Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial.

Abstract

Objective To investigate treatment outcome and mediators of Cognitive-Behavioral Group Therapy (CBGT) vs. Mindfulness-Based Stress Reduction (MBSR) vs. Waitlist (WL) in patients with generalized social anxiety disorder (SAD). Method 108 unmedicated patients (55.6% female; mean age = 32.7, SD = 8.0; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) were randomized to CBGT vs. MBSR vs. WL and completed assessments at baseline, post-treatment/WL, and at 1-year follow-up, including the Liebowitz Social Anxiety Scale – Self-Report (primary outcome) 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 to 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.

Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder

“…Such an interpretation is in alignment with mindfulness-to-meaning theory (Garland et al, 2015), which proposes increases in emotion regulation as an important sequela of mindfulness training. If enhancement of emotion regulation ability is a reliable result of MBSR, then this may help explain the similar decrease and maintenance of social anxiety immediately and 1-year post-CBT and post-MBSR in this sample of patients with SAD (Goldin et al, 2016). …”

“…As reported in Goldin and colleagues (2016), from 2012 to 2014, 724 potential participants completed an online screener, of whom 307 were screened by telephone (see the flowchart for Consolidated Standards of Reporting Trials, Supplemental Figure 1). The 173 patients who were potentially eligible were administered the ADIS-IV-L in person to determine whether they met diagnostic inclusion/exclusion criteria.…”

“…Formal mediation analyses of the impact of CBT for SAD on social anxiety symptom severity have provided support for several potential mediators of CBT for SAD clinical outcomes. These include decreases in maladaptive interpersonal beliefs (Boden et al, 2012), negative cognitions (Niles et al, 2014), subtle avoidance behaviors (Goldin et al, 2016), cognitive distortions (Goldin et al, 2016), and perceived social costs (Hofmann, 2004), as well as increases in positive self-views (Goldin et al, 2013a), cognitive reappraisal frequency (Goldin et al, 2016; Kocovski et al, 2015), cognitive reappraisal self-efficacy (Goldin et al, 2012b), and threat reappraisal (Smits, Rosenfield, & Powers, 2012). Thus, there is evidence that changes in specific cognitive and behavioral variables mediate the impact of CBT for SAD on social anxiety symptoms.…”

“…Thus, the authors called for greater methodologically rigor and a more refined examination of the processes that mediate the observed reductions in SAD symptoms during mindfulness-based interventions versus CBT. A recent randomized controlled trial of cognitive-behavioral group therapy (CBGT) versus MBSR in patients with SAD found similar improvements in social anxiety symptoms (Goldin et al, 2016). Thus, there is initial evidence that MBSR may be as effective as CBT.…”

Comparison of the Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR): Reducing Anxiety Symptoms

“…Furthermore, some studies have investigated MBSR versus CBT (23)(24)(25)(26). The findings of the Stravynski et al study (27) suggest that social phobia includes problems with cognitive functions.…”