Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder

Abstract

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. CLINICALTRIALS.

Gov identifier: NCT02036658.

Keywords: Cognitive reappraisal; Cognitive-behavioral therapy; MBSR; Mechanisms; Mindfulness; Randomized controlled trial; Social anxiety.

Conflict of interest statement

None of the authors of this manuscript have any biomedical financial interests or potential conflicts of interest.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Social anxiety weekly during CBGT and MBSR

Multilevel modeling revealed significant linear decreases in social anxiety during CBGT (cognitive behavioral group therapy), b = −1.83, 95% CI [−2.28, −1.39], t = −8.18, p < .001, and MBSR (mindfulness-based stress reduction), b = −1.42, 95% CI [−1.87, −0.99], t = −6.40, p < .001. The group × session interaction was not significant, b = −0.40, 95% CI = −1.03 to 0.23, t = −1.27, p = .201.

Figure 2. Disputing during CBGT and MBSR

Weekly disputing or challenging anxious thought and feelings increased significantly during CBGT (cognitive behavioral group therapy), b = 1.60, 95% CI [1.11, 2.08], t = 6.57, p < .001, and MBSR (mindfulness-based stress reduction), b = 0.76, 95% CI [0.27, 1.24], t = 3.10, p = .003. The session by group interaction was significant, indicating greater increases during CBGT vs. MBSR, b = 0.84, 95% CI [0.16, 1.52], t = 2.44, p = .016.

Figure 3. Reappraisal and perceived reappraisal success during CBGT and MBSR

Weekly reappraisal increased significantly during CBGT (cognitive behavioral group therapy), b = 1.65, 95% CI [1.13, 2.17], t = 6.27, p < .001, and MBSR (mindfulness-based stress reduction), b = 1.50, 95% CI [0.98, 2.02], t = 5.69, p < .001. The session by group interaction was not significant, b = 0.15, 95% CI [−0.59, 0.89], t = 0.40, p = .69. Weekly perceived reappraisal success increased significantly during CBGT, b = 2.22, 95% CI [1.78, 2.67], t = 9.98, p < .001, and MBSR, b = 1.31, 95% CI [0.87, 1.75], t = 5.87, p < .001, with a significant session by group interaction indicating greater increases during CBGT (vs. MBSR), b = 0.91, 95% CI [0.29, 1.54], t = 2.89, p = .005.

Figure 4. Mindful attitude during CBGT and MBSR

Weekly mindful attitude increased during both CBGT (cognitive behavioral group therapy), b = 1.25, 95% CI [0.76, 1.74], t = 5.09, p < .001, and MBSR (mindfulness-based stress reduction), b = 1.76, 95% CI [1.27, 2.25], t = 7.13, p < .001, with no interaction of session by group, b = −0.51, 95% CI [−1.20, 0.18], t = −1.46, p = .15.

Figure 5. Acceptance and perceived acceptance success during CBGT and MBSR

Acceptance of anxiety increased during MBSR (mindfulness-based stress reduction), b = 1.16, 95% CI [0.55, 1.77], t = 3.75, p < .001, but not in CBGT (cognitive behavioral group therapy), b = −0.08, 95% CI [−0.69, 0.53], t = −0.25, p = .80, with a significant interaction of group by session indicating greater increases in acceptance during MBSR, b = −1.23, 95% CI[−2.10, −0.37], t = −2.84, p = .006. Perceived acceptance success did not change during CBGT, b = 0.16, 95% CI [−0.45, 0.76], t = 0.51, p = .61, but did increase during MBSR, b = 1.60, 95% CI [0.99, 2.21], t = 5.19, p < .001. The session by group interaction was significant, indicating greater increases during MBSR, b = −1.44, 95% CI [−2.31, −0.58], t = −3.32, p = .001.