Mindfulness Training and Cognitive Therapy Improves Social Anxiety Disorder

Mindfulness Training and Cognitive Therapy Improves Social Anxiety Disorder


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.” – Jeena Chi


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).


In today’s Research News article “Emotional clarity and attention to emotions in cognitive behavioral group therapy and mindfulness-based stress reduction for social anxiety disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879018/), Butler and colleagues recruited patients diagnosed with Social Anxiety Disorder (SAD) and a healthy control group and randomly assigned them to receive 12 weekly 2.5 hour sessions of either Cognitive Behavioral Group Therapy (CBGT) or Mindfulness-Based Stress Reduction (MBSR) or to a wait-list control condition. They were measured before and after treatment and 12 months later for emotional clarity, attention to emotions, and social anxiety.


They found that at baseline the patients with Social Anxiety Disorder (SAD) had significantly greater social anxiety and lower emotional clarity than the healthy controls. After treatment the patients who had received either MBSR or CBGT had significantly higher levels of emotional clarity than the wait-list controls. The effect remained 12 months later. They also found that the greater the changes in emotional clarity observed after treatment and at the 12-month follow-up, the greater the improvement in Social Anxiety Disorder (SAD). There were no significant effects on attention to emotions.


Emotional clarity is an aspect of emotional regulation which involves the ability to identify the emotion that is being experienced. The results suggest that this ability is enhanced by both Cognitive Behavioral Group Therapy (CBGT) and Mindfulness-Based Stress Reduction (MBSR) and that this improvement is related to the treatments ability to improve the symptoms of Social Anxiety Disorder (SAD). This is in line with the repeated finding that mindfulness training improves emotion regulation. The results further refine this understanding by identifying emotional clarity and not attention to emotions as the component of emotional regulation that’s important for improvements in SAD. So, being more sensitive to what is the identity of the emotion being experienced is helpful in dealing with social anxiety, but paying more attention to emotions is not. This further suggests that treatment focusing on emotional clarity may be even more effective in treating SAD.


So, improve social anxiety disorder with mindfulness training or cognitive therapy.


The power of a mindfulness practice, however, may come in the realization that one can live a meaningful life even with social anxiety. Schjerning, who participated in Fleming and Kocovski’s group, 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


This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch


Study Summary


Butler, R. M., Boden, M. T., Olino, T. M., Morrison, A. S., Goldin, P. R., Gross, J. J., & Heimberg, R. G. (2018). Emotional clarity and attention to emotions in cognitive behavioral group therapy and mindfulness-based stress reduction for social anxiety disorder. Journal of anxiety disorders55, 31–38. doi:10.1016/j.janxdis.2018.03.003



We examined emotional clarity (EC) and attention to emotion in patients with social anxiety disorder (SAD).

  • Patients demonstrated lower levels of EC than healthy controls.
  • Cognitive-behavioral group therapy increased EC more than a waitlist.
  • Mindfulness-based stress reduction did not increase EC more than a waitlist.
  • Changes in emotional clarity predicted changes in social anxiety.
  • Analyses involving attention to emotions were not significant.


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.



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