Two treatments were effective and provided long-term benefits for patients with social anxiety disorder, according to results of a randomised clinical trial published in JAMA Psychiatry.
The interventions, cognitive behavioural group therapy (CBGT) and mindfulness-based stress reduction (MBSR), recruited cognitive and attention-regulation brain networks.
“Evidence suggests that both CBT and MBSR for [social anxiety disorder] increase recruitment of emotion regulatory brain regions,” Philippe R. Goldin, PhD, of the University of California, Davis, and colleagues wrote. “CBT has been shown to increase activity in the reappraisal-associated dorsolateral, ventrolateral and medial prefrontal cortical regions. For MBSR, attentional deployment of observing present-moment experience (referred to as open monitoring) has been shown to downregulate emotional reactivity to idiographic negative self-beliefs and to increase activity in attention-associated brain regions.”
To the researchers’ knowledge, no studies have yet to directly compare the effects of CBT and MBSR on brain substrates related to emotion regulation; thus, prior research has provided limited understanding of the common and specifics effects on frontoparietal brain regions linked to reappraisal and acceptance among patients with social anxiety disorder. In the current study,
Goldin and colleagues aimed to address this research gap by analyzing data of unmedicated adults who had a diagnosis of generalized social anxiety disorder and were randomly assigned to 12 weeks of CBGT (n = 31), MBSR (n = 32) or waitlist (n = 32) at a single psychology department between September 2012 and December 2014. Main outcomes and measures included changes in self-reported negative emotion and functional MRI blood oxygen level-dependent (BOLD) signal within a brain search region mask defined a priori and derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year after treatment. Participants had a mean age of 32.7 years, 56% were women, 43.5% were white, 38.9% were Asian, 9.3% were Latinx (a term used as a gender-neutral alternative to Latino), 1% were Black, 1% were Native American and 6.5% identified as more than one race.
Results showed a significant decrease in negative emotions associated with CBGT and MBSR, and the researchers noted reported no significant between-group differences when reacting, reappraising or accepting. They noted a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising and accepting negative self-beliefs. Decreased negative emotion and increased reappraisal and acceptance BOLD responses did not differ between CBGT and MBSR. The researchers noted an association between social anxiety symptoms 1 year after treatment and reappraisal-associated MBSR (compared with CBGT) negative emotions and CBGT (compared with MBSR) brain responses.
“Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies,” Goldin and colleagues wrote.
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