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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.
JAMA Psychiatry ( IF 22.5 ) Pub Date : 2021-10-01 , DOI: 10.1001/jamapsychiatry.2021.1862
Philippe R Goldin 1 , Matthew Thurston 2 , Santiago Allende 3 , Craig Moodie 4 , Matthew L Dixon 4 , Richard G Heimberg 5 , James J Gross 4
Affiliation  

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 (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (β, -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.

中文翻译:

认知行为疗法与正念冥想在社交焦虑症患者重新评估和接受期间大脑变化的评估:一项随机临床试验。

重要性认知行为小组疗法 (CBGT) 和基于正念的减压 (MBSR) 被认为可以通过不同的情绪调节机制帮助患有社交焦虑症 (SAD) 的患者。然而,没有研究比较 CBGT 和 MBSR 对 SAD 患者认知重评和接受的大脑和负面情绪指标的影响。目的 探讨 CBGT 和 MBSR 对 SAD 患者重新评估和接受的影响,并检验治疗相关的大脑变化是否与治疗后 1 年的社交焦虑症状相关。设计、设置和参与者 在这项随机临床试验中,共有 108 名诊断为全身性 SAD 的未服药成人被随机分配到 12 周的 CBGT、MBSR 或候补名单。最终样本包括 31 名接受 CBGT 的患者,32 名患者接受 MBSR,32 名候补患者。数据于 2012 年 9 月至 2014 年 12 月在斯坦福大学心理学系收集。数据分析于 2019 年 2 月至 2020 年 12 月。干预措施 CBGT 和 MBSR。主要结果和措施 自我报告的负面情绪和功能性磁共振成像 (fMRI) 血氧水平依赖 (BOLD) 信号在一个先验定义的大脑搜索区域掩码中的变化,该掩码源自对认知重新评估和注意力调节的荟萃分析治疗后 1 年。结果 108 名参与者中,60 名 (56%) 为女性。平均 (SD) 年龄为 32.7 (8.0) 岁。收集了自我报告的种族和民族数据,以告知该研究对更广泛人群的普遍性,并满足美国国立卫生研究院的要求。从美国国立卫生研究院提供的类别中,47 名参与者选择了白人 (43.5%),42 人选择了亚洲人 (38.9%) 10 人选择了拉丁裔 (9.3%),1 人选择了黑人 (1%),1 人选择了美洲原住民 (1%) ), 7 人选择了超过 1 个种族 (6.5%)。CBGT 和 MBSR 与消极情绪的显着降低相关(部分 η2 范围,0.38 至 0.53),反应时没有显着组间差异(β,-0.04;SE,0.09;95% CI,-0.11 至 0.08;t92 = -0.37;P = .71),重新评估(β,-0.15;SE,0.09;95% CI,-0.32 至 0.03;t92 = -1.67;P = .10),或接受(β,-0.05;SE , 0.08;95% CI,-0.20 至 0.11;t92 = -0.59;P = .56)。在重新评估 (CBGT = 0.031; MBSR = 0.037) 和接受 (CBGT = 0.012; MBSR = 0. 077)消极的自我信念。CBGT 和 MBSR 在减少负面情绪和增加重新评估和接受 BOLD 反应方面没有差异。重新评估相关的 MBSR (vs CBGT) 负面情绪和 CBGT (vs MBSR) 大脑反应与治疗后 1 年的社交焦虑症状相关。结论和相关性 本研究结果表明,CBGT 和 MBSR 可能是有效的治疗方法,对招募认知和注意力调节大脑网络的 SAD 患者具有长期益处。尽管治疗变化的模型不同,但 CBT 和 MBSR 都可以增强重新评估和接受情绪调节策略。试验注册 ClinicalTrials.gov 标识符:NCT02036658。重新评估相关的 MBSR (vs CBGT) 负面情绪和 CBGT (vs MBSR) 大脑反应与治疗后 1 年的社交焦虑症状相关。结论和相关性 本研究结果表明,CBGT 和 MBSR 可能是有效的治疗方法,对招募认知和注意力调节大脑网络的 SAD 患者具有长期益处。尽管治疗变化的模型不同,但 CBT 和 MBSR 都可以增强重新评估和接受情绪调节策略。试验注册 ClinicalTrials.gov 标识符:NCT02036658。重新评估相关的 MBSR (vs CBGT) 负面情绪和 CBGT (vs MBSR) 大脑反应与治疗后 1 年的社交焦虑症状相关。结论和相关性 本研究结果表明,CBGT 和 MBSR 可能是有效的治疗方法,对招募认知和注意力调节大脑网络的 SAD 患者具有长期益处。尽管治疗变化的模型不同,但 CBT 和 MBSR 都可以增强重新评估和接受情绪调节策略。试验注册 ClinicalTrials.gov 标识符:NCT02036658。结论和相关性 本研究结果表明,CBGT 和 MBSR 可能是有效的治疗方法,对招募认知和注意力调节大脑网络的 SAD 患者具有长期益处。尽管治疗变化的模型不同,但 CBT 和 MBSR 都可以增强重新评估和接受情绪调节策略。试验注册 ClinicalTrials.gov 标识符:NCT02036658。结论和相关性 本研究结果表明,CBGT 和 MBSR 可能是有效的治疗方法,对招募认知和注意力调节大脑网络的 SAD 患者具有长期益处。尽管治疗变化的模型不同,但 CBT 和 MBSR 都可以增强重新评估和接受情绪调节策略。试验注册 ClinicalTrials.gov 标识符:NCT02036658。
更新日期:2021-07-21
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