Comparing Therapies for Social Anxiety Disorder

Philippe R. Goldin, PhD

New research shows there is long-term efficacies in both cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) as viable therapies for patients with social anxiety disorder (SAD).

A team, led by Phillippe R. Goldin, PhD, University of California, Davis, investigated the effects of CBGT and MBSR on reappraisal and acceptance in patients with social anxiety disorder and tested whether treatment-associated brain changes are linked to social anxiety symptoms a year following treatment.

CBGT and MBSR are both therapeutic options to help patients with social anxiety disorder that utilize distinct emotion-regulation mechanisms. However, there has not been studies conducted in the past comparing the effects of the 2 therapies on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD.

“CBGT and MBSR may reduce clinical symptoms in patients with social anxiety disorder via enhancing reappraisal and acceptance emotion-regulation brain circuitry,” the authors wrote.

The Study

In the randomized study, the investigators examined 108 unmedicated adults diagnosed with generalized SAD. Each patient was randomly assigned to either 12 weeks of CBGT (N = 31), MBSR (n = 32), or waitlist (n = 32). The mean age of the patient population was 32.7 years old.

The researchers collected data between September 2012 and December 2014 at Stanford University.

The investigators sought main outcomes of changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation at the 1 year mark following treatment.

The researchers also collected self-reported race and ethnicity data to inform the generalizability of the study in wider populations and to satisfy requirements of the National Institutes of Health.

Results

Overall, both therapeutic programs were linked to a significant decrease in negative emotion (partial η2 range, 0.38-.53). There was no significant between-group differences when reacting (β, −0.04; SE, 0.09; 95% CI, −0.11 to 0.08; t92 = −0.37; P = 0 .71), reappraising (β, −0.15; SE, 0.09; 95% CI, −0.32 to 0.03; t92 = −1.67; P = 0 .10), or accepting (β, −0.05; SE, 0.08; 95% CI, −0.20 to 0.11; t92 = −0.59; P = 0 .56).

BOLD percentage change in cognitive and attention-regulation regions also significantly increased when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs.

On the other hand, the 2 therapies did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses, while reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment.

“The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks,” the authors wrote. “Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies.”

The study, “Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder,” was published online in JAMA Psychiatry.