Improve Social Anxiety Disorder with Mindfulness
By John M. de Castro, Ph.D.
“Using mindfulness, we can begin to notice what happens in the body when anxiety is present and develop strategies to empower clients to “signal safety” to their nervous system. Over time, clients feel empowered to slow down their response to triggers, manage their body’s fear response (fight-or-flight) and increase their ability to tolerate discomfort. The client experiences this as feeling like they have a choice about how they will respond to a trigger.” – Jeena Cho
It is a common human phenomenon that being in a social situation can be stressful and anxiety producing. This is particularly true when asked to perform in a social context such as giving a speech. Most people can deal with the anxiety and can become quite comfortable. But many do not cope well and the anxiety is overwhelming, causing the individual to withdraw. Social Anxiety Disorder (SAD) is characterized by a persistent, intense, and chronic fear of being watched and judged by others and feeling embarrassed or humiliated by their actions. This fear may be so severe that it interferes with work, school, and other activities and may negatively affect the person’s ability to form relationships.
SAD is the most common form of anxiety disorder and it is widespread, occurring in about 7% of the U.S. population and is particularly widespread among young adults. Anxiety disorders have generally been treated with drugs. But, there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for SAD. Although, these therapies can be effective they are costly and because of availability, cost, and inconvenience, are only available to small numbers of sufferers. As a result, there is a growing trend to using group based therapy. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders including Social Anxiety Disorder (SAD). Mindfulness-Based Stress Reduction (MBSR) contains three mindfulness trainings, meditation, body scan, and yoga, and has been shown to be effective in treating anxiety disorders. So, it would be reasonable to expect that MBSR training would improve the symptoms of Social Anxiety Disorder (SAD) in young adults.
In today’s Research News article “Group CBT versus MBSR for Social Anxiety Disorder: A Randomized Controlled Trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837056/, Goldin and colleagues compared the efficacy of Group Cognitive Behavioral Therapy (Group-CBT) to Mindfulness-Based Stress Reduction (MBSR) program for the relief of Social Anxiety Disorder (SAD). They recruited through clinician referrals and community listings, patients who were diagnosed with SAD but had not been treated with drugs, CBT or MBSR in the recent past. In Group-CBT 6 patients met once a week for 2.5 hours over 12 weeks while the standard MBSR program was modified to include meetings of 6 patients once a week for 2.5 hours over 12 weeks. They were assigned in consecutive blocks of 6 patients to either Group-CBT, MBSR, or a wait-list control group. They were measured before and after treatment and every 3 months for the next year for social anxiety, emotion regulation, cognitive reappraisal self-efficacy, subtle avoidance, cognitive distortions, mindfulness, attention control, and rumination.
They found that compared to the wait-list control patients both Group-CBT and MBSR produced clinically significant improvements in social anxiety, increases in mindfulness, cognitive reappraisal, cognitive reappraisal self-efficacy, and attention control, and decreases in subtle avoidance, cognitive distortions, and rumination. There were no significant differences in the effectiveness of Group-CBT and MBSR and the effects appeared to last for a year afterward. Hence, both forms of therapy were highly effective and long-lasting for patients with Social Anxiety Disorder (SAD), improving emotions and thought processes.
It is interesting that the two therapies had such similar effects given that they target different processes. But, the results showed that both therapies equally improved the processes that are targeted by Group-CBT, thought processes, and the processes that are targeted by MBSR, mindfulness and attention. So, although designed to effect different processes the two therapies produced the same outcomes. Regardless, they were both highly effective in oriducing long-lasting improvements in the conditions of these patients suffering from SAD.
So, improve social anxiety disorder with mindfulness.
“The power of a mindfulness practice, however, may come in the realization that one can live a meaningful life even with social anxiety. (Participant) says that he still feels nervous in social situations but now feels compassion — not judgment — for himself, and sees that “I can be more the person I want to be.”’ – Jason Drwal
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R., & Gross, J. J. (2016). Group CBT versus MBSR for Social Anxiety Disorder: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 84(5), 427–437. http://doi.org/10.1037/ccp0000092
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.