Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial.
Philippe R. Goldin, Matthew D Thurston, Santiago Allende, Craig Moodie, Matthew L. Dixon, Richard G. Heimberg, James J. Gross
JAMA Psychiatry October 1, 2021 DOI: 10.1001/jamapsychiatry.2021.1862 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized clinical trial Peer reviewed |
|---|---|
| Sample size | 108 |
| Population | Unmedicated adults diagnosed with generalized social anxiety disorder; final analyzed sample of 95 (31 CBGT, 32 MBSR, 32 waitlist), mean age 32.7 years, 56% female |
| Interventions | Cognitive behavioral group therapy (CBGT) Mindfulness-based stress reduction (MBSR) |
| Duration | 12 weeks of treatment; outcomes assessed 1 year posttreatment |
| Topics | Anxiety Meditation |
| Registration | NCT02036658 |
| Key findings | CBGT and MBSR were each associated with significant decreases in negative emotion (partial eta-squared 0.38 to 0.53) and increased BOLD responses in cognitive and attention-regulation regions during reappraisal and acceptance of negative self-beliefs, with no significant between-group differences in these outcomes. The authors suggest both treatments may be effective with long-term benefits for social anxiety disorder and may share emotion-regulation mechanisms despite contrasting therapeutic models. |
Abstract
Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD. To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment. In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020. CBGT and MBSR. Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment. Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (β, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment. The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies. ClinicalTrials.gov Identifier: NCT02036658.
Comparable studies
Other randomized controlled trials on anxiety, most cited first.
Citations in the library
Cited by 17
- Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders. Depression and Anxiety 2024
- Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder. Journal of Psychiatry and Neuroscience 2023
- ENIGMA-Meditation: Worldwide Consortium for Neuroscientific Investigations of Meditation Practices. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging April 1, 2025
- Epistemic Challenges in Neurophenomenology: Exploring the Reliability of Knowledge and Its Ontological Implications Philosophies October 3, 2023
- Mindfulness-Based Intervention for Treatment of Anxiety Disorders During the Postpartum Period: A 4-Week Proof-of-Concept Randomized Controlled Trial Protocol Brain Sciences January 13, 2026
and 12 more in the library
Cites 13
- Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training NeuroImage: Clinical 2013
- Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. PLoS One December 6, 2017
- Common and Dissociable Neural Activity After Mindfulness-Based Stress Reduction and Relaxation Response Programs Psychosomatic Medicine April 11, 2018
- Practice of Therapy Acquired Regulatory Skills and Depressive Relapse/Recurrence Prophylaxis Following Cognitive Therapy or Mindfulness Based Cognitive Therapy Journal of Consulting and Clinical Psychology February 1, 2019
- The Many Facets of Mindfulness and the Prediction of Change Following Mindfulness-Based Stress Reduction (MBSR) Journal of Clinical Psychology August 16, 2017
and 8 more in the library