Mindfulness-based therapy

At a glance

Compared with waiting

Better than no treatment. When 11 trials were combined, the difference was large.

Compared with other treatments

A little less effective than CBT. In one US trial of 108 people, a mindfulness course and group CBT gave similar symptom changes.

Does it last

Some benefit was still there at 12 months, but it was small.

What it takes

Usually a group course over several weeks, with home practice. Many courses are not made for social anxiety.

What it is

Mindfulness means paying attention to what is happening right now, on purpose, without judging it. In a mindfulness course you practise this through breathing exercises, body scans and gentle movement.

The best-known course is mindfulness-based stress reduction (MBSR). It is a course of weekly group sessions plus home practice. It was made for stress in general, not for social anxiety.

For social anxiety, the idea is that mindfulness can help you:

• Notice anxious thoughts without getting caught up in them.
• Move attention away from yourself. In social anxiety, attention tends to turn inward, onto your face, voice and hands. What keeps social anxiety going explains why that matters.
• Replay conversations less. Mindfulness trains you to come back to the present instead of going over the past.

What the evidence shows

• It helps more than no treatment. A study that combined 11 trials found a large difference between mindfulness and no treatment.
• It does a little less well than CBT. In the same study, mindfulness did slightly worse than CBT. Across all comparisons, including other active treatments, it showed no extra benefit.
• One good trial came out close to group CBT. In a US trial of 108 people, an MBSR course and group CBT both beat waiting, with similar changes in symptoms. Group CBT reduced subtle avoidance more. Subtle avoidance means small ways of hiding, like not making eye contact.
• CBT tops the big comparison. In the study that combined 101 trials, individual CBT made for social anxiety had the largest effect of any treatment.
• Longer courses seemed to help more, and some benefit was still there at 12 months, though small, in the combined study.

Why it is not rated higher

The UK guideline (NICE) does not recommend mindfulness as a routine treatment for social anxiety. The trials show it helps, but CBT made for social anxiety helps more.

What the trials have not answered

• Whether a mindfulness course made for social anxiety works better than a general stress course.
• Whether it works as well as cognitive therapy made for social anxiety. No trial has compared them directly.

How to try it

• As an extra, not instead of treatment. Mindfulness can sit well alongside CBT, or help with stress in general.
• Look for a course with real practice in it. Learning to sit calmly is useful. Facing the situations you avoid is what changes social anxiety.
• Group courses can be a gentle step. Mindfulness groups often involve little talking. For some people, simply going is a first exposure.

If you want a therapy that uses mindfulness and also asks you to act on what matters to you, see acceptance and commitment therapy.