Change in Decentering Mediates Improvement in Anxiety in Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder

Abstract

Objective We sought to examine psychological mechanisms of treatment outcomes of a mindfulness meditation intervention for Generalized Anxiety Disorder (GAD). Methods We examined mindfulness and decentering as two potential therapeutic mechanisms of action of generalized anxiety disorder (GAD) symptom reduction in patients randomized to receive either mindfulness-based stress reduction (MBSR) or an attention control class (N=38). Multiple mediation analyses were conducted using a non-parametric cross product of the coefficients approach that employs bootstrapping. Results Analyses revealed that change in decentering and change in mindfulness significantly mediated the effect of MBSR on anxiety. When both mediators were included in the model, the multiple mediation analysis revealed a significant indirect effect through increases in decentering, but not mindfulness. Furthermore, the direct effect of MBSR on decrease in anxiety was not significant, suggesting that decentering fully mediated the relationship. Results also suggested that MBSR reduces worry through an increase in mindfulness, specifically by increases in awareness and nonreactivity. Conclusions Improvements in GAD symptoms resulting from MBSR are in part explained by increased levels of decentering.

Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial.

“…Although enhancement of mindfulness skills during CBT may be, at first glance, surprising, this is not a novel finding. Changes in mindfulness have been found to be a mediator of MBSR and MBCT across clinical samples (Gu et al, 2015), and specifically in patients with generalized anxiety disorder (Hoge et al, 2015). …”

Mindfulness Interventions

“…Decentering processes holds promise as a mechanism of mindfulness intervention effects in some studies. For example, an early study showed that MBCT improved meta-cognitive awareness in recovered depressed patients (Teasdale et al 2002), and more recently, two well-controlled studies showed that self-reported increases in decentering mediated MBSR treatment effects on anxiety reduction in generalized anxiety disorder patients (Hoge et al 2014) and MBCT decreases in depressive symptoms among individuals at risk for depression relapse (Bieling et al 2012).…”

Reconstructing and deconstructing the self: cognitive mechanisms in meditation practice

“…Clinical studies have shown that a diminished ability to step back and observe one's internal processes of thinking and feeling plays an important role in a variety of psychiatric conditions, including depression [39] and anxiety [40]. In one recent study, authors found that decreases in psychological processes related to experiential fusion were found in patients undergoing treatment for depression who received training in mindfulness-based cognitive therapy but not in control groups, and that these changes were associated with positive changes in depressive symptomology [41].…”