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June 22, 2016       

Treating Social Anxiety Disorder: Comparing Mindfulness Training and Cognitive-Behavioral Therapy
by Monica A. Frank, PhD

Social Anxiety Disorder (SAD) can be debilitating due to the intense anxiety related to social interaction and the tendency to avoid settings that might elicit the anxiety. Although mild social anxiety is common, those with SAD may have panic attacks and can be severely limited in their activities.

The avoidance can interfere with attending school or getting a job. For those who have a job, it can interfere with performing at an optimal level or getting promotions due to not being able to engage adequately in social aspects of the job such as speaking in a meeting, returning phone calls, or managing others. Or the avoidance can cause inconveniences such as shopping and doing laundry in the middle of the night to avoid people. Or, it can cause serious deficits to life quality such as lack of friendships.

The intense anxiety for those with SAD is associated with thoughts related to feeling threatened by social interaction. Most of the threat is psychological threat although it can also be fear of physical harm. Psychological threat involves fear of embarrassment, humiliation, and/or rejection. People with SAD may take extreme measures to avoid the anxiety associated with social settings or interactions that could trigger these feelings.

Cognitive Behavioral Therapy (CBT) has been the standard treatment for SAD. Recent research comparing mindfulness training to group CBT training showed that both equally reduced symptoms of Social Anxiety Disorder (SAD) from average scores of “highly probable” of a SAD diagnosis to less than “probable” scores (Golden et al., 2016).

Even though mindfulness training does not explicitly teach challenging the thoughts of threat as CBT does such thoughts reduced at the same level as the CBT group. This makes sense when you consider that thoughts are often based on the emotional state of mind--when a person is distressed they experience more negative thoughts. In other words, thoughts can create anxiety but anxiety can also create the thoughts.

However, CBT does increase confidence in the ability to reappraise a situation which indicates that CBT and mindfulness obtain the same results through different means. Specifically, CBT reduces the thoughts of threat which reduces the anxiety. Whereas, mindfulness reduces the level of distress while increasing the tolerance of negative emotions which, in turn, reduces the thoughts of threat.

Since both methods can reduce the symptoms and are operating through different mechanisms it seems that the greatest chance of successful treatment is by using both. Thus, many CBT therapists have incorporated mindfulness into a framework of mindfulness-based CBT (MCBT).

For additional information about MCBT: What to Expect from Mindfulness-based Cognitive-Behavioral Therapy (MCBT) When You Have Depression and Anxiety.

Goldin, P.R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R. and Gross, J.J. (2016). Group CBT Versus MBSR for Social Anxiety Disorder: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 84, 5, 427–437. DOI: 10.1037/ccp0000092

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