Mindfulness, in contrast, promotes present-moment awareness and non-judgmental acceptance of thoughts and feelings. It can decrease self-focused attention and improve emotional regulation.
Combining these approaches may offer a comprehensive strategy for managing social anxiety, addressing both cognitive distortions and attentional processes.
Key Points
Rationale
Cognitive-behavioral therapy (CBT) is currently the most effective treatment for SAD symptoms (Mayo-Wilson et al., 2014).
However, some patients do not experience significant improvement even after completing CBT treatment (Rodebaugh et al., 2004). The remission rate for SAD through CBT is approximately 40% (Loerinc et al., 2015; Springer et al., 2018; Ginsburg et al., 2011).
Moscovitch et al. (2012) found that non-responders to CBT did not show significant decreases in cost and probability biases, which are maintaining factors in SAD.
Mindfulness training (MT) has shown promise in reducing cost/probability bias and social anxiety symptoms (Noda et al., 2022; Schmertz et al., 2012).
Combining MT with cognitive restructuring techniques may enhance the efficacy oftreatment for SAD, particularly for those who do not respond to traditional CBT.
This study aims to examine the effectiveness of a 4-session mindfulness and cognitive-behavioral therapy (M-CBT) program for individuals with high social anxiety symptoms.
The program was designed as a brief, low-intensity treatment module specifically targeting those with high levels of cost/probability bias and social anxiety symptoms.
Method
The study employed a randomized controlled trial (RCT) design with two groups: an intervention group that underwent M-CBT and a control group that did not receive any treatment.
Procedure
Participants were randomly assigned to either the intervention or control group. The intervention group underwent a 4-session M-CBT program, with each session lasting 90 minutes and delivered once a week in a group format.
The control group did not participate in any intervention. Questionnaires were administered to both groups before and immediately after the intervention period and one month later as a follow-up.
Sample
The study included 50 Japanese undergraduate students (37 women and 13 men) with high social anxiety symptoms.
Participants were required to score 44 or higher on the Japanese version of the Liebowitz Social Anxiety Scale (LSAS) and 69 or lower on the Japanese version of the Self-Rating Depression Scale (SDS).
Measures:
Statistical measures
The study used analysis of covariances (ANCOVA) to test the effectiveness of M-CBT.
Simple effect analyses using Bonferroni’s method were performed for variables showing significant interactions.
Cohen’s d was calculated to examine effect sizes within the intervention group.
Results
Hypothesis 1:M-CBT will be effective in reducing social anxiety symptoms and cost/probability bias.
Results:Significant interactions were found in probability bias total score and probability bias in the negative cognition generated when paying attention to others. No significant interactions were observed in social anxiety symptoms (LSAS scores) or overall cost bias.
Hypothesis 2:M-CBT will improve fear of negative evaluation and self-focused attention.
Results:Significant interactions were found in fear of negative evaluation. No significant interactions were observed in self-focused attention.
Hypothesis 3:M-CBT will enhance dispositional mindfulness and improve depressive symptoms and subjective happiness.
Results:Significant interactions were found in dispositional mindfulness, depressive symptoms, and subjective happiness.
Insight
The study found that the 4-session M-CBT program was effective in improving several aspects related to social anxiety, particularly probability bias in negative cognition generated when paying attention to others, fear of negative evaluation, dispositional mindfulness, depressive symptoms, and subjective happiness.
However, the program did not show significant improvements in overall social anxiety symptoms or cost bias.
These findings suggest that combining mindfulness training with cognitive restructuring techniques may be beneficial for addressing specific cognitive biases and related symptoms in individuals with high social anxiety.
Future research could focus on comparing the efficacy of M-CBT to traditional CBT, examining the long-term effects of the intervention, and investigating the mechanisms through which mindfulness training enhances cognitive restructuring techniques.
Strengths
The study had several methodological strengths, including:
Limitations
This study also had some methodological limitations, including:
These limitations impact the generalizability of the results and the ability to draw definitive conclusions about the efficacy of M-CBT compared to other interventions.
Implications
The results of this study have several implications for clinical psychology practice and research:
Variables that may influence the results include cultural factors, severity of social anxiety symptoms, and individual differences in responsiveness to mindfulness-based interventions.
References
Primary reference
Noda, S., Shirotsuki, K., & Nakao, M. (2024). Low-intensity mindfulness and cognitive–behavioral therapy for social anxiety: A pilot randomized controlled trial.BMC Psychiatry, 24(1), Article 190.https://doi.org/10.1186/s12888-024-05651-0
Other references
American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders(5th ed.). Washington, DC: American Psychiatric Association.
Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., Walkup, J. T., Sherrill, J., Coffey, K. A., Rynn, M. A., Keeton, C. P., McCracken, J. T., Bergman, L., Iyengar, S., Birmaher, B., & March, J. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS.Journal of Consulting and Clinical Psychology, 79(6), 806–813.https://doi.org/10.1037/a0025933
Loerinc, A. G., Meuret, A. E., Twohig, M. P., Rosenfield, D., Bluett, E. J., & Craske, M. G. (2015). Response rates for CBT for anxiety disorders: Need for standardized criteria.Clinical psychology review,42, 72-82.https://doi.org/10.1016/j.cpr.2015.08.004
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis.The Lancet Psychiatry,1(5), 368-376.https://doi.org/10.1016/S2215-0366(14)70329-3
Moscovitch, D. A., Gavric, D. L., Senn, J. M., Santesso, D. L., Miskovic, V., Schmidt, L. A., McCabe, R. E., & Antony, M. M. (2012). Changes in judgment biases and use of emotion regulation strategies during cognitive-behavioral therapy for social anxiety disorder: Distinguishing treatment responders from nonresponders.Cognitive Therapy and Research,36, 261-271.https://doi.org/10.1007/s10608-011-9371-1
Noda, S., Shirotsuki, K., & Sasagawa, S. (2022). Self-focused attention, cost/probability bias, and avoidance behavior mediate the relationship between trait mindfulness and social anxiety: A cross-sectional study.Frontiers in Psychology,13, 942801.https://doi.org/10.3389/fpsyg.2022.942801
Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder.Clinical Psychology Review,24(7), 883-908.https://doi.org/10.1016/j.cpr.2004.07.007
Schmertz, S. K., Masuda, A., & Anderson, P. L. (2012). Cognitive processes mediate the relation between mindfulness and social anxiety within a clinical sample.Journal of clinical psychology,68(3), 362-371.https://doi.org/10.1002/jclp.20861
Springer, K. S., Levy, H. C., & Tolin, D. F. (2018). Remission in CBT for adult anxiety disorders: a meta-analysis.Clinical psychology review,61, 1-8.https://doi.org/10.1016/j.cpr.2018.03.002
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
