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We examined (1) differences between controls and patients with social anxiety disorder (SAD) in emotional clarity and attention to emotions; (2) changes in emotional clarity and attention to emotions associated with cognitive-behavioral group therapy (CBGT), mindfulness-based stress reduction (MBSR), or a waitlist (WL) condition; and (3) whether emotional clarity and attention to emotions moderated changes in social anxiety across treatment. Participants were healthy controls (n = 37) and patients with SAD (n = 108) who were assigned to CBGT, MBSR, or WL in a randomized controlled trial. At pretreatment, posttreatment, and 12-month follow-up, patients with SAD completed measures of social anxiety, emotional clarity, and attention to emotions. Controls completed measures at baseline only. At pretreatment, patients with SAD had lower levels of emotional clarity than controls. Emotional clarity increased significantly among patients receiving CBGT, and changes were maintained at 12-month follow-up. Emotional clarity at posttreatment did not differ between CBGT and MBSR or between MBSR and WL. Changes in emotional clarity predicted changes in social anxiety, but emotional clarity did not moderate treatment outcome. Analyses of attention to emotions were not significant. Implications for the role of emotional clarity in the treatment of SAD are discussed.
OBJECTIVE:The goal of this study was to investigate treatment outcome and mediators of cognitive-behavioral group therapy (CBGT) versus mindfulness-based stress reduction (MBSR) versus waitlist (WL) in patients with generalized social anxiety disorder (SAD).
METHOD:
One hundred eight unmedicated patients (55.6% female; mean age = 32.7 years, SD = 8.0; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) were randomized to CBGT versus MBSR versus WL and completed assessments at baseline, posttreatment/WL, and at 1-year follow-up, including the Liebowitz Social Anxiety Scale-Self-Report (primary outcome; Liebowitz, 1987) as well as measures of treatment-related processes.
RESULTS:
Linear mixed model analysis showed that CBGT and MBSR both produced greater improvements on most measures compared with WL. Both treatments yielded similar improvements in social anxiety symptoms, cognitive reappraisal frequency and self-efficacy, cognitive distortions, mindfulness skills, attention focusing, and rumination. There were greater decreases in subtle avoidance behaviors following CBGT than MBSR. Mediation analyses revealed that increases in reappraisal frequency, mindfulness skills, attention focusing, and attention shifting, and decreases in subtle avoidance behaviors and cognitive distortions, mediated the impact of both CBGT and MBSR on social anxiety symptoms. However, increases in reappraisal self-efficacy and decreases in avoidance behaviors mediated the impact of CBGT (vs. MBSR) on social anxiety symptoms.
CONCLUSIONS:
CBGT and MBSR both appear to be efficacious for SAD. However, their effects may be a result of both shared and unique changes in underlying psychological processes.
The treatment of anxiety disorders with combined cognitive‐behavioral therapy (CBT) and pharmacological treatments has been an ongoing topic of discussion. Combined treatments have failed to demonstrate additive benefits despite their continued use in practice. Otto, McHugh, and Kantak (2010) suggest that concurrent use of medication and CBT affects the acute release of cortisol during the extinction phase of exposure therapy and, in turn, interferes with memory consolidation. This commentary expands on some of the psychological aspects of combined treatments for anxiety disorders to consider along with this new biochemical perspective.
This study examines the impact of Cognitive-Behavioral Group Therapy (CBGT) versus Mindfulness-Based Stress Reduction (MBSR) versus Waitlist (WL) on self-views in patients with social anxiety disorder (SAD). One hundred eight unmedicated patients with SAD were randomly assigned to 12 weeks of CBGT, MBSR, or WL, and completed a self-referential encoding task (SRET) that assessed self-endorsement of positive and negative self-views pre- and post-treatment. At baseline, 40 healthy controls (HCs) also completed the SRET. At baseline, patients with SAD endorsed greater negative and lesser positive self-views than HCs. Compared to baseline, patients in both CBGT and MBSR decreased negative self-views and increased positive self-views. Improvement in self-views, specifically increases in positive (but not decreases in negative) self-views, predicted CBGT- and MBSR-related decreases in social anxiety symptoms. Enhancement of positive self-views may be a shared therapeutic process for both CBGT and MBSR for SAD.
The Five Facet Mindfulness Questionnaire is a widely used measure assessing 5 aspects of mindfulness. The Describe subscale is intended to assess the ability to put one's inner experience into words for one's own understanding, but subscale items contain language that may be ambiguous in that regard. The current study investigated whether social anxiety is associated with a tendency to misinterpret Describe items as referring to describing one's experiences to others rather than oneself. Participants were randomized to receive one of 3 versions of the Describe subscale: the original version or one of two variants orienting participants to describe inner experience for self-communication or interpersonal communication. Social anxiety was negatively associated with Describe scores for the Standard Describe subscale and the interpersonal communication variant, but not for the self-communication variant. Results suggest that high levels of social anxiety are associated with misinterpretation of statements on the Describe subscale as probing for interpersonal communication.
Cognitive-Behavioral Group Therapy (CBGT) and Mindfulness-Based Stress Reduction (MBSR) are efficacious in treating social anxiety disorder (SAD). It is not yet clear, however, whether they share similar trajectories of change and underlying mechanisms in the context of SAD. This randomized controlled study of 108 unmedicated adults with generalized SAD investigated the impact of CBGT vs. MBSR on trajectories of social anxiety, cognitive reappraisal, and mindfulness during 12 weeks of treatment. CBGT and MBSR produced similar trajectories showing decreases in social anxiety and increases in reappraisal (changing the way of thinking) and mindfulness (mindful attitude). Compared to MBSR, CBGT produced greater increases in disputing anxious thoughts/feelings and reappraisal success. Compared to CBGT, MBSR produced greater acceptance of anxiety and acceptance success. Granger Causality analyses revealed that increases in weekly reappraisal and reappraisal success predicted subsequent decreases in weekly social anxiety during CBGT (but not MBSR), and that increases in weekly mindful attitude and disputing anxious thoughts/feelings predicted subsequent decreases in weekly social anxiety during MBSR (but not CBGT). This examination of temporal dynamics identified shared and distinct changes during CBGT and MBSR that both support and challenge current conceptualizations of these clinical interventions.