March 18, 2021

Dear colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Suma Chand, PhD, NSAC St. Louis. The article, Group CBT versus MBSR for Social Anxiety Disorder: A RCT by Goldin et al., compares Group CBT to MBSR for individuals with Social Anxiety.

Cognitive-behavioral therapy (CBT) is considered an effective treatment for individuals who meet criteria for social anxiety disorder (SAD). More recently, mindfulness and acceptance-based treatments have also been reported to significantly reduce social anxiety symptoms. This randomized controlled trial (RCT), published in 2016, examined the differential efficacy and durability of group CBT (CBGT) vs. Mindfulness-Based Stress Reduction (MBSR) on generalized SAD symptoms (primary outcome). They also aimed to identify the potential mediators of changes in social anxiety symptoms for both treatments within a group format.

A total of 108 unmedicated patients were randomized to CBGT, MBSR or waitlist (WL). All participants completed assessments at baseline, post-treatment, and at 1-year follow-up. Assessments included the Liebowitz Social Anxiety Scale (primary outcome) as well as measures of treatment-related processes. The three groups did not differ significantly in gender, age, education, ethnicity, marital status, income, current or past Axis I comorbidity, past psychotherapy or pharmacotherapy, age at SAD symptom onset, and years since symptom onset. CBGT was delivered by two Ph.D. clinical psychologists using the SAD protocol developed by Heimberg & Becker (2002). The MBSR intervention was delivered by a University of Massachusetts Center for Mindfulness certified MBSR instructor using the protocol outlined by Jon Kabat-Zinn (1993).

Results indicated that compared to waitlist, both CBTG and MBSR group interventions resulted in improvements in social anxiety symptoms and secondary outcomes measured including cognitive reappraisal frequency, self-efficacy, cognitive distortions, mindfulness skills, attention focusing and rumination. There were greater decreases noted in subtle avoidance behaviors following CBGT compared to MBSR. Mediation analyses revealed that increases in reappraisal frequency, mindfulness skills, attention focusing, attention shifting, decreases in subtle avoidance behaviors, and cognitive distortions mediated the impact of both CBGT and MBSR on social anxiety symptoms. In addition, increases in reappraisal self-efficacy and decreases in avoidance behaviors mediated the impact of CBGT (vs. MBSR) on social anxiety symptoms.

The authors emphasized the limitation of the current results applying only to group therapy, noting mechanisms may differ between individual and group formats. The authors stated that in terms of clinical implications, the study provided evidence for integrating MBSR into the set of interventions used to treat SAD.

Do you treat individuals with SAD in group formats? Have you incorporated or used MBSR in group interventions used to treat adults with social anxiety disorder?

Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R. and Gross, J. J. Group CBT versus MBSR for social anxiety disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 2016, volume 84, issue 5, pages 427–437.

Suma Chand, PhD, A-CBT
NSAC St. Louis