The intervention effect and follow-up of mindfulness cognitive therapy on college students' social anxiety

Abstract Background College students with social anxiety often exhibit negative self-evaluation, social avoidance, and excessive self-focus, which significantly impair their social functioning and academic performance in classroom presentations, interviews, and interpersonal interactions. Although cognitive behavioral interventions and group counseling are widely used, some individuals still experience residual tension, persistent rumination, and heightened sensitivity to physiological arousal, indicating the need to explore more effective intervention approaches that improve emotional processing patterns and reduce self-focused biases. Mindfulness-based cognitive therapy (MBCT), through mindfulness practices and cognitive decentering training, may reduce reactivity to internal experiences and enhance emotional regulation flexibility. However, randomized controlled trials and follow-up evidence for MBCT in college students with social anxiety remain insufficient, and key psychological mechanisms lack longitudinal validation. To address this, the study employs randomized grouping and multi-timewide measurements to compare intervention effects and examine the predictive value of mechanism indicators on symptom trajectories, aiming to evaluate the sustained intervention value of MBCT for college students with social anxiety. Methods The study enrolled 318 college students for baseline assessment, with 240 participants meeting social anxiety screening criteria randomized into intervention groups. A control group of 78 low-anxiety students served as baseline reference. Participants were randomly assigned to one of three 8-week interventions: (1) Mindfulness-Cognitive Therapy (n = 80), (2) Group Cognitive Behavioral Intervention (n = 78), or (3) Waiting List Control (n = 82). Key outcomes included Social Anxiety Symptom Scale scores, negative self-focus and rumination levels, emotion regulation strategies, and mindfulness awareness. Results Experimental results demonstrated that compared to the traditional cognitive behavioral intervention group and waiting control group, the mindfulness cognitive therapy group showed significant reduction in social anxiety symptoms at the end of intervention (p.001, d = 0.52), with the improvement remaining stable during follow-up (p=.004). In terms of psychological mechanism indicators, the mindfulness awareness level in the mindfulness cognitive therapy group increased significantly (p=.002, d = 0.48), while negative self-focus decreased markedly (p=.009, d = 0.41), and emotional reactivity also showed a significant downward trend. Physiological indicators revealed that the heart rate variability in the mindfulness cognitive therapy group during social situational tasks increased significantly (p=.01, d = 0.39), indicating improved autonomic nervous system regulation. Further analysis showed that both the elevated mindfulness awareness (p=.02) and reduced negative self-focus (p=.03) could predict lower social anxiety symptom levels during follow-up, and were associated with reduced risk of symptom relapse. Discussion The findings demonstrate that mindfulness-based cognitive therapy (MBCT) significantly alleviates social anxiety in college students, with sustained improvements observed during follow-up periods. Its efficacy matches or surpasses that of group cognitive behavioral interventions. The core psychological and physiological mechanisms underlying its effects may include enhanced mindfulness awareness, reduced rumination and negative self-focus, and diminished arousal responses in stressful situations. This study suggests MBCT serves as an effective group intervention for social anxiety in higher education, providing a scalable alternative to conventional psychological services. Future research should compare different training intensities and digital implementation approaches, while identifying subgroups more responsive to mindfulness interventions to enhance targeted effectiveness.