anxiety

Objective: The goal of this study was to investigate treatment outcome and mediators of cognitive–behavioral group therapy (CBGT) versus mindfulness-based stress reduction (MBSR) versus waitlist (WL) in patients with generalized social anxiety disorder (SAD).

Method: One hundred eight unmedicated patients (55.6% female; mean age = 32.7 years, SD = 8.0; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) were randomized to CBGT versus MBSR versus WL and completed assessments at baseline, posttreatment/WL, and at 1-year follow-up, including the Liebowitz Social Anxiety Scale—Self-Report (primary outcome; Liebowitz, 1987) as well as measures of treatment-related processes.

Results: Linear mixed model analysis showed that CBGT and MBSR both produced greater improvements on most measures compared with WL. Both treatments yielded similar improvements in social anxiety symptoms, cognitive reappraisal frequency and self-efficacy, cognitive distortions, mindfulness skills, attention focusing, and rumination. There were greater decreases in subtle avoidance behaviors following CBGT than MBSR. Mediation analyses revealed that increases in reappraisal frequency, mindfulness skills, attention focusing, and attention shifting, and decreases in subtle avoidance behaviors and cognitive distortions, mediated the impact of both CBGT and MBSR on social anxiety symptoms. However, increases in reappraisal self-efficacy and decreases in avoidance behaviors mediated the impact of CBGT (vs. MBSR) on social anxiety symptoms.

Conclusions: CBGT and MBSR both appear to be efficacious for SAD. However, their effects may be a result of both shared and unique changes in underlying psychological processes. 

Objective: Understanding for whom, and under what conditions, treatments exert their greatest effects is essential for developing personalized medicine. Research investigating moderators of outcome among evidence-based treatments for anxiety disorders is lacking. The current study examined several theory-driven and atheoretical putative moderators of outcome in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Method: Eighty-seven patients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000) anxiety disorder completed 12 sessions of ACT or CBT and were assessed with a self-report measure of anxiety at baseline, post-treatment, and 6- and 12-month follow-up assessments.

Results: CBT outperformed ACT among those at moderate levels of baseline anxiety sensitivity, and among those with no comorbid mood disorder. ACT outperformed CBT among those with comorbid mood disorders. Higher baseline neuroticism was associated with poorer outcome across treatment conditions. Neither moderation nor general prediction was observed for baseline anxiety disorder comorbidity, race/ethnicity, gender, age, or baseline severity of the principal anxiety disorder. When including all randomized participants who completed the pre-treatment assessment (N = 121), a similar pattern was observed.

Conclusions: Prescriptive recommendations for clinical practice and directions for future research are discussed.

Recent acceptance- and mindfulness-based cognitive–behavioral interventions explicitly target the clarification and commitment to a purpose in life. Yet, scant empirical evidence exists on the value of purpose as a mechanism relevant to psychopathology or well-being. The present research explored daily (within-person) fluctuations in purposeful pursuits and well-being in a community sample of 84 adults with (n = 41) and without (n = 43) the generalized subtype of social anxiety disorder (SAD). After completing an idiographic measure of purpose in life, participants monitored their effort and progress toward this purpose, along with their well-being each day. Across 2 weeks of daily reports, we found that healthy controls reported increased self-esteem, meaning in life, positive emotions, and decreased negative emotions. People with SAD experienced substantial boosts in well-being indicators on days characterized by significant effort or progress toward their life purpose. We found no evidence for the reverse direction (with well-being boosting the amount of effort or progress that people with SAD devote to their purpose), and effects could not be attributed to comorbid mood or anxiety disorders. Results provide evidence for how commitment to a purpose in life enriches the daily existence of people with SAD. The current study supports principles that underlie what many clinicians are already doing with clients for SAD. 

Anxiety disorders present a significant concern for children, affecting up to 20% of those under 12 years old. The importance of parenting behavior in the development and maintenance of childhood anxiety disorders has been established both theoretically and empirically. We review the literature on cognitive-behavioral parenting interventions aimed at reducing child anxiety and discuss the limitations of this approach and of the research to date. We then present Acceptance and Commitment Therapy (ACT) as a treatment model that holds promise for shifting problematic parent–child interactions, and we review the relevant theoretical and empirical literature supporting this promise.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.

Acceptance and Commitment Therapy, a popular transdiagnositic treatment approach, is based on the central tenant that human suffering develops and is exacerbated by psychological inflexibility. Cognitive fusion and experiential avoidance are two interrelated processes central to psychological inflexibility. Despite substantive theoretical rationale that these two processes impact one another’s association with emotional distress and psychopathology, the interaction between cognitive fusion and experiential avoidance in relation to psychological distress has yet to be empirically examined in the extant literature. As such, we examined this interactive effect in relation to four indices of psychological distress (anxiety, depression, stress, and posttraumatic stress) in a large sample of community adults recruited via the internet (N=955). The predicted interactive effect was found across all four symptom measures, with the significant positive association between cognitive fusion and symptom measures being strongest at higher levels of experiential avoidance. These results provide support for proposals that individuals with high cognitive fusion and high experiential avoidance may be particularly prone to experiencing psychological distress.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.

Shyness is a common problem that comes with a high price. If you suffer from shyness or social anxiety you might avoid social situations and may have trouble connecting with others due to an extreme fear of humiliation, rejection, and judgment. As a shy person, you may also experience panic attacks that make it even more likely that you’ll avoid social situations.

With The Mindfulness and Acceptance Workbook for Social Anxiety and Shyness, the authors’ acceptance and commitment therapy (ACT) program for overcoming shyness has become available to the public for the first time. This program has been found to be highly effective in research studies for the treatment of social anxiety disorder and related subclinical levels of shyness.

In the first section, you will confront performance fears, test anxiety, shy bladder, and interpersonal fears—fundamental symptoms of social anxiety. The second part helps you learn psychological flexibility to improve your ability to accept the feelings, thoughts, and behavior that may arise as you learn to work past your anxiety.

By keeping your values front and center, you will gradually learn to move beyond your fears and toward greater social confidence.

This book has been awarded The Association for Behavioral and Cognitive Therapies Self-Help Seal of Merit — an award bestowed on outstanding self-help books that are consistent with cognitive behavioral therapy (CBT) principles and that incorporate scientifically tested strategies for overcoming mental health difficulties. Used alone or in conjunction with therapy, our books offer powerful tools readers can use to jump-start changes in their lives.