Fear of negative and positive evaluation as mediators and moderators of treatment outcome in social anxiety disorder.

INTRODUCTION: Elevated fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are thought to play key roles in the maintenance of social anxiety disorder (SAD). Although efficacious therapies exist for SAD, the potential mediating and moderating effects of FNE and FPE on social anxiety treatment outcome have not been examined. METHODS: This sample comprised a secondary analysis of 210 individuals who participated in one of three randomized controlled trials for the treatment of SAD. Participants were randomized to: individual cognitive behavioral therapy (CBT), group CBT, community mindfulness-based stress reduction (MBSR), group MBSR, or they were randomized to waitlist and offered treatment after waitlist. Assessments were completed pre- and post-treatment/waitlist and, for the treatment groups, at three-month follow-up. RESULTS: CBT and MBSR led to greater reductions in FNE and FPE than waitlist, with CBT more efficacious in reducing FPE than MBSR. For both CBT (vs. waitlist) and MBSR (vs. waitlist), there were significant indirect effects on post-treatment social anxiety through both FNE and FPE, and the indirect effect through FPE was greater for CBT than MBSR. However, in the fully longitudinal model testing mediation, CBT and MBSR were not differentially mediated by FPE. Baseline FNE and FPE each moderated CBT treatment outcome compared to waitlist - higher baseline FNE and FPE were associated with higher baseline social anxiety and greater reductions in social anxiety during CBT. DISCUSSION: FNE and FPE contributed in sometimes similar and sometimes distinct ways to the mediation and moderation of psychosocial approaches for treating SAD. This supports the importance of distinguishing between fears of negative and positive evaluation in the assessment and treatment of SAD.

Effects of a mindfulness-based program on the occupational balance and mental health of university students. Protocol for a randomized controlled trial.

OBJECTIVE: The aim is to examine whether the addition of Virtual Reality (VR) meditation training to a standard 8-week Mindfulness-Based Health Care Program (MBHC-VR) results in a significantly increased improvement in occupational, mental health, and psychological functioning versus MBHC-only in university students. MATERIALS AND METHODS: A randomized controlled clinical trial with three arms (MBHC, MBHC-VR, Control Group), four assessment time points (pre-intervention, inter-session, post-intervention, and 3-month follow-up), and mixed methodology will be proposed. University students (undergraduate, master, or doctoral) interested in participating and who meet the inclusion/exclusion criteria will be included over two years. Data will be collected from different ad hoc questionnaires, several standardized tests, and an Ecological Momentary Assessment. We will use R software to carry out descriptive analyses (univariate and bivariate), multilevel modeling, and structural equation models to respond to the proposed objective. The qualitative analysis will be carried out using the MAXQDA program and the technique of focus groups. DISCUSSION: It is expected that with the proposed intervention university students will learn to relate in a healthier way with their mental processes, so as to improve their occupational balance (OB) and their psychological well-being. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05929430.

Longitudinal outcomes of a therapist-supported digital mental health intervention for depression and anxiety symptoms: A retrospective cohort study.

PURPOSE: This study examined treatment outcomes (depression and anxiety symptoms) up to 24 months after completion of a therapist-supported digital mental health intervention (DMHI). METHODS: The sample consisted of 380 participants who participated in an eight-week DMHI from February 6, 2017 to May 20, 2019. Participants reported depression and anxiety symptoms at eight timepoints from baseline to 24 months. Mixed-effects modelling was used to investigate symptom changes over time. The proportion of participants meeting criteria for treatment response, clinically significant change, and remission of depression and anxiety symptoms were calculated, including proportions demonstrating each outcome sustained up to each timepoint. RESULTS: Multivariate analyses yielded statistically significant reductions in depression (ß = -5.40) and anxiety (ß = -3.31) symptoms from baseline to end of treatment (8 weeks). Symptom levels remained significantly reduced from baseline through 24 months. The proportion of participants meeting criteria for clinical treatment outcomes remained constant over 24 months, although there were linear decreases in the proportions experiencing sustained clinical outcomes. CONCLUSIONS: Treatment gains were made for depression and anxiety symptoms at the end of treatment and up to 24 months. Future studies should determine the feasibility of integrating post-treatment programmes into DMHIs to address symptom deterioration.

The Neural Separability of Emotion Reactivity and Regulation.

One foundational distinction in affective science is between emotion reactivity and regulation. This conceptual distinction has long been assumed to be instantiated in spatially separable brain systems (a typical example: amygdala/insula for reactivity and frontoparietal areas for regulation). In this research, we begin by reviewing previous findings that support and contradict the neural separability hypothesis concerning emotional reactivity and regulation. Further, we conduct a direct test of this hypothesis with empirical data. In five studies involving healthy and clinical samples (total n = 336), we assessed neural responses using fMRI while participants were asked to either react naturally or regulate their emotions (using reappraisal) while viewing emotionally evocative stimuli. Across five studies, we failed to find support for the neural separability hypothesis. In univariate analyses, both presumptive "reactivity" and "regulation" brain regions demonstrated equal or greater activation for the reactivity contrast than for the regulation contrast. In multivariate pattern analyses (MVPA), classifiers decoded reactivity (vs. neutral) trials more accurately than regulation (vs. reactivity) trials using multivoxel data in both presumptive "reactivity" and "regulation" regions. These findings suggest that emotion reactivity and regulation-as measured via fMRI-may not be as spatially separable in the brain as previously assumed. Our secondary whole-brain analyses revealed largely consistent results. We discuss the two theoretical possibilities regarding the neural separability hypothesis and offer thoughts for future research. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-023-00227-9.

A neurophenomenological fMRI study of a spontaneous automatic writer and a hypnotic cohort.

PURPOSE: To evaluate the neurophenomenology of automatic writing (AW) in a spontaneous automatic writer (NN) and four high hypnotizables (HH). METHODS: During fMRI, NN and the HH were cued to perform spontaneous (NN) or induced (HH) AW, and a comparison task of copying complex symbols, and to rate their experience of control and agency. RESULTS: Compared to copying, for all participants AW was associated with less sense of control and agency and decreased BOLD signal responses in brain regions implicated in the sense of agency (left premotor cortex and insula, right premotor cortex, and supplemental motor area), and increased BOLD signal responses in the left and right temporoparietal junctions and the occipital lobes. During AW, the HH differed from NN in widespread BOLD decreases across the brain and increases in frontal and parietal regions. CONCLUSIONS: Spontaneous and induced AW had similar effects on agency, but only partly overlapping effects on cortical activity.

Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis.

Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.

Nonlinear brain correlates of trait self-boundarylessness.

Alterations of the sense of self induced by meditation include an increased sense of boundarylessness. In this study, we investigated behavioural and functional magnetic resonance imaging correlates of trait self-boundarylessness during resting state and the performance of two experimental tasks. We found that boundarylessness correlated with greater self-endorsement of words related to fluidity and with longer response times in a math task. Boundarylessness also correlated negatively with brain activity in the posterior cingulate cortex/precuneus during mind-wandering compared to a task targeting a minimal sense of self. Interestingly, boundarylessness showed quadratic relations to several measures. Participants reporting low or high boundarylessness, as compared to those in between, showed higher functional connectivity within the default mode network during rest, less brain activity in the medial prefrontal cortex during self-referential word processing, and less self-endorsement of words related to constancy. We relate these results to our previous findings of a quadratic relation between boundarylessness and the sense of perspectival ownership of experience. Additionally, an instruction to direct attention to the centre of experience elicited brain activation similar to that of meditation onset, including increases in anterior precentral gyrus and anterior insula and decreases in default mode network areas, for both non-meditators and experienced meditators.

Examining the temporal dynamics of anxiety and depressive symptoms during a therapist-supported, smartphone-based intervention for depression: Longitudinal observational study.

OBJECTIVE: This study examined the temporal dynamics of anxiety and depressive symptoms during a 12-week therapist-supported, smartphone-delivered digital health intervention for symptoms of depression and anxiety. METHODS: A total of 290 participants were included in the present analyses (age Mean = 39.64, SD = 10.25 years; 79% female; 54% self-reported psychotropic medication use). Linear mixed models were used to examine the concurrent anxiety-depression association and (2) the lead-lag anxiety-depression relationship, with greater anxiety predicted to precede an increase in depression. RESULTS: In support of Hypothesis 1, greater anxiety during the current biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment. In support of Hypothesis 2, greater anxiety during the prior biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment but not vice-versa. CONCLUSION: These findings demonstrate that anxiety and depressive symptoms may overlap and fluctuate in concert, with anxiety symptoms predicting subsequent depressive symptoms but not vice-versa. With sensitivity to study limitations, implications for future intervention designs are discussed.

Mindfulness-Based Stress Reduction, Cognitive Behavioral Therapy, and Acupuncture in Chronic Low Back Pain: Protocol for Two Linked Randomized Controlled Trials.

BACKGROUND: Nonpharmacologic mind-body therapies have demonstrated efficacy in low back pain. However, the mechanisms underlying these therapies remain to be fully elucidated. OBJECTIVE: In response to these knowledge gaps, the Stanford Center for Low Back Pain-a collaborative, National Institutes of Health P01-funded, multidisciplinary research center-was established to investigate the common and distinct biobehavioral mechanisms of three mind-body therapies for chronic low back pain: cognitive behavioral therapy (CBT) that is used to treat pain, mindfulness-based stress reduction (MBSR), and electroacupuncture. Here, we describe the design and implementation of the center structure and the associated randomized controlled trials for characterizing the mechanisms of chronic low back pain treatments. METHODS: The multidisciplinary center is running two randomized controlled trials that share common resources for recruitment, enrollment, study execution, and data acquisition. We expect to recruit over 300 chronic low back pain participants across two projects and across different treatment arms within each project. The first project will examine pain-CBT compared with MBSR and a wait-list control group. The second project will examine real versus sham electroacupuncture. We will use behavioral, psychophysical, physical measure, and neuroimaging techniques to characterize the central pain modulatory and emotion regulatory systems in chronic low back pain at baseline and longitudinally. We will characterize how these interventions impact these systems, characterize the longitudinal treatment effects, and identify predictors of treatment efficacy. RESULTS: Participant recruitment began on March 17, 2015, and will end in March 2023. Recruitment was halted in March 2020 due to COVID-19 and resumed in December 2021. CONCLUSIONS: This center uses a comprehensive approach to study chronic low back pain. Findings are expected to significantly advance our understanding in (1) the baseline and longitudinal mechanisms of chronic low back pain, (2) the common and distinctive mechanisms of three mind-body therapies, and (3) predictors of treatment response, thereby informing future delivery of nonpharmacologic chronic low back pain treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT02503475; https://clinicaltrials.gov/ct2/show/NCT02503475. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37823.

Optimized short-forms of the Cognitive Distortions Questionnaire.

INTRODUCTION: The Cognitive Distortions Questionnaire (CD-Quest) is a self-report questionnaire that assesses common cognitive distortions. Although the CD-Quest has excellent psychometric properties, its length may limit its use. METHODS: We attempted to develop short-forms of the CD-Quest using RiskSLIM - a machine learning method to build short-form scales that can be scored by hand. Each short-form was fit to maximize concordance with the total CD-Quest score for a specified number of items based on an objective function, in this case R2, by selecting an optimal subset of items and an optimal set of small integer weights. The models were trained in a sample of US undergraduate students (N = 906). We then validated each short-form on five independent samples: two samples of undergraduate students in Brazil (Ns = 182, 183); patients with depression in Brazil (N = 62); patients with social anxiety disorder in the US (N = 198); and psychiatric outpatients in Turkey (N = 269). RESULTS: A 9-item short-form with integer scoring was created that reproduced the total 15-item CD-Quest score in all validation samples with excellent accuracy (R2 = 90.4-93.6%). A 5-item ultra-short-form had good accuracy (R2 = 78.2-85.5%). DISCUSSION: A 9-item short-form and a 5-item ultra-short-form of the CD-Quest both reproduced full CD-Quest scores with excellent to good accuracy. These shorter versions of the full CD-Quest could facilitate measurement of cognitive distortions for users with limited time and resources.

Microaggressions, school satisfaction and depression: A national survey of nursing students.

BACKGROUND: Microaggressions are thought to negatively impact learning and mental health in underrepresented (UR) nursing students. PURPOSE: The purpose of this study was to investigate three hypotheses in a sample of nursing students: (a) whether, compared to White nursing students, UR nursing students experienced higher frequency of microaggressions, (b) whether microaggressions predict lesser satisfaction with nursing training and (c) whether microaggressions are associated with higher depression screening scores. METHODS: A survey during Summer 2020 assessed 862 nursing students (71.8% female, Mean age = 28.8, SD = 9.27, 61.4% White, 20.0% UR) on microaggressions, satisfaction with their nursing program, and depression symptoms. DISCUSSION: We found that compared to White nursing students, UR nursing students reported significantly greater microaggression frequency (with Black students reporting the highest frequency), lesser nursing training satisfaction, and equivalent potential depression rates. CONCLUSION: Microaggressions deteriorate indicators of wellbeing, especially in UR nursing students. Strategic action to mitigate microaggressions and promote inclusion is needed.

Frontoparietal and Default Mode Network Contributions to Self-Referential Processing in Social Anxiety Disorder.

Social anxiety disorder (SAD) is characterized by negative self-referential processing, which triggers excessive emotional reactivity. In healthy individuals, positive self-views typically predominate and are supported by regions of the default mode network (DMN) that represent self-related information and regions of the frontoparietal control network (FPCN) that contribute to metacognitive awareness and emotion regulation. The current study used functional magnetic resonance imaging (fMRI) to examine patterns of DMN and FPCN activation during positive and negative self-referential judgments in SAD patients (N = 97) and controls (N = 34). As expected, SAD patients demonstrated a striking difference in self-beliefs compared with non-anxious healthy controls, endorsing fewer positive traits and more negative traits. However, SAD patients and controls demonstrated largely similar patterns of DMN and FPCN recruitment during self-referential judgements. No significant group differences were observed. However, equivalence testing identified numerous regions demonstrating effect sizes that were not small enough to conclude that they were practically equivalent to zero, despite the nonsignificant null hypothesis test. These regions may be key targets to investigate in future studies using larger samples.

Alpha and theta oscillations are inversely related to progressive levels of meditation depth.

Meditation training is proposed to enhance mental well-being by modulating neural activity, particularly alpha and theta brain oscillations, and autonomic activity. Although such enhancement also depends on the quality of meditation, little is known about how these neural and physiological changes relate to meditation quality. One model characterizes meditation quality as five increasing levels of 'depth': hindrances, relaxation, concentration, transpersonal qualities and nonduality. We investigated the neural oscillatory (theta, alpha, beta and gamma) and physiological (respiration rate, heart rate and heart rate variability) correlates of the self-reported meditation depth in long-term meditators (LTMs) and meditation-naïve controls (CTLs). To determine the neural and physiological correlates of meditation depth, we modelled the change in the slope of the relationship between self-reported experiential degree at each of the five depth levels and the multiple neural and physiological measures. CTLs reported experiencing more 'hindrances' than LTMs, while LTMs reported more 'transpersonal qualities' and 'nonduality' compared to CTLs, confirming the experiential manipulation of meditation depth. We found that in both groups, theta (4-6 Hz) and alpha (7-13 Hz) oscillations were related to meditation depth in a precisely opposite manner. The theta amplitude positively correlated with 'hindrances' and increasingly negatively correlated with increasing meditation depth levels. Alpha amplitude negatively correlated with 'hindrances' and increasingly positively with increasing depth levels. The increase in the inverse association between theta and meditation depth occurred over different scalp locations in the two groups-frontal midline in LTMs and frontal lateral in CTLs-possibly reflecting the downregulation of two different aspects of executive processing-monitoring and attention regulation, respectively-during deep meditation. These results suggest a functional dissociation of the two classical neural signatures of meditation training, namely, alpha and theta oscillations. Moreover, while essential for overcoming 'hindrances', executive neural processing appears to be downregulated during deeper meditation experiences.

Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial.

Importance: Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD. Objective: To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment. Design, Setting, and Participants: In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020. Interventions: CBGT and MBSR. Main Outcomes and Measures: Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment. Results: Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (ß, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (ß, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (ß, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment. Conclusions and Relevance: The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies. Trial Registration: ClinicalTrials.gov Identifier: NCT02036658.

Individual differences in perceived sleep quality do not predict negative affect reactivity or regulation.

Do people who have low-quality sleep tend to have more negative affect? This question is of great public interest, and many would assume the answer is "yes." However, previous findings have been mixed, possibly due to differing measures of sleep and affect, or to a failure to separately examine negative affect reactivity and regulation. Across two studies, we assessed adults' perceived sleep quality for at least two weeks and tested their negative affect reactivity and regulation in response to unpleasant pictures (Study 1) or painful thermal stimulation (Study 2) using both self-report and physiological measures. The relationships between perceived sleep quality, on the one hand, and negative affect reactivity and regulation, on the other, were non-significant. Furthermore, a Bayesian approach unanimously favored the null hypothesis. These results suggest that individual differences in perceived sleep quality may not predict negative affect reactivity or regulation across adult individuals.

Brain markers predicting response to cognitive-behavioral therapy for social anxiety disorder: an independent replication of Whitfield-Gabrieli et al. 2015.

Predictive brain markers promise a number of important scientific, clinical, and societal applications. Over 600 predictive brain markers have been described in published reports, but very few have been tested in independent replication attempts. Here, we conducted an independent replication of a previously published marker predicting treatment response to cognitive-behavioral therapy for social anxiety disorder from patterns of resting-state fMRI amygdala connectivity1. The replication attempt was conducted in an existing dataset similar to the dataset used in the original report, by a team of independent investigators in consultation with the original authors. The precise model described in the original report positively predicted treatment outcomes in the replication dataset, but with marginal statistical significance, permutation test p = 0.1. The effect size was substantially smaller in the replication dataset, with the model explaining 2% of the variance in treatment outcomes, as compared to 21% in the original report. Several lines of evidence, including the current replication attempt, suggest that features of amygdala function or structure may be able to predict treatment response in anxiety disorders. However, predictive models that explain a substantial amount of variance in independent datasets will be needed for scientific and clinical applications.

Neural correlates of nonjudgmental perception induced through meditation.

Ambiguous sensory stimuli provide insight into the dynamics of the human mind. When viewing substantially different images in the two eyes (i.e., binocular rivalry (BR)), perception spontaneously fluctuates between the two images along with patch-like mixtures of the two, with limited ability to control such fluctuations. Previous studies have shown that long-term meditation training can enable a more stable perception by reducing such fluctuations. Using electroencephalography, we investigated the neural bases of perceptual stabilization in long-term meditators (LTMs) and age-matched meditation-naive control participants. We measured BR alternations before and after participants practiced meditation. We expected that perceptual stabilization through meditation could occur via one of two neurocognitive mechanisms: (1) a more engaged/effortful attention reflected by increased long-range phase synchronization between early visual sensory and higher-level brain regions, or (2) a disengaged/nonevaluative form of attention reflected by decreased phase synchronization. We found that compared with control participants, LTMs were in a significantly longer mixed perceptual state following concentrative meditation practice. The increase in mixed percepts across individuals was strongly correlated with reduced parietal-occipital gamma-band (30-50 Hz) phase synchrony. These findings suggest that concentrative meditation enables a nonevaluative perceptual stance supported by reduced communication between hierarchical visual brain regions.

The moderating effects of anger suppression and anger expression on cognitive behavioral group therapy and mindfulness-based stress reduction among individuals with social anxiety disorder.

BACKGROUND: . Cognitive-behavioral therapy and mindfulness-based stress reduction (MBSR) are two prominent evidence-based treatments for social anxiety disorder (SAD). It is not clear, however, whether outcomes of these two treatments are moderated by similar factors. For example, whereas anger suppression and anger expression each predict outcomes in cognitive- behavioral group therapy (CBGT), it is unknown whether they differentially influence outcomes in CBGT versus MBSR. METHODS: . One hundred eight participants with SAD were randomized to CBGT, MBSR or Waitlist (WL). WL participants were later randomized to CBGT or MBSR, and their data were combined with data from those originally randomized to CBGT or MBSR. Anger suppression and anger expression were assessed at pre-treatment, and social anxiety was assessed at pre-treatment, post-treatment, and every 3 months throughout a 12-month follow-up period. RESULTS: . From pre- to post-treatment, higher anger suppression was associated with significantly greater reduction in social anxiety in CBGT compared with MBSR. From post-treatment through follow-up, higher anger expression was associated lesser reduction in social anxiety in MBSR but not in CBGT. LIMITATIONS: . Data are limited by sole reliance on self-report and it is unclear whether these findings generalize beyond group-based interventions. CONCLUSIONS: . Individuals with SAD who are higher in anger suppression and/or expression might be better suited to CBGT than MBSR.

Reductions in social anxiety during treatment predict lower levels of loneliness during follow-up among individuals with social anxiety disorder.

INTRODUCTION: Individuals with social anxiety disorder (SAD) are at elevated risk of loneliness, yet little research has examined loneliness in this population. Cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) have demonstrated efficacy in treating SAD, yet research has not examined whether they lead to reductions in loneliness. METHODS: This sample comprised 108 individuals with SAD who were randomized to CBGT, MBSR, or a waitlist control (WL); WL participants were re-randomized to CBGT or MBSR following WL. Assessments were completed pre- and post-treatment, and 3-, 6-, 9-, and 12-month follow-up assessments. RESULTS: Compared to WL, individuals in CBGT and MBSR were less lonely at post-treatment; there was no difference between treatments after treatment or during follow-up. Greater reductions in social anxiety from pre- to post-treatment predicted lower levels of loneliness during follow-up. Greater reductions in loneliness from pre- to post-treatment also predicted lower levels of social anxiety during follow-up. DISCUSSION: Individuals who experience reductions in their social anxiety during treatment may also feel less lonely following treatment. Reductions in loneliness also lead to improvements in social anxiety. Future research should continue to examine the relationship between social anxiety and loneliness and how interventions for SAD may help reduce loneliness.