Mindfulness Training boosts CBT in social phobia

Mindfulness training boosts CBT in social phobia by Diana Mahoney BOSTON -- Mindfulness training was shown to enhance cognitive-behavioral task-concentration techniques used to treat social phobia, Susan M. Bogels, Ph.D., reported at the annual meeting of the Association for Advancement of Behavior Therapy. Dr. Bogels' findings are based on the preliminary results of a Dutch study involving 10 patients diagnosed with social phobia, as measured by the Social Phobia and Anxiety Inventory. Patients were randomized to receive either combination therapy--mindfulness training plus task-concentration techniques--or task-concentration therapy alone. Those who received combination therapy showed more significant improvements based on self-report measures in levels of anxiety caused by negative thoughts and worry, compared with patients in the task-concentration control group, said Dr. Bogels of the University of Maastricht (the Netherlands). All of the patients were evaluated before and after the trial using a detailed structured interview (Structured Clinical Interview for DSM-IV) conducted by trained researchers, as well as various measurements of symptom severity and symptom impact on quality of life, and all patients received nine sessions of the therapy. As part of their therapy, patients in the experimental group received mindfulness training from therapists experienced in using the technique, which aims to change unhelpful and negative patterns of thinking that have become habit. Studies have shown that such thinking contributes to depressed mood, stress, and anxiety. "The [mindfulness training] approach focuses on the here and now, starting with body and breathing awareness--incorporating the advantages of applied relaxation--but also includes perceived negative aspects of self," Dr. Bogels said. The mindfulness exercises were used as the "starting point" for the implementation of task-concentration techniques, she explained. The latter involve first directing one's attention toward a task instead of oneself, then implementing coping strategies in both neutral and social phobic situations. The focus of task concentration stems from the assumption that social phobic individuals process themselves as social objects being negatively evaluated, ultimately leading to anxiety and possibly to cognitive and somatic symptoms, which in turn reinforce and increase the anxiety. The investigators evaluated the effect of the two therapies on four dependent variables: social phobia, cognition, attention, and other psychopathologies. Preliminary results showed significant improvements in both the social phobia and cognition composite scores, but no effect was reported on attention or other types of psychopathologies, Dr. Bogels noted. "The mean [posttest] effect size in terms of reducing the discrepancy between ideal and actual self--the general measure of happiness with oneself--was 1.8, which is significant," she said. Follow-up evaluations are ongoing. The combined approach may be successful because it enables patients to reduce such negative processes as attentional avoidance, self-focused attention, and mindless worrying while providing them with a sense of control over their attention and fostering improved self-esteem, Dr. Bogels said. Although a longer-term study with a larger sample is needed to validate the findings, the early results suggest that the combined approach may be an effective, efficient therapeutic alternative to existing methods. "Significant improvements were achieved in 9 sessions vs. the 12-16 sessions for current cognitive-behavioral therapy for social phobia," Dr. Bogels said. BY DIANA MAHONEY New England Bureau COPYRIGHT 2004 International Medical News Group COPYRIGHT 2008 Gale, Cengage Learning All ResourceLibrary