KENTARO SHIROTSUKI

Abstract Background Cognitive–behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive–behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety. Methods Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment. Results A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51–1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention. Conclusions These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others. Trial registration University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.

Abstract A four-session program of mindfulness and cognitive behavioral therapy (M-CBT) is a low-intensity treatment module for individuals with high cost/probability bias and social anxiety symptoms. We tested its effectiveness with 23 patients with social anxiety disorder. The patients completed a set of questionnaires that evaluated social anxiety symptoms, cost/probability bias, fear of negative evaluation from others, self-focused attention, trait mindfulness, depressive symptoms, cognitive reappraisal, and suppression at pretreatment, the time before each session of treatment, post-treatment, and follow-up. Linear mixed-effects models showed that the M-CBT was effective for social anxiety symptoms, cost/probability bias, fear of negative evaluation from others, self-focused attention, trait mindfulness, depressive symptoms, and cognitive reappraisal. The M-CBT also produced significant pre-post-improvements in social anxiety symptoms and cost bias with high effect sizes (social anxiety symptoms: d = 1.04–1.06, cost bias: d = 0.82–1.02). These results suggest that M-CBT is effective for treating social anxiety symptoms and cost bias. This study demonstrates that M-CBT is feasible and acceptable for social anxiety disorder. It may comprise a treatment module for those who do not respond to traditional cognitive behavioral therapy. Trial registration number: University Hospital Medical Information Network (UMIN CTR) UMIN000043720, Registered 23 Mar 2021.