Background-Social anxiety disorder (SAD) is characterized by distorted negative self-beliefs (NSBs) which are thought to enhance emotional reactivity, interfere with emotion regulation, and undermine social functioning. Cognitive reappraisal is a type of emotion regulation used to alter NSBs, with the goal of modulating emotional reactivity. Despite its relevance, little is known about the neural bases and temporal features of cognitive reappraisal in patients with SAD.

Objective To examine whether changes in cognitive reappraisal self-efficacy (CR-SE) mediate the effects of individually-administered Cognitive-Behavioral Therapy (I-CBT) for social anxiety disorder (SAD) on severity of social anxiety symptoms. Method A randomized controlled trial in which 75 adult patients (21–55 years of age; 53% male; 57% Caucasian) with a principal diagnosis of generalized SAD were randomly assigned to 16 sessions of I-CBT (n = 38) or a waitlist control (WL) group (n = 37). All patients completed self-report inventories measuring cognitive reappraisal self-efficacy (CR-SE) and social anxiety symptoms at baseline and post-I-CBT/post-WL, and I-CBT completers were also assessed at 1-year post-treatment. Results Compared to WL, I-CBT resulted in greater increases in CR-SE and greater decreases in social anxiety. Increases in CR-SE during I-CBT mediated the effect of I-CBT on social anxiety. Gains achieved by patients receiving I-CBT were maintained 1-year post-treatment, and I-CBT-related increases in CR-SE were also associated with reduction in social anxiety at the 1-year follow-up. Conclusions Increasing CR-SE may be an important mechanism by which I-CBT for SAD produces both immediate and long-term reductions in social anxiety.

OBJECTIVE Effective treatments for social anxiety disorder (SAD) exist, but additional treatment options are needed for non-responders as well as those who are either unable or unwilling to engage in traditional treatments. Mindfulness-Based Stress Reduction (MBSR) is one non-traditional treatment that has demonstrated efficacy in treating other mood and anxiety disorders, and preliminary data suggest its efficacy in SAD as well. METHOD Fifty-six adults (52% female; 41% Caucasian; Age (M ± SD): 32.8 ± 8.4) with SAD were randomized to MBSR or an active comparison condition, aerobic exercise (AE). At baseline and post-intervention, participants completed measures of clinical symptoms (Liebowitz Social Anxiety Scale, Social Interaction Anxiety Scale, Beck Depression Inventory-II, and Perceived Stress Scale) and subjective well-being (Rosenberg Self-Esteem Scale, Satisfaction with Life Scale, Self-Compassion Scale and UCLA-8 Loneliness Scale). At 3-months post intervention, a subset of these measures were re-administered. For clinical significance analyses, 48 healthy adults (52.1% female; 56.3% Caucasian; Age (M ± SD): 33.9 ± 9.8) were recruited. MBSR and AE participants were also compared to a separate untreated group of 29 adults (44.8% female; 48.3% Caucasian; Age (M ± SD): 32.3 ± 9.4) with generalized SAD who completed assessments over a comparable time period with no intervening treatment. RESULTS A 2 (Group) × 2 (Time) repeated-measures analyses of variance (ANOVAs) on measures of clinical symptoms and well-being were conducted to examine pre to post and pre- to 3-month follow-up. MBSR and AE were both associated with reductions in social anxiety and depression and increases in subjective well-being, both immediately post intervention and at 3-months post intervention. When participants in the RCT were compared to the untreated SAD group, participants in both interventions exhibited improvements on measures of clinical symptoms and well-being. CONCLUSION Non-traditional interventions such as MBSR and AE merit further exploration as alternative or complementary treatments for SAD.

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Etiological models of social anxiety disorder (SAD) suggest that early childhood trauma contributes to the development of this disorder. However, surprisingly little is known about the link between different forms of childhood trauma and adult clinical symptoms in SAD. This study (1) compared levels of childhood trauma in adults with generalized SAD versus healthy controls (HCs), and (2) examined the relationship between specific types of childhood trauma and adult clinical symptoms in SAD. Participants were 102 individuals with generalized SAD and 30 HCs who completed measures of childhood trauma, social anxiety, trait anxiety, depression, and selfesteem. Compared to HCs, individuals with SAD reported greater childhood emotional abuse and emotional neglect. Within the SAD group, childhood emotional abuse and neglect, but not sexual abuse, physical abuse, or physical neglect, were associated with the severity of social anxiety, trait anxiety, depression, and self-esteem.