Efficacy and mechanisms of internet-delivered mindfulness-based cognitive therapy for Adjustment Disorder: A randomized controlled trial.
Paweł Holas, Jan Wardęszkiewicz, Malgorzata Grochowska, Stefan G Hofmann
Journal of Anxiety Disorders July 1, 2026 DOI: 10.1016/j.janxdis.2026.103173 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 301 |
| Population | Adults meeting ICD-11 criteria for Adjustment Disorder during the COVID-19 pandemic |
| Interventions | internet-delivered Mindfulness-Based Cognitive Therapy internet-delivered progressive muscle relaxation |
| Duration | 4-week intervention, 1-month follow-up |
| Topics | Meditation |
| Keywords | Adjustment disorder Covid-19 pandemic Cognitive defusion Internet-delivered intervention Mindfulness-based cognitive therapy Self-compassion |
| Key findings | iMBCT produced greater reductions in Adjustment Disorder symptoms than waitlist control and higher remission rates, and compared with iPMR yielded larger decreases in depression and anxiety. |
Abstract
Adjustment Disorder (AjD) is a common stress-related condition, yet evidence-based interventions remain scarce. Mindfulness-Based Cognitive Therapy (MBCT) targets transdiagnostic mechanisms such as cognitive fusion and low self-compassion, which may be particularly relevant for AjD. This randomized controlled trial tested the efficacy of a brief, guided, asynchronous internet-delivered MBCT (iMBCT) for AjD during the COVID-19 pandemic, compared with internet-delivered progressive muscle relaxation (iPMR) and a waitlist control (WLC). Adults meeting ICD-11 criteria for AjD (N = 301) were randomized to iMBCT, iPMR, or WLC for four weeks. Primary outcomes were changes in AjD symptoms (ADNM-20) and remission rates. Secondary outcomes were changes in depression, anxiety, cognitive fusion, experiential avoidance, and self-compassion. Outcomes were assessed at baseline, post-intervention, and one-month follow-up. Mediation analyses tested cognitive defusion and self-compassion as mechanisms. iMBCT produced greater reductions in AjD symptoms than WLC (η² =.17) and higher remission rates. Compared with iPMR, iMBCT yielded larger decreases in depression and anxiety. Cognitive defusion fully mediated iMBCT effects on depression and anxiety. Some improvements were maintained at follow-up; however, findings were mixed and should be interpreted cautiously due to substantial attrition. A brief, minimally guided, asynchronous iMBCT is an effective and scalable intervention for AjD that targets cognitive and self-regulatory mechanisms. Findings support the use of online mindfulness-based programs for stress-related disorders during large-scale crises.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cites 19
- Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse JAMA Psychiatry April 28, 2016
- Treatment-specific changes in decentering following mindfulness-based cognitive therapy versus antidepressant medication or placebo for prevention of depressive relapse. Journal of Consulting and Clinical Psychology March 12, 2012
- Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis Cognitive Behaviour Therapy February 8, 2019
- Intensive mindfulness training-related changes in cognitive and emotional experience The Journal of Positive Psychology May 1, 2009
- Mindfulness to improve the mental health of university students. A systematic review and meta-analysis. Frontiers in Public Health 2023
and 14 more in the library