Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder

In the paper

“A recent study of trauma-focused CBT for posttraumatic stress disorder found a unidirectional relationship of weekly decreases in dysfunctional trauma related appraisals predicting subsequent reduction in weekly PTSD symptoms (Kleim et al., 2013).”

What the sources say

• Supported

  The Discussion reports that changes in negative trauma-related appraisals predicted PTSD symptom change in the following week during CT-PTSD, a form of trauma-focused CBT. It also states that symptom change did not significantly predict appraisal change in the following week, supporting the cited sentence’s description of a unidirectional relationship. (LLM, conf=0.94)

  cites Kleim et al., 2013 source

In the paper

“A study of CBT for panic disorder found that antecedent changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms (Gallagher et al., 2013).”

What the sources say

• Supported

  The Discussion reports that changes in both anxiety sensitivity and self-efficacy predicted subsequent changes in panic symptoms during CBT for panic disorder. The Results section also describes their effects on subsequent symptom changes at different stages of treatment. (LLM, conf=0.94)

  cites Gallagher et al., 2013 source

In the paper

“More specifically, in patients with SAD, MBSR has been shown to increase mindfulness skills, attention regulation, self-esteem, functioning and quality of life, as well as decrease negative self-views, trait anxiety, negative emotional reactivity, and depression (Goldin & Gross, 2010; Goldin, Ramel, & Gross, 2009; Goldin, Ziv, Jazaieri, & Gross, 2012a; Goldin, Ziv, Jazaieri, Hahn, & Gross, 2013b;”

What the sources say

• Partly supported

  The Results (Clinical Results and Behavioral Results; page numbers unavailable) report increased self-esteem, decreased depression and reduced negative emotion during breath-focused attention, but no reduction in negative emotion when simply reacting to negative self-beliefs. The paper also reports earlier SAD studies finding improvements in functioning, quality of life and negative self-view. It does not establish increased mindfulness skills, and its measured reduction was in state anxiety, not trait anxiety. (LLM, conf=0.87)

  cites Goldin & Gross, 2010 sourceExperimental — accuracy not yet measured
• Partly supported

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

  cites Goldin et al., 2009 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites Koszycki et al., 2007 source

In the paper

“A recent meta-analysis of mindfulness-based interventions (Hofmann, Sawyer, Witt, & Oh, 2010) showed that they reliably reduced anxiety symptoms across a variety of psychiatric and medical populations (Hedges's g = 0.63), and more so in patients with anxiety and mood disorders (g = 0.97).”

What the sources say

• Supported

  The RESULTS summary reports an overall anxiety effect of Hedges’ g = 0.63 and a larger anxiety effect of g = 0.97 in the specified clinical subgroup. The BACKGROUND describes studies spanning psychiatric and medical conditions. The detailed Results identify g = 0.97 specifically for anxiety symptoms in patients with anxiety disorders. (LLM, conf=0.92)

  cites Hofmann, Sawyer, Witt, & Oh, 2010 source

In the paper

“If enhancement of emotion regulation ability is a reliable result of MBSR, then this may help explain the similar decrease and maintenance of social anxiety immediately and 1-year post-CBT and post-MBSR in this sample of patients with SAD (Goldin et al., 2016).”

What the sources say

• Supported

  The Discussion reports that group CBT and MBSR produced similar reductions in social anxiety immediately and one year after treatment in adults with SAD, with treatment gains maintained. The proposed emotion-regulation explanation is framed as the citing authors’ conditional interpretation, not as a finding attributed to this trial. (LLM, conf=0.93)

  cites Goldin et al., 2016 source

In the paper

“Garland and colleagues (Garland, Farb, Goldin, & Fredrickson, 2015) recently introduced a mindfulness-to-meaning theory (MMT) that suggests mindfulness meditation practice will facilitate reappraisal of adversity and savoring of positive experience by enhancing interoceptive attention and cognitive flexibility.”

What the sources say

• Supported

  The “Why Reappraisal?” section (page not provided) explicitly proposes that mindfulness changes attention to interoceptive responses and introduces flexibility in meaning-making, enabling positive reappraisal of adversity and savoring of positive experience. The Conclusion (page not provided) describes this process as beginning with mindfulness meditation practice. (LLM, conf=0.93)

  cites Garland et al., 2015 source

In the paper

“MMT predicts that mindfulness meditation training should increase the ability to implement a variety of emotion regulation strategies, including reappraisal, attention deployment, and acceptance.”

What the sources say

• Supported

  The Conclusion (page unavailable) says the theory links mindful acceptance with broadened attention and more adaptive reappraisal. The section on the role of mindfulness in positive reappraisal (page unavailable) describes improved attentional reorienting, while the evidence section reports greater reappraisal ability after mindfulness training. Together, these support the citing sentence as a paraphrase of the model's prediction. (LLM, conf=0.85)

  cites Garland et al., 2015 source

In the paper

“CBT-related increases in cognitive reappraisal processes have been observed in prior studies of patients with SAD (Goldin et al., 2014; Goldin et al., 2012b).”

What the sources say

• Supported

  The Results (Hypothesis 1: Pre-Post CBT Change; page unavailable) report greater increases in cognitive reappraisal frequency and success with CBT than with waitlist in patients with SAD. The Discussion (Weekly Changes in Emotion Regulation and Anxiety; page unavailable) also reports that both increased during treatment. (LLM, conf=0.94)

  cites Goldin et al., 2014 source
• ?Not matched

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

  cites Goldin et al., 2012b

In the paper

“Such an interpretation is in alignment with mindfulness-to-meaning theory (Garland et al., 2015), which proposes increases in emotion regulation as an important sequela of mindfulness training.”

What the sources say

• Supported

  The Abstract describes the Mindfulness-to-Meaning Theory as a model of how mindfulness practice affects downstream emotion-regulatory processes. The Conclusion further says mindfulness facilitates positive reappraisal, a form of emotion regulation. The citing sentence accurately paraphrases the theory's proposal rather than claiming a measured training effect. (LLM, conf=0.91)

  cites Garland et al., 2015 source

In the paper

“Acceptance of anxiety increased during MBSR (37% increase), but not during CBT (7% decrease) (Figure 5), with a significant interaction of group by session indicating greater increases in acceptance during MBSR.”

In the paper

“However, the inverse relationship was significant, F(2,11) = 7.17, p < .05, ΔR2 = .13, unstandardized b = −.56, SE of b = .22, 95% CI [−1.06, −.07], standardized β = −.78, t(11) = 2.55, p = .029.”

In the paper

“The inverse relationship was also significant, F(2,11) = 4.41, p < .05, ΔR2 = .09, unstandardized b = −1.01, SE of b = .51, 95% CI [−2.15, .11], standardized β = −.93, t(11) = 2.00, p = .07, suggesting a bi-directional relationship.”

In the paper

“as were the two MBSR related variables”

In the paper

“We also found that prior decreases in social anxiety predicted subsequent increases in mindful attitude during both CBGT and MBSR, and subsequent increases in acceptance success during MBSR only.”

In the paper

“However, the inverse relationship was significant, F(2,11) = 5.40, p > .05, ΔR2 = .12.”

In the paper

“In summary, all three indicators of reappraisal improved significantly during both CBGT and MBSR, but CBGT resulted in greater improvement than MBSR for disputing and reappraisal success.”

• Also stated in: § The Role of Cognitive Reappraisal in CBGT and MBSR · plain

  “Compared to MBSR, CBGT led to greater increases in the weekly trajectories of disputing and reappraisal success.”

In the paper

“Cognitive-behavioral therapy (CBT) is considered the most efficacious and effective psychosocial intervention for SAD (Gordon et al., 2014).”

What the sources say

• ?Not checked — no full text of the sourcecites Gordon et al., 2014 source

In the paper

“Based on a criterion of 9 of 12 sessions attended for treatment completer status, 33 (92%) of patients completed CBGT and 33 (92%) completed MBSR. Mean number of sessions attended for CBGT (Mean ± SD = 10.47 ± 1.56) and MBSR (10.37 ± 2.09) was not significantly different, t(71) = 0.22, p = .82.”

In the paper

“The sequence of groups was determined by a random number generator constrained to 6 instances for each of the three types of group so that at the end of the study we had 18 groups of 6 patients, with 6 groups each for CBGT, MBSR or WL.”

In the paper

“However, a recent review (Norton, Abbott, Norberg, & Hunt, 2015) concluded that, although mindfulness and acceptance-based treatments may reduce social anxiety symptoms in adults with SAD, methodological weaknesses (e.g., small sample sizes, lack of an active treatment comparisons or control groups) limit the confidence that should be placed in the results reported for MBSR in patients with SAD.”

What the sources say

• ?Not checked — no full text of the sourcecites Norton, Abbott, Norberg, & Hunt, 2015 source

In the paper

“However, it is still not clear whether CBT and MBSR produce similar changes across therapeutic processes during treatment.”

What the sources say

• ?Not checked — no full text of the sourcecites Norton et al., 2015 source

In the paper

“The ADIS-IV has demonstrated excellent inter-rater reliability (Brown, Di Nardo, Lehman, & Campbell, 2001).”

What the sources say

• ?Not checked — no full text of the sourcecites Brown, Di Nardo, Lehman, & Campbell, 2001 source

In the paper

“In summary, the Granger Causality analysis showed that 2 of 3 cognitive reappraisal indicators during CBGT and one cognitive reappraisal indicator during MBSR predicted subsequent social anxiety reduction during treatment.”

In the paper

“Adherence ratings indicated that both CBGT therapists and MBSR instructors were “in protocol” (rating > 4 of 5 for each session) with no between-group differences, t(11) = 0.83, p = .43, in adherence for CBGT (Mean ± SD: 4.92 ± 0.27) versus MBSR (4.81 ± 0.17).”

In the paper

“Weekly change intent-to-treat analyses included all patients except two who did not provide weekly data. Thus, the final sample was 106 patients.”

In the paper

“Furthermore, weekly trajectories of mindfulness and cognitive reappraisal and their relationship to clinical symptoms have not been examined during MBSR and have not been compared to CBT for SAD.”

In the paper

“In summary, while both CBGT and MBSR produced increases in weekly mindful attitude, only MBSR produced increases in acceptance and acceptance success.”

In the paper

“Because there were no significant differences, we combined data from the immediate and delayed treatment groups to increase statistical power to detect changes during CBGT (n = 54) versus MBSR (n = 52).”

In the paper

“Furthermore, many patients do not have access to quality CBT or are hesitant to enter psychotherapy (Wolitzky-Taylor et al., 2015).”

What the sources say

• ?Not checked — no full text of the sourcecites Wolitzky-Taylor et al., 2015 source

In the paper

“Older age was associated with greater likelihood of missing data for the last three sessions, b = 0.06, Wald’s Z = 4.62, p = .031, Odds Ratio = 1.06. Therefore, we included age as a covariate in all multilevel modeling analyses. No other variables predicted missingness.”

In the paper

“This non-differentiation of the meaning of weekly questions may have interfered with accurate responses.”

In the paper

“The single study that directly compared CBGT (n = 27) to MBSR (n = 26) in patients with SAD (Koszycki et al., 2007) found comparable pre-to-post-treatment improvement in mood, functioning, and quality of life, and, importantly, greater improvement for CBGT vs. MBSR in social anxiety, response rates and remission rates.”

What the sources say

• ?Not checked — no full text of the sourcecites Koszycki et al., 2007 source

In the paper

“Thus, our findings confirm the expected impact of CBGT on cognitive reappraisal and suggest that MBSR also may increase cognitive reappraisal ability and implementation.”

In the paper

“More broadly, acceptance of experience may be viewed as an emotion regulation strategy that may incorporate aspects of cognitive reappraisal, at least initially, and then may differ more when the individual begins to implement acceptance more spontaneously rather than volitionally.”

In the paper

“These findings both support and contradict our current conceptualization of how we expect MBSR to work.”

In the paper

“In summary, the Granger Causality analysis showed that none of the mindfulness indicators during CBGT and only one mindfulness indicator during MBSR predicted subsequent social anxiety reduction during treatment.”

In the paper

“We found partial support for Hypothesis 3, with prior increases in 2 of 3 weekly reappraisal indicators (reappraisal, reappraisal success) predicting subsequent decreases in social anxiety during CBGT (but not during MBSR), and increases in 1 of 3 weekly mindfulness indicators (mindful attitude) predicting subsequent decreases in social anxiety during MBSR (but not during CBGT).”

In the paper

“This suggests a synergistic relationship between mindfulness skills (e.g., acceptance) and cognitive reappraisal.”

In the paper

“It is important to note that traditional Buddhist models characterize mindfulness meditation training as a set of tools for enhancing mental qualities, skills and attitudes that already exist in human beings but require enhancement and refinement (Thera, 1998).”

What the sources say

• ?Not matched

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

  cites Thera, 1998

In the paper

“Implementation of mindfulness skills may be less effortful than cognitive reappraisal, and thus the access to cognitive resources and executive functioning afforded by even small reductions in social anxiety impact mindfulness skills more easily relative to cognitive reappraisal strategies.”

In the paper

“Furthermore, differences in the meaning of what is being assessed by some of the weekly questions, for example, “try to change the way you were thinking” (cognitive change strategy of reappraisal) versus “adopting a mindful, open, curious, and willing attitude” (observing/noticing/accepting/allowing strategy) are subtle, and there is no guarantee that the participants in our study after 12 weeks”

In the paper

“This may be due to acceptance of emotion being difficult to do and being unfamiliar in patients with SAD.”

In the paper

“However, under the rubric of mindfulness, there are a variety of practices that likely impact different types of mindfulness skills and attitudes.”

In the paper

“A cross-sectional study in a community sample demonstrated that acceptance of emotion is implemented to a greater extent across different situations than any other emotion regulation strategy, including cognitive reappraisal, and negatively predicted psychopathology (Aldao & Nolen-Hoeksema, 2012).”

What the sources say

• ?Not checked — no full text of the sourcecites Aldao & Nolen-Hoeksema, 2012 source

In the paper

“One explanation is that during CBGT reappraisal skills increase, anxiety decreases, and these changes may disinhibit latent mindfulness skills and attitudes that had been chronically suppressed in patients with SAD.”