May 13, 2026
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 Hsiao-ching Chu, PsyD, A-CBT, DBT-LBC of NSAC Avon, Connecticut. The article, Improvement in indices of cellular protection after psychological treatment for social anxiety disorder, by Månsson et al. (2019), investigated changes in biological markers of cellular protection following cognitive behavioral therapy for social anxiety disorder (SAD).
Recent studies indicate that psychiatric disorders may increase the risk of somatic illness by accelerating cellular aging and weakening cellular protection. This process is characterized by shorter telomeres (the protective caps on DNA) and increased oxidative stress, leading to cell death (apoptosis). For instance, one study found that individuals with anxiety disorders had significantly shorter telomeres compared to those without anxiety disorders.
Other research suggests that both psychotropic medications (such as SSRIs) and psychosocial interventions (like mindfulness training and behavior activation) can combat cellular aging by strengthening telomere-related protection, increasing telomerase activity, and reducing oxidative stress and harmful oxidized low-density lipoprotein.
The present study investigated telomerase (the enzyme that restores telomeres), glutathione peroxidase (GPx; the enzyme that counteracts oxidative stress), and their relationship with SAD symptom reduction. Forty-six participants with SAD were included in a within-subject design with repeated measures before and after receiving 9 weeks of online CBT treatment.
The results indicated that social anxiety symptom severity was significantly reduced after CBT treatment (Cohen’s d = 1.46), suggesting that enhanced cellular protection is involved in the therapeutic mechanisms of CBT. While the treatment did not significantly change telomere length or telomerase activity overall, individuals who experienced an increase in telomerase activity saw a corresponding decrease in their anxiety symptoms. Moreover, GPx activity increased significantly during treatment and was associated with symptom reduction. Finally, the link between reduced social anxiety disorder (SAD) symptoms and increased cellular protective enzymes remained strong, even after accounting for factors like BMI, sex, smoking, and medication.
The authors concluded that successful psychological treatment goes deeper than behavior, potentially strengthening the body’s protective mechanisms at the cellular level. Although the study included comprehensive biological assessments with high patient retention (no CBT dropouts), it was limited by its non-randomized design and lack of a placebo control group. While these novel findings require replication, identifying these cellular-level biological markers could advance understanding of remission mechanisms and guide the development of new treatments.
Questions and Considerations for Clinicians:
How would you utilize this study’s findings to help clients with SAD? (For example, would you do it through psychoeducation, motivating treatment engagement, and/or validating, normalizing, or de-shaming their internal experiences?)
Reference:
Månsson KN, Lindqvist D, Yang LL, Svanborg C, Isung J, Nilsonne G, Bergman-Nordgren L, El Alaoui S, Hedman-Lagerlöf E, Kraepelien M, Högström J, Andersson G, Boraxbekk CJ, Fischer H, Lavebratt C, Wolkowitz OM, & Furmark T. (2019). Improvement in indices of cellular protection after psychological treatment for social anxiety disorder. Translational Psychiatry, 9 (1).
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Hsiao-ching Chu, PsyD, A-CBT, DBT-LBC
Representing NSAC Avon, Connecticut
(Cognitive Behavioral Services of Connecticut)