Can cognitive behavioral additions improve the efficacy of self-help mindfulness intervention for depression and anxiety ?: A randomized controlled trial.
Ying Huang, Z. Chong, Zenan Dou, Hoyin Lo, Sisi Wang, Wei Xu
Behaviour Research and Therapy March 15, 2026 DOI: 10.1016/j.brat.2026.105020 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 335 |
| Population | University students from various institutions across China experiencing moderate to severe emotional distress |
| Interventions | Self-help mindfulness intervention (sMBI) Combined mindfulness and cognitive behavioral therapy intervention (sMBI + CBT) Waitlist control |
| Duration | 60-day intervention, with follow-ups at three and six months |
| Topics | Anxiety Depression Meditation |
| Key findings | Both sMBI and sMBI + CBT significantly reduced depression and anxiety compared to waitlist, with no significant difference between the two interventions. The sMBI effect was sequentially mediated by mindfulness and psychological flexibility, while sMBI + CBT was mediated by mindfulness and reduced irrational beliefs. |
Abstract
Objectives: This study evaluated the comparative efficacy of a self-help mindfulness intervention (sMBI) and a combined mindfulness and cognitive behavioral therapy intervention (sMBI + CBT) in reducing symptoms of depression and anxiety. Additionally, it explored the mechanisms underlying these interventions.
Methods: In this randomized controlled trial (RCT), 335 university students from various institutions across China, all experiencing moderate to severe emotional distress, were randomly assigned to one of three groups: sMBI, sMBI + CBT, or a waitlist control group (WL). Interventions were delivered via an internet-based website over a 60-day period, with assessments conducted at baseline, during treatment, post-treatment, and at three-month and six-month follow-ups. An intention-to-treat (ITT) analysis using multilevel mixed-effects models was employed to estimate the effects of the interventions.
Results: Both sMBI and sMBI + CBT were significantly more effective than WL in reducing symptoms of depression and anxiety. However, no significant differences were observed between sMBI and sMBI + CBT in their impact on depression and anxiety. The effects of sMBI on depression and anxiety were sequentially mediated by increases in mindfulness and psychological flexibility. In contrast, the effects of sMBI + CBT were sequentially mediated by increases in mindfulness and reductions in irrational beliefs.
Conclusions: This RCT confirms the efficacy of sMBI in reducing depression and anxiety through improvements in mindfulness and psychological flexibility. It also supports the efficacy of sMBI + CBT in alleviating depression by enhancing mindfulness and correcting irrational beliefs. However, the addition of CBT to sMBI does not appear to provide additional benefits in the treatment of depression and anxiety.
Trial Registration: Chictr.org Identifier: ChiCTR2300075928.https://www.chictr.org.cn/showproj.html?proj=207327.
Comparable studies
Other randomized controlled trials on anxiety, most cited first.
Citations in the library
Cites 22
- Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse JAMA Psychiatry April 28, 2016
- Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes Behaviour Research and Therapy May 10, 2017
- A Qualitative Study with Healthcare Staff Exploring the Facilitators and Barriers to Engaging in a Self-Help Mindfulness-Based Intervention Mindfulness May 25, 2017
- Does self-report mindfulness mediate the effect of Mindfulness-Based Stress Reduction (MBSR) on spirituality and posttraumatic growth in cancer patients? The Journal of Positive Psychology June 30, 2014
- Mindfulness-enhanced internet-based cognitive behavioural therapy for anxiety and depression: Outcomes in routine care. Journal of Affective Disorders August 23, 2023
and 17 more in the library