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. 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.
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 anxiety. 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) and also Cognitive Behavioral Therapy (CBT) have been shown to be effective in treating Social Anxiety Disorder (SAD). It is not known, however, if they operate through similar or different mechanisms.
In today’s Research News article “Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600696/ ), Goldin and colleagues recruited patients with diagnosed Social Anxiety Disorder (SAD) and randomly assigned them to receive 12 weekly 2..5 hour sessions with daily homework of either Mindfulness-Based Stress Reduction (MBSR) or Cognitive Behavioral Therapy (CBT). MBSR consists of a combination of meditation, body scanning, and yoga practices. Cognitive Behavioral Therapy (CBT) is designed to alter how the patient relates to the thought processes that often underlie and exacerbate mood disorders. They were measured before treatment, once a week during treatment, and every 3 months for the following year for social anxiety, mindfulness, and cognitive reappraisal.
They found that both MBSR and CBT produced a progressive significant reduction in social anxiety and significant increases in mindful attitude and reappraisal, changing thinking about social anxiety, over the course of treatment that was maintained for the year following. They also found that the cognitive reappraisal strategy of disputing, challenging anxious thoughts and feelings and reappraisal success significantly increased over the course of treatment and were maintained for the year following but CBT produce a significantly greater increases than MBSR. In addition, they found that MBSR but not CBT produced significant increases in acceptance and acceptance success of anxiety over the course of treatment that were maintained for the year following. In examining the relationships between the variables they found that reappraisal and reappraisal success were significantly associated with the reduction of social anxiety for CBT but not MBSR. On the other hand, reappraisal disputing was significantly associated with reduction of social anxiety for MBSR but not CBT.
These are complex but interesting results that suggest that while both MBSR and CBT produce significant reductions in social anxiety and share many similar mechanisms, they also do so in different ways. CBT appears to reduce social anxiety by increasing the cognitive reappraisal strategy of disputing, challenging anxious thoughts and feelings, and its success in reducing anxiety. MBSR, on the other hand, appears to reduce social anxiety by increasing mindful acceptance of anxiety and its success.
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. Schjerning 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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Goldin, P. R., Morrison, A. S., Jazaieri, H., Heimberg, R. G., & Gross, J. J. (2017). Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behaviour research and therapy, 97, 1-13.
CBGT and MBSR produced similar decreases in social anxiety
CBGT (vs. MBSR): greater disputing anxiety and reappraisal success
CBGT: weekly reappraisal and reappraisal success predict social anxiety
MBSR (vs. CBGT): greater acceptance of anxiety and acceptance success
MBSR: weekly mindful attitude and disputing anxiety predict social anxiety
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.