Posted 02.16.2017 | by AMRA

Social Anxiety Disorder (SAD) is a psychiatric condition affecting approximately 7% of Americans. Symptoms include fear, embarrassment, and humiliation in social situations, along with avoidance of social interactions. People with SAD have negative beliefs about their social acceptability and self-worth, creating fear that others will discover their self-perceived negative qualities. Altering these negative self-beliefs may be an effective way to reduce the severity of SAD symptoms.

Thurston et al. [Journal of Anxiety Disorders] conducted a randomized, controlled study to test the effects of Mindfulness-Based Stress Reduction (MBSR) and Cognitive Behavioral Group Therapy (CBGT) on positive and negative self-evaluations and their relationship to social anxiety symptoms in patients with SAD.

The researchers randomly assigned 108 volunteers (56% female; mean age = 33 years; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) with SAD to a 12-week MBSR program, CBGT program, or wait-list control. The volunteers completed a Self-Referential Encoding Task (SRET) and a self-report scale of social anxiety at baseline and after the assigned intervention. The SRET was also completed by a separate group of 40 healthy controls that served as a baseline comparison group. The SRET measures participants’ positive and negative self-views by having them select the words that best describe themselves from pairs of computer-presented negative and positive adjectives.

The standard curriculum-based MBSR intervention omitted the usual “retreat day” in the sixth week of the program, but extended the program by adding four additional weekly group sessions so that it better matched the 12-week CBGT program. The CBGT program taught cognitive restructuring and relapse prevention and offered graded exposure to feared social situations, both in-program and the “real world.” Wait-listed controls did not participate in any intervention during the 12 weeks between baseline and post-intervention assessments.

At baseline, participants with SAD had significantly higher negative self-views (Cohen’s d=2.9) and lower positive self-views (d=2.4) than the healthy control comparison group. There was a significant negative association (r=-.26) between positive self-views and social anxiety symptoms. After intervention, MBSR participants showed significant increases in positive self-views (d=0.09) and decreases in negative self-views (d=1.1). CBGT participants showed increases in positive self-views (d=0.7) and decreases in negative self-views (d=0.8) of similar magnitude. Wait-listed controls showed smaller magnitude increases in positive self-views (d=0.03) and decreases in negative self-views (d=0.04).

The MBSR and CBTG groups increased positive self-views by 19 and 17 points respectively, while the wait-listed controls increased their positive self-views by only 7 points. MBSR participants had significantly larger improvements than wait-listed controls yet their improvements were not significantly different from those of CBGT participants. For both MBSR (R2 = 0.23) and CBGT (R2 = 0.27), improvements in positive self-views were associated with improvements in social anxiety symptoms. Decreases in negative self-views, however, had no effect on social anxiety symptoms.

The results show that MBSR and CBGT are equally effective in increasing positive self-views and decreasing social anxiety in people diagnosed with SAD. They may each achieve the same result, however, through different mechanisms. For example, CBGT may increase positive self-views through cognitive restructuring, and MBSR through enhanced cognitive flexibility and decreased attachment to prior notions of the self. The possible differences in mechanisms were not explicitly tested in this study, however. The finding that increased positive self-views are associated with symptom improvement while decreased negative self-views are not suggests that an increased focus on cultivating positive self-views may be more effective than disputing negative ones among people with SAD.

Reference:

Laurent, H. K., Duncan, L. G., Lightcap, A., Khan, F. (2016). Mindful parenting predicts mothers’ and infants’ hypothalamic-pituitary-adrenal activity during a dyadic stressor. Developmental Psychology.

[Link to abstract]