Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders.
Luise Pruessner, Christina Timm, Julia Kalmar, Hinrich Bents, Sven Barnow, Johannes Mander
Depression and Anxiety 2024 DOI: 10.1155/2024/9081139 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Longitudinal mediation study Peer reviewed |
|---|---|
| Sample size | 162 |
| Population | Patients with depression and anxiety disorders |
| Interventions | brief mindfulness intervention progressive muscle relaxation |
| Duration | 25 sessions (baseline, session 5, session 15, session 25) |
| Topics | Anxiety Depression Meditation |
| Citations | 22 |
| Key findings | Decreases in rumination and increases in reappraisal and acceptance mediated the relationship between mindfulness and reductions in depressive symptoms, while reductions in avoidance mediated the relationship between mindfulness and changes in anxiety symptoms. |
Abstract
The global prevalence of depression and anxiety disorders underscores the need for a more profound comprehension of effective treatments. Mindfulness has shown promise in enhancing treatment outcomes and preventing relapse in these conditions, but the underlying mechanisms remain poorly understood. This study examined the role of emotion regulation as a mediator in the relationship between changes in mindfulness and the reduction of depression and anxiety symptoms during individual cognitive-behavioral therapy (CBT). We tracked longitudinal changes in mindfulness, emotion regulation, depression, and anxiety at baseline (pre), early treatment (session 5), midtreatment (session 15), and posttreatment (session 25) in 162 patients with depression and anxiety disorders. Further, we examined whether the effects of mindfulness on emotion regulation could be enhanced by introducing a brief mindfulness intervention at the beginning of each CBT session, as compared to progressive muscle relaxation and individual psychotherapy without any standardized session-introducing interventions. Multilevel structural equation modeling indicated that decreases in rumination and increases in reappraisal and acceptance mediated the relationship between mindfulness and reductions in depressive symptoms. In contrast, reductions in avoidance explained the association between mindfulness and changes in anxiety symptoms. These links remained unchanged when adding a mindfulness intervention into individual CBT. Results support emotion regulatory properties of mindfulness and highlight distinct pathways of symptom reduction in depression and anxiety. These findings have important implications for understanding the mechanisms of mindfulness and tailoring treatment to individual patient needs. This trial is registered with NTC02270073.
Comparable studies
Other observational and cohort studies on anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders Patients with generalized anxiety disorder or panic disorder with or without agoraphobia | 1992 | Observational cohort | n = 22 |
| Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report Patients with a depressive disorder | 2015 | Observational study | |
| Patterning of Cognitive and Somatic Processes in the Self-Regulation of Anxiety: Effects of Meditation versus Exercise Regular practitioners of physical exercise or meditation | 1978 | Retrospective study | n = 77 |
| Dynamic coupling of whole-brain neuronal and neurotransmitter systems Healthy humans | 2020 | Observational study | |
| Psychedelics not linked to mental health problems or suicidal behavior: A population study Randomly selected United States adults | 2015 | Observational cohort | n = 135,095 |
Citations in the library
Cited by 10
- Rumination and alexithymia serially mediate the relationship between mindfulness and anxiety symptoms in Chinese university students. Scientific Reports July 16, 2025
- Reinterpretation of Logotherapy’s Dimensional Ontology via Embodied Phenomenology Journal of Humanistic Psychology September 24, 2026
- Vipassanā Meditation in Contemporary Psychiatry: Transformation of a Buddhist Practice into a Mental Health Intervention Kamali: Jurnal Ilmu Agama June 26, 2026
- The relationship between trait mindfulness and problematic smartphone use: the serial mediation role of difficulties with emotion regulation and fear of missing out. Psychology, Health & Medicine September 8, 2026
- From Buddhist meditation to psychological well-being: an ethical-cultural training ecology model Frontiers in Psychology September 3, 2026
and 5 more in the library
Cites 33
- Mindfulness: A proposed operational definition. Clinical Psychology Science and Practice 2004
- Assessment of Mindfulness by Self-Report Assessment September 1, 2004
- Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse JAMA Psychiatry April 28, 2016
- Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress Complementary health practice review April 1, 2008
- Prospects for a clinical science of mindfulness-based intervention. American Psychologist October 1, 2015
and 28 more in the library