Therapy for social anxiety: How 2 different types compare and contrast

By Sarah Sloat

A standard intervention for social anxiety disorder (SAD), is cognitive-behavioral group therapy (CBGT). Its effectiveness is linked to learning how to reappraise unhelpful responses and maladaptive beliefs.

Also considered helpful is a program called mindfulness-based stress reduction (MBSR). It involves multiple forms of mindfulness practices, inducing breath work, meditation, and experience monitoring. The aim is to increase present-moment awareness and curiosity while decreasing avoidance behavior.

Self-reported measures suggest both methods work: They decrease cognitive distortions and rumination and increase self-efficacy and the ability to reappraise. They produce “similar trajectories of social anxiety symptom reduction,” write the authors of a recent study.

The similar outcomes are interesting because the two therapies have different goals:

  • Cognitive-behavioral group therapy is about helping people reappraise anxious thoughts and feelings.
  • Mindfulness-based stress reduction is more about helping people accept those thoughts and feelings — and move on.

However, no one has directly compared the effects of CBGT and MBSR on the brain. So the authors of the recent study, published in JAMA Psychiatry, set out to investigate how the two therapeutic options shift neurobiological substrates — the parts of the brain that underlie specific behavior, psychological states, and cognitive processes.

“We expected [cognitive-behavioral group therapy] to be superior,” Philippe Goldin told Inverse over email. Goldin is a professor and director of the Clinically Applied Affective Neuroscience Laboratory at the University of California, Davis.

Instead, they found that both therapies were equally effective immediately and one year after the completion of treatment. “We also did not expect to find similar increases in brain networks associated with acceptance and cognitive appraisal, following both CBGT and MBSR,” Goldin explains.

How the discovery was made — The study team evaluated 31 people receiving cognitive-behavioral group therapy, 32 patients receiving mindfulness-based stress reduction, and 32 members of a control group.

Their data was collected from 2012 to 2014 via self-reported changes in emotion. The study team also collected functional magnetic resonance imaging (fMRI), which captured something called the blood oxygen level-dependent signal, or BOLD for short.

“BOLD is one type of functional neuroimaging dependent variable,” Goldin explains. “We infer brain activity based on the BOLD signal, and we examined changes in priori brain regions associated with attention and cognitive regulation of emotion.”

The study participants across the groups underwent tests that measured two critical forms of emotion regulation: reappraisal and acceptance. During the process, the scientists measured what was going on in their brains, and examined changes in self-reported negative emotions.

Ultimately, they found a significant increase in the BOLD percentage signal among the cognitive-behavioral group therapy cohort: When they reappraised negative self-beliefs, that decision translated into activity in the brain.

The same brain reaction was not seen in the mindfulness group: However, when it came to people reporting how they felt, both forms of therapies lessened social anxiety and its related symptoms.

The results suggest both methods “may be effective treatments with long-term benefits for patients with [social anxiety disorder] that recruit cognitive and attention-regulation brain networks,” despite this difference in the BOLD signal.

It’s counter to what the study team expected — and pushes back on the backlash against mindfulness that peaked around 2016. Today, the scientific understanding of mindfulness-based practices is different than it was before.

There are many more studies and “much more evidence that people who practice meditation regularly have concrete improvements in depression, anxiety, and stress, as well as increasing in wellbeing,” Goldin explains.


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