KENTARO SHIROTSUKI

AIM: Cost and probability biases are known to predict improvements in symptoms of social anxiety disorder (SAD). This study developed a high-intensity mindfulness and cognitive behavioral group therapy (M-CBT) program-comprising mindfulness training, psychoeducation, cognitive restructuring, exposure exercises, and group sharing-designed to reduce these biases. The intervention was delivered in a group format, and its preliminary efficacy in patients with SAD was evaluated in a pilot single-arm trial. METHODS: Patients (N = 10) diagnosed with SAD through a structured clinical interview participated in an eight-session M-CBT program. They completed a set of questionnaires assessing SAD symptoms, cost and probability biases, fear of negative evaluation, self-focused attention, depressive symptoms, subjective happiness, dispositional mindfulness, cognitive reappraisal, and suppression at pre-intervention, mid-intervention, post-intervention, and follow-up. RESULTS: Analyses using linear mixed-effects models revealed that high-intensity M-CBT produced improvements in SAD symptoms, cost and probability biases, depressive symptoms, subjective happiness, dispositional mindfulness, and cognitive reappraisal (p < 0.05). The intervention also yielded significant reductions in cost and probability biases from pre- to post-treatment and at follow-up, with large effect sizes (cost bias: Cohen's d = 0.85-1.27; probability bias: d = 1.07-2.42). In contrast, the effect sizes for SAD symptoms were moderate (d = 0.57-0.67). CONCLUSIONS: These findings suggest that high-intensity M-CBT can alleviate SAD symptoms and reduce cost and probability biases. Moreover, delivering M-CBT in a high-intensity format appears to be effective for individuals with SAD. Future randomized-controlled trials are warranted to more rigorously confirm these effects.

Self-focused attention, cost/probability bias, and avoidance behavior are maintaining factors of social anxiety. The manipulation of dispositional mindfulness has been shown to reduce social anxiety and its maintaining factors. This study examined the associations among dispositional mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety to explore the mechanism of mindfulness and its relationship with social anxiety in patients with social anxiety disorder (SAD) and university students. Data from 412 patients with SAD and 367 students were analyzed using psychometric network analysis. Both groups completed self-report measures assessing dispositional mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. A weak negative association was found between non-judging in dispositional mindfulness and self-focused attention to one's behavior in the SAD patients' network. In the students' network, a weak negative association was observed between non-judging and self-focused attention to one's behaviors, as well as between describing and social anxiety. In the SAD patients' network, nodes with the highest strength centrality were probability bias and social anxiety. In the students' network, nodes with the highest strength centrality were social anxiety and cost bias. The global network structure and connectivity differed between patients with SAD and students. The findings support the cognitive-behavioral model of SAD and highlight the heterogeneity of social anxiety, necessitating tailored intervention strategies.

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.