Cognitive Behavioral Group Therapy and Mindfulness Based Stress Reduction Recruit Similar Brain Regions

Post by Lincoln Tracy

What's the science?

Social anxiety disorder is a common psychiatric disorder that affects around one in every eight people. Individuals affected by social anxiety disorder experience significant burdens on social functioning and quality of life. Two different treatments – cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) – have been proven effective in treating SAD. Previous research into the effects of CBGT and MBSR on social anxiety disorder has predominantly relied on self-report measures but has shown similar effects on decreasing negative thoughts while increasing mindfulness skills. Evidence suggests that CBGT and MBSR activate similar brain regions involved in emotion regulation. However, there is yet to be a study that directly compares the effects of CBGT and MBSR on emotion-regulating brain activation and how this activation relates to symptoms at 1-year post-treatment. This week in JAMA Psychiatry, Goldin and colleagues tested for common and specific effects of CBGT and MBSR on brain activity during emotion regulation in adults with social anxiety disorder.

How did they do it?

The authors recruited 108 patients with a diagnosis of social anxiety disorder. None of the patients were currently taking medication for their disorder. The patients were randomly assigned into one of three evenly sized groups: CBGT, MBSR, or the waitlist control group. Patients in the CBGT and MBSR groups received 12 2.5-hour sessions of their respective therapy from qualified instructors and received workbooks to supplement the 12 sessions. Assessments were completed at baseline and at 1-year post-treatment, consisting of self-report measures and completing an emotion regulation task while undergoing a functional magnetic resonance imaging (fMRI) scan. Pre- and post-treatment data were compared to determine: 1) the effects of treatment on negative emotions and brain activation compared to waitlist controls; 2) whether there were specific treatment effects on negative emotions and brain activation, and 3) if treatment-specific effects on negative emotions and brain activation related to social anxiety symptoms at 1-year post-treatment.

What did they find?

First, the authors found that compared to the waitlisted control patients, patients who received CBGT or MBSR displayed greater pre-treatment to post-treatment decreases in negative emotions while also increasing the recruitment of regulation-associated brain regions such as the prefrontal cortex when completing the emotion regulation task. Second, the authors found no difference between CBGT and MBSR with respect to negative emotions and brain responses during the emotion regulation task. This means that similar brain regions were activated during the task regardless of which treatment the patients received. Finally, the authors found that post-treatment negative emotion was associated with social anxiety symptoms at 1-year post-MBSR, but not post-CBGT.

What's the impact?

This study demonstrates that CBGT and MBSR may strengthen overlapping skills in dealing with social anxiety disorder and may rely on common emotion-regulating areas of the brain to produce these improvements. Both treatment approaches may be effective and have long-term benefits in patients with social anxiety disorder through the use of similar emotion regulation strategies. Further research is required to compare the effects of CBGT and MBSR with pharmacotherapy, as well as testing patients with different mood and anxiety disorders to see if the current results generalize to other clinical populations. 

Goldin et al. 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. JAMA Psychiatry (2021). Access the original scientific publication here.