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Cited by 70Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion InterventionsPsychotherapy Techniques and Applications

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

Open access
Goldin, Philippe R., Thurston, Matthew, Allende, Santiago, Moodie, Craig, Dixon, Matthew L., Heimberg, Richard G., Gross, James J.·2021·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2021.1862PMC PMC8295897
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Abstract

Importance: 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.Objective: 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.Design, Setting, and Participants: 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.Interventions: CBGT and MBSR.Main Outcomes and Measures: 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.Results: 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.Conclusions and Relevance: 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.Trial Registration: ClinicalTrials.gov Identifier: NCT02036658.

Verified 2026-10-11 · 2 references not checked yet

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2021.1862

Cites

53 of 56 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

26 of 38 cited sources checked · 11 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Comparisons of CBGT and MBSR have demonstrated decreased frequency of subtle avoidance behaviors during CBGT but not during MBSR.

    “Comparisons of CBGT and MBSR have demonstrated decreased frequency of subtle avoidance behaviors during CBGT but not during MBSR 13 as one point of difference in mechanism.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [13] 13. Goldin PR, Morrison A, Jazaieri H, Brozovich F, Heimberg R, Gross JJ. Group CBT versus MBSR for social anxiety disorder: a randomized controlled trial. J Consult Clin Psychol. 2016;84(5):427-437. doi:10.1037/ccp0000092 source

      The Results section (page not supplied) reports significant decreases in subtle avoidance behaviors for both CBGT and MBSR compared with the waitlist, though the decrease was greater for CBGT. This contradicts the claim that avoidance decreased during CBGT but not during MBSR. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    More fine-grained analyses of weekly changes during treatment for social anxiety disorder suggest that both CBGT and MBSR produced similar trajectories of social anxiety symptom reduction.

    “more fine-grained analyses of weekly changes during treatment for SAD suggest that, although both CBGT and MBSR produced similar trajectories of social anxiety symptom reduction”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [16] 16. Goldin PR, Morrison AS, Jazaieri H, Heimberg RG, Gross JJ. Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behav Res Ther. 2017;97:1-13. doi:10.1016/j.brat. 2017.06.001 source

      The Discussion (page not provided) reports that MBSR reduced social anxiety symptoms, and the Results give pre- and post-treatment scores. But this trial compared MBSR with aerobic exercise, not CBGT, and the cited passages do not report weekly symptom trajectories or a CBGT–MBSR comparison. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    The autobiographical social situation emotion-regulation task used was validated.

    “We used a previously 23 validated version of the autobiographical social situation emotion-regulation task”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [23] 23. Goldin PR, Moodie CA, Gross JJ. Acceptance versus reappraisal: behavioral, autonomic, and neural effects. Cogn Affect Behav Neurosci. 2019;19 (4):927-944. doi:10.3758/s13415-019-00690-7 source

      The Procedure and Autobiographical social situation task sections show that this paper used the named emotion-regulation task. The Reactivity to negative self-beliefs section reports that its stimuli induced heightened negative-emotion reactivity, but our copy does not establish that the task was previously validated. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Research has demonstrated the efficacy of mindfulness-based stress reduction (MBSR) in treating social anxiety disorder.

    “Research has also demonstrated the efficacy of mindfulness-based stress reduction (MBSR) 12 in treating SAD. 13”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [12] 12. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Dell Publishing; 1990.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [13] 13. Goldin PR, Morrison A, Jazaieri H, Brozovich F, Heimberg R, Gross JJ. Group CBT versus MBSR for social anxiety disorder: a randomized controlled trial. J Consult Clin Psychol. 2016;84(5):427-437. doi:10.1037/ccp0000092 source
  • Premisecitation

    Evidence suggests that both CBT and MBSR for social anxiety disorder increase recruitment of emotion regulatory brain regions.

    “Evidence suggests that both CBT and MBSR for SAD increase recruitment of emotion regulatory brain regions.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [17] 17. Goldin PR, Ziv M, Jazaieri H, Hahn K, Heimberg R, Gross JJ. Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: randomized clinical trial. JAMA Psychiatry. 2013;70 (10):1048-1056. doi:10.1001/jamapsychiatry.2013.234 source

      The Discussion (Clinical Implications; page not provided) reports greater and quicker recruitment of a reappraisal-related brain region following CBT for social anxiety disorder. Our copy does not report that MBSR increases recruitment of emotion-regulatory brain regions, so it supports only the CBT part of the claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [18][19][20]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 21
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Premisecitation

    MBSR produced greater acceptance of anxiety and acceptance success than CBGT.

    “CBGT produced greater increases in disputing anxious thoughts and feelings and reappraisal success, while MBSR produced greater acceptance of anxiety and acceptance success.16”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [16] 16. Goldin PR, Morrison AS, Jazaieri H, Heimberg RG, Gross JJ. Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behav Res Ther. 2017;97:1-13. doi:10.1016/j.brat. 2017.06.001 source

      The Introduction and Discussion describe a comparison of MBSR with aerobic exercise, not CBGT. The Results report self-views, symptoms, and mindfulness skills, but do not address acceptance of anxiety or acceptance success. Searches for those outcomes and for CBGT found no passage establishing the claimed comparison; the aerobic-exercise findings do not contradict it. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The study design, search region, and data analytic strategy were preregistered at Open Science Framework.

    “The study design, search region, and data analytic strategy were preregistered at Open Science Framework.27”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] 27. Goldin PR, Moodie C, Gross J. A randomized controlled trial of the effectiveness of cognitive-behavioral therapy vs. mindfulness-based stress reduction in adults with social anxiety disorder. Accessed December 12, 2018. https://osf. io/j8uy5/?view_only= 97e15b7e2ac04e2499043ebb560dc3a0 source

      The Method sections (pages not available in our copy) describe the trial design and statistical analyses, but do not say they were preregistered. Searches for Open Science Framework, preregistration, and a search region found no passage addressing the claim. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    CBGT produced greater increases in disputing anxious thoughts and feelings and reappraisal success than MBSR.

    “CBGT produced greater increases in disputing anxious thoughts and feelings and reappraisal success, while MBSR produced greater acceptance of anxiety and acceptance success.16”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [16] 16. Goldin PR, Morrison AS, Jazaieri H, Heimberg RG, Gross JJ. Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behav Res Ther. 2017;97:1-13. doi:10.1016/j.brat. 2017.06.001 source

      The Introduction and Discussion describe a trial comparing MBSR with aerobic exercise, not CBGT. Searches for disputing anxious thoughts, reappraisal success, and a CBGT–MBSR comparison found no passage in our copy reporting the claimed outcomes. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    CBT has been shown to increase activity in the reappraisal-associated dorsolateral, ventrolateral, and medial prefrontal cortical regions.

    “CBT has been shown to increase activity in the reappraisalassociated dorsolateral, ventrolateral, and medial prefrontal cortical regions.17”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [17] 17. Goldin PR, Ziv M, Jazaieri H, Hahn K, Heimberg R, Gross JJ. Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: randomized clinical trial. JAMA Psychiatry. 2013;70 (10):1048-1056. doi:10.1001/jamapsychiatry.2013.234 source

      The Results section reports CBT-related increases in reappraisal-related activity in dorsomedial prefrontal cortex and left dorsolateral prefrontal cortex. It identifies these as the only two regions with corrected between-group differences; it does not support the claimed increase in ventrolateral prefrontal activity. Page numbers were not supplied with the passages. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Acceptance is a key facet of decentering, which is considered a fundamental mechanism of mindfulness.

    “Acceptance is a key facet of decentering (ie, the ability to observe one's thoughts, feelings, and sensations as temporary mental events as opposed to true reflections of the self), 14 which is considered a fundamental mechanism of mindfulness”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] 14. Gawrysiak MJ, Grassetti SN, Greeson JM, Shorey RC, Pohlig R, Baime MJ. The many facets of mindfulness and the prediction of change following mindfulness-based stress reduction (MBSR). J Clin Psychol. 2018;74(4):523-535. doi:10.1002/jclp.22521 source

      The Methods (Measures; page unavailable) describe acceptance and decentering as components of mindfulness, but do not call acceptance a facet of decentering. The Discussion treats them as distinct facets and says research implicates decentering as a mechanism of change in mindfulness-based interventions. Thus, the mechanism and definition of decentering are supported, but the claimed relationship between acceptance and decentering is not. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    These results converge with previously detected brain patterns in nonanxious healthy adults using the same autobiographical social situation emotion-regulation fMRI task in executive attention control during acceptance of sad images, and in perspective shifting and effortful attention during decentering from stressful events.

    “These results converge with previously detected brain patterns in nonanxious healthy adults using the same autobiographical social situation emotion-regulation fMRI task 23 in executive attention control during acceptance of sad images, 36 and in perspective shifting and effortful attention during decentering from stressful events.37”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [23] 23. Goldin PR, Moodie CA, Gross JJ. Acceptance versus reappraisal: behavioral, autonomic, and neural effects. Cogn Affect Behav Neurosci. 2019;19 (4):927-944. doi:10.3758/s13415-019-00690-7 source
    • cites [36] 36. Smoski MJ, Keng SL, Ji JL, Moore T, Minkel J, Dichter GS. Neural indicators of emotion regulation via acceptance vs reappraisal in remitted major depressive disorder. Soc Cogn Affect Neurosci. 2015;10(9):1187-1194. doi:10.1093/scan/nsv003 source
    • cites [37] 37. Lebois LAM, Papies EK, Gopinath K, et al. A shift in perspective: decentering through mindful attention to imagined stressful events. Neuropsychologia. 2015;75:505-524. doi:10.1016/j. neuropsychologia.2015.05.030 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    fMRI studies of pretreatment brain predictors have reported that lesser rostral anterior cingulate cortex and lesser left DLPFC activity during reappraisal of negative images, inverse connectivity between amygdala and right VLPFC during affect labeling, greater occipitotemporal activation to angry vs neutral faces, and dorsal ACC activation during self-referential criticism are associated with响应

    “fMRI studies of pretreatment brain predictors have reported that lesser rostral anterior cingulate cortex and lesser left DLPFC activity during reappraisal of negative images, 42,43 inverse connectivity between amygdala and right VLPFC during affect labeling, 44 greater occipitotemporal activation to angry vs neutral faces, 45 and dorsal ACC activation 46 during self-referential criticism are”
    Quote in the paperNot a substantial claim4 of 4 sources checked
    • cites [42] 42. Klumpp H, Fitzgerald JM, Kinney KL, et al. Predicting cognitive behavioral therapy response in social anxiety disorder with anterior cingulate cortex and amygdala during emotion regulation. Neuroimage Clin. 2017;15:25-34. doi:10.1016/j.nicl. 2017.04.006 source
    • cites [43] 43. Klumpp H, Roberts J, Kennedy AE, et al. Emotion regulation related neural predictors of cognitive behavioral therapy response in social anxiety disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2017;75:106-112. doi:10.1016/j.pnpbp. 2017.01.010 source
    • cites [44] 44. Young KS, LeBeau RT, Niles AN, et al. Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder. J Affect Disord. 2019;242: 105-110. doi:10.1016/j.jad.2018.08.016 source
    • cites [45] 45. Doehrmann O, Ghosh SS, Polli FE, et al. Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry. 2013;70(1):87-97. doi:10. 1001/2013.jamapsychiatry.5 source

  • May combine two claims.

    Findingown data

    CBGT and MBSR yielded similar reductions in negative emotion with no significant between-group differences when reappraising.

    “reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t 92 = -1.67;P = .10)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    CBGT and MBSR yielded similar reductions in negative emotion with no significant between-group differences when reacting.

    “CBGT and MBSR yielded similar reductions in negative emotion (partial η 2 range, 0.38 to 0.53) with no significant between-group differences (Table 1) when reacting (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t 92 = -0.37;P = .71)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There were treatment-specific weekly changes in frequency of disputing (CBGT greater than MBSR) and of acceptance (MBSR greater than CBGT) of anxious thoughts and feelings.

    “with treatment- specific weekly changes in frequency of disputing (CBGT greater than MBSR) and of acceptance (MBSR greater than CBGT) of anxious thoughts and feelings (eFigure 4 in Supplement 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    CBGT and MBSR yielded similar reductions in negative emotion with no significant between-group differences when accepting.

    “or accepting (β,-0.05;SE, 0.08; 95% CI, -0.20 to 0.11; t 92 = -0.59;P = .56).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    CBGT and MBSR were each associated with increased BOLD percentage signal when reacting, reappraising, or accepting, with no significant between-group differences in the brain regions identified above.

    “CBGT and MBSR were each associated with increased BOLD percentage signal when reacting (CBGT, 0.012; MBSR, 0.019; P > .28),reappraising (CBGT, 0.031; MBSR, 0.037; P > .28),or accepting (CBGT, 0.012; MBSR, 0.077; P > .28),with no significant between-group differences in the brain regions identified above.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only the treatment-specific changes during reappraisal were significantly associated with reduced social anxiety symptoms 1 year posttreatment, specifically MBSR (vs CBGT) decreases in negative emotion and CBGT (vs MBSR) increases in fMRI BOLD signal.

    “Only the treatment-specific changes during reappraisal were significantly associated with reduced social anxiety symptoms 1 year posttreatment, specifically MBSR (vs CBGT) decreases in negative emotion and CBGT (vs MBSR) increases in fMRI BOLD signal.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    These results are specific to reappraisal (vs acceptance) and to CBT (vs MBSR).

    “Our study replicates the finding of CBTassociated increased PFC-parietal brain activity with reduction of social anxiety 1 year post-CBT and further identifies that these results are specific to reappraisal (vs acceptance) and to CBT (vs MBSR).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Compared with waitlist, CBT and MBSR treatment decreased negative emotion and increased recruitment of regulation-associated brain regions (PFC, parietal cortex, and caudate nucleus) during reappraisal and acceptance.

    “Compared with WL, treatment decreased negative emotion and increased recruitment of regulation-associated brain regions (PFC, parietal cortex, and caudate nucleus) during reappraisal and acceptance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Adherence-to-protocol ratings indicated that CBGT therapists and the MBSR instructor were in protocol with no between-group differences.

    “Adherence-toprotocol ratings conducted in real time in each session indicated that CBGT therapists and the MBSR instructor were in protocol with no between-group differences.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Negative emotion ratings were analyzed with intention-to-treat linear mixed models.

    “For negative emotion ratings, we implemented intention-totreat linear mixed models”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    All brain results were corrected for multiple comparisons at P < .05, familywise error corrected, and all tests were 2-tailed.

    “All brain results were corrected for multiple comparisons at P < .05,familywise error corrected, and all tests were 2-tailed”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A random number generator determined the sequence of 6 groups per 3 arms of the randomized clinical trial.

    “A random number generator determined the sequence of 6 groups per 3 arms of the randomized clinical trial.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Research assistants who collected brain and behavioral data were blind to group assignment.

    “Research assistants who collected brain and behavioral data were blind to group assignment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Acceptance has been shown to predict decreased relapse rates over 24 months in adults with remitted depression.

    “has been shown to predict decreased relapse rates over 24 months in adults with remitted depression.15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] 15. Segal ZV, Anderson AK, Gulamani T, et al. Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. J Consult Clin Psychol. 2019;87 (2):161-170. doi:10.1037/ccp0000351 source

  • May combine two claims.

    Study design and conductown data

    Using a criterion of 9 of 12 sessions attended for treatment completion, 33 patients (92%) completed CBGT and 33 patients (92%) completed MBSR.

    “Using a criterion of 9 of 12 sessions attended for treatment completion status, 33 patients (92%) completed CBGT and 33 patients (92%) completed MBSR.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    After dropout and exclusion of incomplete neuroimaging data, the final sample included 31 CBGT, 32 MBSR, and 32 waitlist participants.

    “After dropout from CBGT (n = 2), MBSR (n = 3), and WL (n = 1), and exclusion of incomplete neuroimaging data (n = 7), the final sample included 31 individuals in the CBGT group, 32 individuals in the MBSR group, and 32 individuals in the WL group”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For MBSR, open monitoring has been shown to increase activity in attention-associated brain regions.

    “and to increase activity in attention-associated brain regions.[18][19][20]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18][19][20]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients were randomly assigned in cohorts of 6 to CBGT, MBSR, or waitlist groups.

    “Patients were randomly assigned in cohorts of 6 to CBGT (n = 36), MBSR (n = 36), or WL (n = 36) groups.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    For hypothesis 3, multiple linear regression controlled for baseline emotion or brain responses and residualized scores controlled for pretreatment social anxiety symptoms.

    “after controlling for baseline emotion or brain responses) were associated with social anxiety symptoms 1 year posttreatment (residualized scores that control for pretreatment social anxiety symptoms).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Directly probing social anxiety disorder-associated brain functioning may provide a more direct assessment of therapeutic mechanisms.

    “However, directly probing SAD-associated brain functioning may provide a more direct assessment of therapeutic mechanisms.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Investigations of therapeutic mechanisms in CBGT and MBSR have relied primarily on self-report measures.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The analysis was focused within an a priori-defined brain search region mask derived from meta-analyses of cognitive reappraisal and attention regulation.

    “We focused our analysis within an a priori-defined brain search region mask (Figure 1) derived from meta-analyses of cognitive reappraisal and attention regulation.[24][25][26]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24][25][26]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cognitive behavioral group therapy (CBGT) is a criterion-standard intervention for social anxiety disorder.

    “Cognitive behavioral group therapy (CBGT), a criterionstandard intervention for SAD, 8 trains patients to implement cognitive restructuring of maladaptive beliefs and interpretations in the context of within-session and in vivo exposures to feared situations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] 8. Gordon D, Wong J, Heimberg R. Cognitive-behavioral therapy for social anxiety disorder: the state of the science. In: Weeks JW, ed. The Wiley-Blackwell Handbook of Social Anxiety Disorder. Wiley-Blackwell; 2014:477-497. doi:10.1002/ 9781118653920.ch22 source

  • May combine two claims.

    Premisecitation

    The effectiveness of CBGT is associated with fear-inhibitory learning, a form of implicit emotion regulation, and with learning cognitive reappraisal of unhelpful responses to specific situations.

    “The effectiveness of CBGT is associated with fear-inhibitory learning, a form of implicit emotion regulation, and with learning cognitive reappraisal of unhelpful responses to specific situations.[9][10][11]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9][10][11]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This finding may be associated with numerous other factors.

    “this finding may be associated with numerous other factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The clinical implications of our study findings are that CBT and MBSR may strengthen overlapping skills, including refining awareness of thought content and emotions, learning to diminish overlearned reactive avoidant tendencies and instead choose adaptive coping strategies, and weakening the salience of negative self-beliefs (by challenging or reframing them, or by experiencing them as transient

    “The clinical implications of our study findings are that CBT and MBSR may strengthen overlapping skills, including refining awareness of thought content and emotions, learning to diminish overlearned reactive avoidant tendencies and instead choose adaptive coping strategies, and weakening the salience of negative self-beliefs (by challenging or reframing them, or by experiencing them as transient”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    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.

    “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.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    MBSR-associated enhancement of reappraisal abilities has been previously reported.

    “MBSR-associated enhancement of reappraisal abilities has been previously reported.41”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] 41. Garland EL, Hanley AW, Goldin PR, Gross JJ. Testing the mindfulness-to-meaning theory: evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. PLoS One. 2017;12(12):e0187727. doi:10.1371/journal.pone. 0187727 source
34 of 34

  • The paper relies on this without support.

    Investigations of therapeutic mechanisms in CBGT and MBSR have relied primarily on self-report measures.

    “Investigations of therapeutic mechanisms in CBGT and MBSR thus far have relied primarily on self-report measures”

  • The paper relies on this without support.

    No studies have directly compared the effects of CBT and MBSR on emotion-regulation brain substrates.

    “because no studies, to our knowledge, have directly compared the effects of CBT and MBSR on emotion-regulation brain substrates”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • This heightened self-awareness helps identify stress triggers and patterns, allowing for proactive stress management through positive reappraisal, emotion regulation, or other strategies, thereby modulating cortisol and testosterone profiles effectively.

    “this heightened self-awareness helps identify stress triggers and patterns, allowing for proactive stress management through positive reappraisal, emotion regulation, or other strategies, thereby modulating cortisol and testosterone profiles effectively (Goldin et al., 2021;González-Palau & Medrano, 2022;hanley et al., 2021;tang, tang, & Posner, 2016;terburg et al., 2009).”

    From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Goldin et al., 2021

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Cognitive behavioural therapy has been shown to alter PFC-insula connectivity in patients with depression.

    “Cognitive behavioural therapy has been shown to alter PFC–insula connectivity in patients with depression.57”

    From Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder (2023) · cites this paper as [57]

    The Effects of CBT and MBSR on Negative Emotion and Brain Responses section reports increased PFC activation after cognitive behavioral group therapy in patients with social anxiety disorder. It does not establish altered PFC–insula connectivity or a finding in patients with depression; the reported measure is brain activation, not connectivity. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Waitlist acceptance F statistic conflicts with its P value

    Minor

    For the waitlist group, the acceptance F statistic is 32.11 but its P value is .16. The same-sized waitlist group's much smaller reappraisal F statistic of 3.03 has a lower P value of .09, which is inconsistent for these comparable tests.

  • Stated effect-size range omits a reported value

    Minor

    The stated partial η2 range ends at 0.53, but Table 1 reports 0.64 for MBSR during acceptance.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. DiNardo, 1994, Anxiety Disorders Interview Schedule for DSM-IV, Lifetime Version, ADIS-IV-L
  2. Hope, 2010, Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach

Cited by

Sorted by citations

Related

Authors
Goldin, P. R., Thurston, M., Allende, S., Moodie, C., Dixon, M. L., Heimberg, R. G., & Gross, J. J.
Affiliations
  • University of California, Davis (US)
  • University of Southern California (US)
  • PGSP-Stanford PsyD Consortium, Palo Alto, California
  • Stanford University (US)
  • Temple University (US)
Corresponding author
Goldin, Philippe R.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2021-10-01
Volume
78
Issue
10
Pages
1134
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2021.1862
PMC
PMC8295897
OpenAlex
W3186474423
Cited by
69
References
52
Citations by year
2026: 16 · 2025: 18 · 2024: 21 · 2023: 8 · 2022: 4 · 2021: 2
FWCI
8.45
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH076074)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
social anxiety disorder, group cognitive behavioral therapy, mindfulness-based stress reduction, cognitive reappraisal, acceptance, emotion regulation, negative emotions, brain changes, BOLD signal, prefrontal cortex, anterior cingulate cortex, insula, treatment response, medication adherence, generalized social anxiety disorder, waitlist control, randomized controlled trials
MeSH terms
Phobia, Social, Emotional Regulation, Adult, Cerebral Cortex, Female, Humans, Magnetic Resonance Imaging, Male, Nerve Net, Psychotherapy, Group, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Meditation, Young Adult, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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