Running Head: Mindfulness and Anxiety

EDPS651ResearchPaper:AnxietyandtheEfficacyofMindfulness
ChristinaMajcher
UniversityofCalgary
7November2012

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Be happy in the moment, that's enough. Each moment is all we need, not more.
Mother Theresa
One of lifes greatest challenges is living in the moment, staying connected to the present
without lamenting the past or stressing about the future. In our increasingly fragmented and busy
society, adults are multi-tasking and dividing their attention between thoughts of bills, work,
home and family. Children have days filled with active classrooms, play dates, after school
activities, gadgets, gizmos and other attention-seeking devices. Many children are coming to
school highly anxious and unable to function. How does this constant state of distraction and
inability to be anchored to the present affect us as a society? What about an adult or child with
an anxiety disorder, who has an even harder time living in the present?
This paper will review current literature and empirical based studies on adult and
childhood anxiety, explore the concept of mindfulness and the efficacy of mindfulness-based
therapy to help reduce symptoms of anxiety. In addition, the paper will examine the benefits of
implementing mindfulness training in education practices to help promote holistic learning and a
mind-body-spirit awareness to help children reconnect to their world.
Anxiety disorders are the most common psychiatric disorders affecting children and
youth (Albano, Chorpita & Barlow 2003). Every classroom has children with varying degrees of
anxiety. Many of these children manage anxieties with minimal support. However, some
children suffer in silence with anxiety that often goes undetected and unnoticed (Albano et al.,
2003). Without intervention and support, children are often trapped in a cycle that can lead to
greater risk and likelihood of comorbid disorders, particularly depression and substance abuse
(Albano et al., 2003; Campbell, 2003; Roemer, Orsillo & Salters-Pedneault, 2008). Research
conducted over the last 20 years has proven that prognosis for individuals who receive treatment

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for anxiety is significantly better than those who are left untreated (Albano et al., 2003;
Campbell, 2003; Hoffmann, Sawyer, Witt & Oh, 2010). There are many interventions available
to help improve a persons ability to function and find success in life.
Current intervention strategies used to treat anxiety disorders include exposure,
pharmacological support, play therapy, psychodynamic or family therapy and a wide variety of
cognitive behaviour therapy programs (Campbell, 2003; Evans, Ferrando, Findler, Stowell &
Haglin, 2008). Over the past couple of decades these approaches have been widely researched to
explore their benefits and impact on reducing anxiety (Roemer et al., 2009). Cognitive
behavioural treatments have demonstrated efficacy, but research has shown that many
individuals struggle with residual symptoms (Evans et al., 2008; Roemer, Lee, Salters-Pedneault,
Erisman, Orsillo & Mennin, 2009). Evans and his colleagues (2008) state that generalized
anxiety disorders are the least successfully treated anxiety disorder. Although cognitive
behaviour therapy (CBT) continues to be the most common form of intervention to treat anxiety,
the concept of mindfulness-based stress reduction has come to the forefront in recent years. This
is because some researchers believe that cognitive behaviour therapy does not address the
psychological processing difficulties of emotional regulation and mindfulness that are typical
symptoms associated with generalized anxiety disorder (Roemer et al., 2009).
An increasing body of research has begun exploring the underlying psychological skills
that may be targeted with mindfulness training (Troy, Shallcross, Davis & Mauss, 2012). One of
these skills is emotional regulation and in particular the ability to change how one thinks about
an emotional stimulus in order to change its emotional impact (Troy et al., 2012, para. 2).
Individuals with generalized anxiety disorders often report significantly lower levels of
mindfulness and significantly higher levels of difficulties regulating their emotions (Roemer, et

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al., 2009).
Mindfulness, synonymous with awareness, is the basic human capacity for non-judging,
present-moment and fully centered awareness (Evans et al., 2008; Miller, Fletcher & KabbatZinn, 1995). This technique, rooted in Buddhist tradition and eastern meditation, is learned
through meditative practices and self-awareness exercises. (Hooker & Foder, 2008; Miller et al.,
1995; Troy et al., 2012). Mindfulness training attempts to promote a state of acceptance as well
as an ability to distinguish negative thoughts and emotions by recognizing these thoughts and
emotions as passing events as opposed to a permanent reality (Miller et al., 1995; Troy et al.,
2012).
The intent of mindfulness training is to teach a person to pay attention on purpose,
through an active process that involves attention that leads to awareness (Hooker & Foder,
2008). It encourages a person to regard their current external environment and internal
experiences to observe these experiences, accept them and let them go to attend to another
present moment experience (Hooker & Foder, 2008). This increased attention to the present
moment also helps an individual think of multiple ways to reappraise a current situation
successfully, thus helping to break the habitual cycle of worry (Roemer & Orsillo, 2007; Troy et
al., 2012). Although at first glance it appears that there are similarities between CBT and
mindfulness training, they are very different forms of intervention.
Both cognitive behaviour training and mindfulness-based training are used to help
increase an individuals awareness to look at their current situation. However, these therapies
have different end goals. Cognitive behaviour therapy focuses on changing negative thoughts to
break the link that exists between negative thoughts, negative emotions and the resulting
behaviour (Roemer & Orsillo, 2007; Roemer et al., 2008; Troy et al., 2012). Individuals are

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encouraged to determine if their thoughts are logical and then to generate a new, helpful thought
to then change their behaviour (Troy et al., 2012). The goal of mindfulness training is that
acceptance may help an individual switch their attention and thereby reorient towards positive
reinterpretations (Troy et al., 2012, para. 3). Cognitive behaviour therapy requires an individual
to focus on and control negative thoughts and feelings. Conversely, mindfulness encourages an
individual to increase their awareness of all thoughts and feelings, bodily sensation and an
awareness of the external environment in the present moment (Hoffmann et al., 2010; Roemer &
Orsillo, 2007; Troy et al., 2012). Many studies have examined the efficacy of a combination of
these interventions to help reduce symptoms of anxiety and depression.
It is important to note that there are many psychotherapeutic techniques based on
mindfulness such as mindfulness-based stress reduction, dialectical behaviour therapy,
acceptance and commitment therapy, and mindfulness-based cognitive therapy (Kim et al., 2009;
Miller et al., 1995). Due to the scope of this paper, the efficacy of each aforementioned therapy
will not be examined individually. However, they will all be included to examine the efficacy of
mindfulness-based therapies on anxiety symptoms.
A study conducted by Roemer and Orsillo (2007) used an open trial of acceptance based
behaviour therapy for individuals with generalized anxiety disorder (GAD). Sixteen participants
with GAD were encouraged to practice mindfulness with planned exercises as well as informally
every day (Roemer & Orsillo, 2007). The treatment plan was based on a program using aspects
of cognitive behaviour therapy, acceptance and commitment therapy, mindfulness based
cognitive therapy and dialectical behaviour therapy (Roemer & Orsillo, 2007). When assessed at
the end of the study, clients demonstrated a significant improvement in worry, anxiety and
depressive symptoms (Roemer & Orsillo, 2007). Clients also reported improved quality of life

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of a large magnitude (Roemer & Orsillo, 2007). Finally, the results indicated decreased feelings
of fear and avoidance of external experiences (Roemer & Orsillo, 2007). The researchers
(Roemer & Orsillo, 2007) stated, this novel treatment seems to be targeting the phenomena at
which it is directed, with corresponding improvements in symptoms and quality of life (p. 81).
The significant reduction in GAD symptoms continued following a three-month follow- up.
Results of this study demonstrated a need for more research to determine the efficacy of this
approach to treating individuals with GAD. However, these results did illustrate the benefits of
mindfulness practice as a part of an acceptance based therapeutic program.
A similar study conducted by a team of researchers examined the effects of mindfulnessbased cognitive therapy to treat generalized anxiety disorders (Evans et al., 2008). Eleven
subjects participated in an eight-week intensive program based on the work of Jon Kabatt-Zann
and his colleagues (Evans et al., 2008). The focus of these two-hour group meetings was on
mindfulness training through body-scan meditation, sitting meditation, hatha yoga, and other
mindfulness practices (Evans et al., 2008). Measures of anxiety, worry, depressive symptoms,
mood states and mindful awareness were collected at the beginning of the study to determine a
baseline as well as at the end of treatment (Evans et al., 2008). The results of this study
demonstrated significant reductions in anxiety and depressive symptoms from the baseline to the
end of treatment (Evans et al., 2008). Although this is a promising result indicating that a
mindfulness-based approach is a potentially feasible and acceptable treatment for individuals
with GAD, the researchers also cautioned over interpreting the results based on the study being
small, non-randomized and a cross-sectional trial (Evans et al., 2008). As with the previous
study, researchers encouraged future, randomized clinical trials to further examine the efficacy of
mindfulness-based training for individuals with GAD (Evans et al., 2008).

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Lee and her colleagues (2009) were interested in examining whether mindfulness-based
cognitive therapy was more effective than control therapy for individuals with anxiety disorders
already receiving treatment through pharmacotherapy. Forty-six clients were assigned to either
an eight week mindfulness-based cognitive therapy program or anxiety disorders education (Lee
et al., 2009). A baseline of anxiety and depressive symptoms was collected at the beginning of
the study as well as at the two, four and eight week mark (Lee et al., 2009). The results indicated
significantly more improvement with the mindfulness-based cognitive therapy group than the
anxiety disorders education group (Lee et al., 2009). Although Lee (2009) and her fellow
researchers felt the results of the study indicated the efficacy of mindfulness-based cognitive
therapy to treat anxiety and depressive symptoms, they stressed the need for well-designed,
randomized controlled trials. The results of these and similar studies led other researchers to
examine the benefits of using reflective mindfulness practices with children. However, it is
important to note that the vast majority of research conducted has been with adults (Albano et al.,
2003). Consequently, less is known in terms of the effects of mindfulness training with children
suffering with anxiety disorders.
Semple (2005) conducted one of the initial studies exploring mindfulness training to aid
children with anxiety management and academic performance. When examining the impact of
anxiety, Semple and her colleagues (2009) noted that is difficult to exclude the interactions
between anxiety, impaired attention and academic challenges. Her research involved a six-week
study to examine the feasibility, acceptability and helpfulness of teaching mindfulness to help
reduce anxiety in children. Results of this noteworthy study concluded that mindfulness-based
techniques do alleviate symptoms of attention and anxiety and can be effectively taught to
children as young as seven years old (Semple, 2005).

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Semple later teamed up with Lee, Rosa and Miller (2009) to conduct a randomized trial
of mindfulness-based cognitive therapy for children to determine its effects on promoting
mindful attention to enhance social-emotional resiliency in children. Twenty-five boys and girls
participated in a randomized control trial (Semple et al., 2009). Symptoms of anxiety were
collected using the Child Behaviour Checklist, State-Trait Anxiety Inventory for Children, and
Multidimensional Anxiety Scale at the beginning of the study, after the intervention and at a
three month follow up session (Semple et al., 2009). The results of the study indicated that
participants who completed the mindfulness-based cognitive therapy program showed fewer
attention problems than the control group and that these improvements were maintained three
months following the intervention (Semple et al., 2009). In addition, children who reported
elevated levels of anxiety at pretest reported a significant reduction in anxiety symptoms and
behaviour problems (Semple et al., 2009). This study further identified mindfulness cognitive
behaviour therapy as an effective intervention to help reduce anxiety.
Although using mindfulness-based approaches with children and adolescents is still a
developing field, current evidence suggests that this approach is acceptable and feasible
(Meiklejohn et al., 2012; Schonert-Reichel & Lawlor, 2010). To date, much of the research
stems from a clinical perspective, mirroring trends with adults (Meikeljohn et al., 2012). School
counselors and school psychologists are becoming increasingly aware of mindfulness training to
be used as an alternative intervention or compliment to existing intervention strategies used to
support anxiety in children. As noted by Meikeljohn and his colleagues (2012), there is
enormous potential for the universal applicability of mindfulness in the K-12 education setting to
enhance students capacities in self-regulation of attention and emotions, and buffer the
developing brain from the deleterious effects of excessive stress (Rationale for Offering

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Mindfulness Training to K-12 Students, para. 1). These constant interruptions in todays world
not only affect a childs attention span, but also increase a childs level of anxiety and stress,
thereby affecting their spiritual growth and development (Lau, 2009).
Schonert-Reichl and Stewart Lawlor (2010) examined the effects of a mindfulness-based
education program on pre and early adolescents well-being and social emotional competence.
Their study evaluated the effectiveness of a teacher taught preventative intervention program
using daily mindful attention training exercises to help promote the development of social and
emotional competence and positive emotions (Schonert-Reichel & Lawlor, 2010). Children in
six classrooms from grades four to seven participated in the training and results were compared
to students in six classrooms who did not receive any mindfulness-based training (SchonertReichel & Lawlor, 2010). The children completed pre and post test self reports assessing
optimism, general and school self-concept, and positive and negative affect (Schonert-Reichel &
Lawlor, 2010). In addition, teachers rated the adolescents on their classroom social and
emotional competence (Schonert-Reichel & Lawlor, 2010). Results indicated significant
increases in optimism and self-concept from the self-reporting pre test to post test for students
who received the mindfulness training (Schonert-Reichel & Lawlor, 2010). Similarly, teachers
rated the children who completed the training higher with social competent behaviours
(Schonert-Reichel & Lawlor, 2010). Interestingly, Schonert-Reichler and Lawlor (2010)
indicated that the preadolescents involved in the study showed a higher level of benefit than the
early adolescents. Teachers provided positive feedback in regards to the program noting the ease
of implementation and ability to integrate the mindful attention exercises into their classroom.
Mindfulness can be integrated into the classroom indirectly with the teacher developing
his or her own personal mindfulness practice to help foster mindful attitudes and behaviours

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throughout the day, directly by using programs to teach students mindfulness exercises and skills
or a combination of these approaches (Meiklejohn et al., 2012). One of these interventions,
known as CARE aims to improve teacher well-being, improve teacher effectiveness with support
to students, improve teacher-student relationships and classroom climate and to increase
students prosocial behaviour (Meiklejohn et al., 2012). Preliminary studies of this program are
showing promising results in terms of teacher well-being, as well as reports of teachers
improving their abilities to manage classrooms and maintain supportive relationships with
students (Meikeljohn et al., 2012).
A separate program modeled upon mindfulness-based stress reduction referred to as
Stress Management and Relaxation Techniques in Education (SMART) is receiving increasing
attention, particularly as it is currently being piloted in Vancouver, British Columbia (Meikeljohn
et al., 2012). This program for K-12 teachers and educators includes curriculum to support
concentration, attention and mindfulness, increase awareness and understanding of emotions and
empathy and compassion training (Meikeljohn et al., 2012). Individuals are expected to
participate for 10-30 minutes of daily meditation practice (Meikeljohn et al., 2012). Preliminary
reports are indicating that teachers feel that the program has positively influenced interactions
with students and co-workers, as well as increased mindfulness, decreased occupational stress
and increased work motivation (Meikeljohn et al., 2012). The results of these studies prove the
importance of integrating mindfulness training into the K-12 education system to help foster the
resilience of teachers and students.
Agreatdealofresearchovertheyearshasexaminedtheeffectofstressonchildren
throughbothgeneticandenvironmentalfactors.Wenowknowthatexcessivestressdamages
developingbrainsaswellasimpactsachildsabilitytolearn.Childrenarecomingtoschool

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11

withincreasingamountsofstressyetwithalackofcopingstrategiestohelpreducetheir
anxieties.Itisclearfromallofthestudiesexaminedinthispaperthatmindfulnesshelpsreduce
symptomsofanxiety.Mindfulnesshasearneditsrighttobeconsideredausefulandbeneficial
approachwithadultsandchildren.Asaresultofthispaper,Iwillbeimplementingmindfulness
trainingtohelpfosteradeepersenseofself,improveemotionalregulationandtoaidwithmy
ownandmystudentsoverallwellbeing.

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References

Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood Anxiety Disorders. In
Barkley, R. A. & Mash, E. J. Editor (Eds.)., Child psychopathology, 2nd edition, 279-329.
New York: Guilford Press.
Campbell, M. A. (2003). Prevention and intervention for anxiety disorders
in children and adolescents: A whole school approach. Australian Journal of
Guidance and Counselling, 13(1), 47-62.
Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D. (2008). Mindfulnessbased cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders,
22 (4), 716-721.
Hoffman, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness based
therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and
Clinical Psychology, 78 (2), 169- 183.
Hooker, K. E., & Fodder, I., E. (2008). Teaching mindfulness to children. Gestalt Review, 12
(1), 75-91.
Kim, Y. W., Lee, S. H., Choi, T. K., Suh, S. Y., Kim, B., Kim, C. M.,Yook, K. H. (2009).
Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy
in patients with panic disorder or generalized anxiety disorder. Depression and Anxiety,
26, 601-606.
Lau, N. (2009). Cultivation of mindfulness: Promoting holistic learning and wellbeing in
education. In M. Souza, L. Francis, J. O Higgins-Norman, & D. Scott Editor (Eds.),
International Handbook of Education for Spirituality, Care and Wellbeing (715-737).
Netherlands: Springer

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13

Meiklejohn, J., Phillips, C., Freedman, M., Griffin, M., Biegel, G., Roach, A., Jenny, F.,
.Saltzman, A. (2012). Integrating mindfulness training into K-12 education: Fostering
the resilience of teachers and students. Mindfulness, 1-17. DOI: 10.1007/s12671-0120094-5
Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical
implications of a mindfulness meditation-based stress reduction intervention in the
treatment of anxiety disorders. Hospital Psychiatry, 17, 192-200.
Roemner, L., & Orsillo, S., M. (2007). An open trial of an acceptance-based behavior therapy
for generalized anxiety disorder. Behavior Therapy, 38, 72-85.
Roemner, L., Orsillo, S.M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based
behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled
trial. Journal of Consulting and Clinical Psychology, 76 (6), 1083-1089.
Roemner, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S.
(2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder:
Preliminary evidence for independent and overlapping contributions. Behavior Therapy,
40, 142-154.
Schonert- Reichl, K. A., & Stewart Lawlor, M. (2010). The effects of a mindfulness-based
education program on pre- and early adolescents well-being and social emotional
competence. Mindfulness
Semple, R. J. (2005). Mindfulness-based cognitive therapy for children: A randomized group
psychotherapy trial developed to enhance attention and reduce anxiety (Doctoral
dissertation). Retrieved from ProQuest Dissertations and Theses database (UMI No.
305007863).

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Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2009). A randomized trial of mindfulness-based
cognitive therapy for children: Promoting mindful attention to enhance social-emotional
resiliency in children. Journal of Child and Family Studies, 19, 218- 229. DOI
10.1007/s10826-009-9301-y
Troy, A., Shallcross, A., Davis, T., & Mauss, I. B. (2012). History of mindfulness based cognitive
therapy is associated with increased cognitive reappraisal abilities. Mindfulness 1-10.
DOI 10.1007/s12671-012-0114-5