale JD, Segal Z, Williams JM. How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behav Res Ther 1995; 33(1): 25-39.
[] [PMID: 7872934]
Eberth J, Sedlmeier P. The effects of mindfulness meditation: a meta-analysis. Mindfulness 2012; 3(3): 174-89.
Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York, NY: Guilford Press 2002.
Baer RA, Carmody J, Hunsinger M. Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program. J Clin Psychol 2012; 68(7): 755-65.
[] [PMID: 22623334]
Fjorback LO, Arendt M, Ornbøl E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand 2011; 124(2): 102-19.
[] [PMID: 21534932]
Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. J Psychiatr Pract 2012; 18(4): 233-52.
[] [PMID: 22805898]
Kimbrough E, Magyari T, Langenberg P, Chesney M, Berman B. Mindfulness intervention for child abuse survivors. J Clin Psychol 2010; 66(1): 17-33.
[] [PMID: 19998425]
Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav 2014; 15(2): 197-204.
[] [PMID: 24854804]
Arch JJ, Ayers CR, Baker A, Almklov E, Dean DJ, Craske MG. Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behav Res Ther 2013; 51(4-5): 185-96.
[] [PMID: 23419887]
Goldin PR, Morrison A, Jazaieri H, Brozovich F, Heimberg R, Gross JJ. Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. J Consult Clin Psychol 2016; 84(5): 427-37.
[] [PMID: 26950097]
Vøllestad J, Nielsen MB, Nielsen GH. Mindfulness- and acceptance-based interventions for anxiety disorders: a systematic review and meta-analysis. Br J Clin Psychol 2012; 51(3): 239-60.
[] [PMID: 22803933]
Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014; 174(3): 357-68.
[] [PMID: 24395196]
Hayes-Skelton SA, Calloway A, Roemer L, Orsillo SM. Decentering as a potential common mechanism across two therapies for generalized anxiety disorder. J Consult Clin Psychol 2015; 83(2): 395-404.
[] [PMID: 25403015]
Keng S-LMA, Smoski MJP, Robins CJP, Ekblad AGP, Brantley JG. Mechanisms of change in mindfulness-based stress reduction: self-compassion and mindfulness as mediators of intervention outcomes. J Cogn Psychother 2012; 26(3): 270-80.
Bondolfi G. Mindfulness and anxiety disorders: possible developments. Constr Human Sci 2005; 10(1/2): 45-52.
Hart R, Ivtzan I, Hart D. Mind the gap in mindfulness research: a comparative account of the leading schools of thought. Rev Gen Psychol 2013; 17(4): 453-66.
Safran J, Segal ZV. Interpersonal process in cognitive therapy. Jason Aronson, Incorporated 1996.
Curtiss J, Klemanski DH, Andrews L, Ito M, Hofmann SG. The conditional process model of mindfulness and emotion regulation: An empirical test. J Affect Disord 2017; 212: 93-100.
[] [PMID: 28157552]
Delgado-Pastor LC, Ciria LF, Blanca B, Mata JL, Vera MN, Vila J. Dissociation between the cognitive and interoceptive components of mindfulness in the treatment of chronic worry. J Behav Ther Exp Psychiatry 2015; 48: 192-9.
[] [PMID: 25912677]
Lindsay EK, Creswell JD. Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT). Clin Psychol Rev 2017; 51: 48-59.
[] [PMID: 27835764]
Santorelli SF. Mindfulness-based stress reduction (MBSR): standards of practice.2014. Retrieved August 26, 2019. Available at:
Sass SM, Berenbaum H, Abrams EM. Discomfort with emotion moderates distress reduction in a brief mindfulness intervention. Int J Behav Consult Ther 2013; 7(4): 24-7.
Khoury B, Lecomte T, Fortin G, et al. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev 2013; 33(6): 763-71.
[] [PMID: 23796855]
Arch JJ, Ayers CR. Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behav Res Ther 2013; 51(8): 434-42.
[] [PMID: 23747582]
Craske MG, Barlow DH. Mastery of your anxiety and panic: therapist guide. New York: Oxford University Press 2006.
Pickert K. The mindful revolution. Soc Psychiatry & Psychiatric Epidem 2014; 43(4): 257-65.
Wahbeh H, Svalina MN, Oken BS. Group, one-on-one, or internet? Preferences for mindfulness meditation delivery format and their predictors. Open Med J 2014; 1: 66-74.
[] [PMID: 27057260]
Cavanagh K, Strauss C, Cicconi F, Griffiths N, Wyper A, Jones F. A randomised controlled trial of a brief online mindfulness-based intervention. Behav Res Ther 2013; 51(9): 573-8.
[] [PMID: 23872699]
Cavanagh K, Strauss C, Forder L, Jones F. Can mindfulness and acceptance be learnt by self-help?: a systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clin Psychol Rev 2014; 34(2): 118-29.
[] [PMID: 24487343]
van Emmerik AAP, Berings F, Lancee J. Efficacy of a mindfulness-based mobile application: a randomized waiting-list controlled trial. Mindfulness 2017; 9(1): 1-12.
[] [PMID: 29387266]
Chittaro L, Vianello A. Evaluation of a mobile mindfulness app distributed through on-line stores: A 4-week study. Int J Hum Comput Stud 2016; 86: 63-80.
Fish J, Brimson J, Lynch S. Mindfulness interventions delivered by technology without facilitator involvement: what research exists and what are the clinical outcomes? Mindfulness 2016; 7(5): 1011-23.
[] [PMID: 27642370]
Jayewardene WP, Lohrmann DK, Erbe RG, Torabi MR. Effects of preventive online mindfulness interventions on stress and mindfulness: A meta-analysis of randomized controlled trials. Prev Med Rep 2016; 5: 150-9.
[] [PMID: 28050336]
Flessner CA, Woods DW. Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behav Modif 2006; 30(6): 944-63.
[] [PMID: 17050772]
Howells A, Ivtzan I, Eiroa-orosa FJ. Putting the ‘app’ in Happiness: a randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing. J Happiness Stud 2016; 17(1): 163-85.
Editors Buddhism by the numbers: the economics of mindfulness (2019). Available at
Onken LS, Carroll KM, Shoham V, Cuthbert BN, Riddle M. Reenvisioning clinical science: unifying the discipline to improve public health. Clin Psychol Sci 2014; 2(1): 22-34.
[] [PMID: 25821658]
Dimidjian S, Segal ZV. Prospects for a clinical science of mindfulness-based intervention. Am Psychol 2015; 70(7): 593-620.
[] [PMID: 26436311]

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Article Details

Year: 2020
Published on: 05 August, 2020
Page: [60 - 67]
Pages: 8
DOI: 10.2174/2666082216666200220121648
Price: $65

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