The Effectiveness of Mindfulness-Based Cognitive Therapy on Cognitive Emotion Regulation, Intolerance of Uncertainty and Cognitive Flexibility in People with Generalized Anxiety Disorder

Document Type : Original Article

Authors

• Kobra Ghanizadeh Balderloo ¹
• Naimeh Moheb ²
• Marziyeh Alivandi Vafa ³
• Masomeh Azemodeh ⁴

¹ Educated Ph.D. degree in Psychology, Department of Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran.

² Assistant Professor, Department of Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran

³ Assistant Professor, Islamic Azad University, Tabriz, Iran.

⁴ Assistant Professor, Department of Clinical Psychology, Faculty of Medicine, Tabriz Medical Sciences, Islamic Azad University, Tabriz, Iran

10.22067/tpccp.2025.81957.1483

Abstract

Introduction
Generalized Anxiety Disorder (GAD) is a mental health condition marked by persistent, excessive, and difficult-to-control worry over everyday events (Kamil et al., 2025). Research by Knapp et al. (2015) explored the impact of anxiety sensitivity on adolescents with GAD, revealing a strong link between heightened anxiety sensitivity, increased worry, and more severe anxiety symptoms. Meanwhile, Segal et al. (2002) introduced an innovative eight-session program designed to aid recovery from depression and reduce relapse risk. This evidence-based approach merges cognitive therapy techniques with mindfulness practices, offering clinicians effective strategies to help clients sustain treatment progress and achieve long-term remission. Mindfulness-Based Cognitive Therapy (MBCT) teaches individuals to reframe their relationship with negative thoughts, emotions, and physical sensations that contribute to depressive relapse. The method includes structured exercises to enhance awareness and prevent mild distress from escalating. This study aims to assess the efficacy of MBCT in improving cognitive emotion regulation, reducing intolerance of uncertainty, and enhancing cognitive flexibility in individuals with GAD.
Method
This study employed a semi-experimental design with a control group. The target population consisted of individuals diagnosed with GAD who sought treatment at psychiatric, psychological, and health centers in Urmia during 2022. Participants were selected based on the following criteria: (1) a confirmed GAD diagnosis through a structured clinical interview using the GAD questionnaire (Spitzer et al., 2006) and the Pennsylvania State Worry Questionnaire (Meyer et al., 1990), (2) age between 18 and 45 years, and (3) voluntary participation with informed consent. A total of 30 eligible participants were randomly assigned to either an experimental group (n=15) or a control group (n=15). The experimental group underwent an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program (Segal, Williams, & Teasdale, 2002), with each session lasting 90 minutes. The final session included a review of the program, strategies for maintaining mindfulness practices, and a discussion on sustaining progress. The intervention concluded with a guided meditation exercise (tile, stone, bead). Pre- and post-intervention assessments were conducted using standardized measures: the Cognitive Emotion Regulation Questionnaire (Garnefski, Kraaij, & Spinhoven, 2001), the Intolerance of Uncertainty Scale (Buhr & Dugas, 2002), and the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2010). Data were analyzed using SPSS version 28, with multivariate analysis of covariance (MANCOVA) applied to examine group differences.
Findings
The MANCOVA analysis revealed that MBCT significantly improved emotion regulation, intolerance of uncertainty, and cognitive flexibility in GAD patients (P < 0.01). Post-test scores in the experimental group were notably higher than both their baseline scores and those of the control group, confirming the intervention’s effectiveness. These findings demonstrate that MBCT has a statistically meaningful impact on the targeted variables, with significance maintained at both 1% and 5% levels (P < 0.01).
Discussion and Conclusion
The study demonstrated that MBCT significantly enhances cognitive emotion regulation, reduces intolerance of uncertainty, and improves psychological flexibility in individuals with GAD. These outcomes were supported by statistically meaningful pre- to post-test improvements in the experimental group compared to the control group. The results align with prior research, including studies by Nasiri et al. (2022), Dakani et al. (2021), Amiri et al. (2019), Raki & Naderi, (2019), Nasiri et al. (2015), Afshari & Hasani, (2020), and Park et al. (2020) reinforcing MBCT’s efficacy as a hybrid approach that blends cognitive restructuring with mindfulness techniques. By cultivating adaptive cognitive and behavioral patterns while mitigating maladaptive ones (Peixoto & Gondim, 2020), MBCT fosters resilience against negative thought cycles. Therapists should prioritize mindfulness-based interventions like MBCT to help patients develop focused awareness. Such training equips individuals to navigate stressful scenarios with greater mental control, reducing vulnerability to anxiety triggers. Future applications could further explore MBCT’s role in long-term anxiety management.

Keywords

• Mindfulness-based cognitive therapy
• cognitive emotion regulation
• intolerance of uncertainty
• psychological flexibility
• generalized anxiety disorder

Main Subjects

• Anxiety

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