Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder

Abstract

Mindfulness-based stress reduction (MBSR) is an established program shown to reduce symptoms of stress, anxiety, and depression. MBSR is believed to alter emotional responding by modifying cognitive-affective processes. Given that social anxiety disorder (SAD) is characterized by emotional and attentional biases as well as distorted negative self-beliefs, we examined MBSR-related changes in the brain-behavior indices of emotional reactivity and regulation of negative self-beliefs in patients with SAD. Sixteen patients underwent functional MRI while reacting to negative self-beliefs and while regulating negative emotions using 2 types of attention deployment emotion regulation-breath-focused attention and distraction-focused attention. Post-MBSR, 14 patients completed neuroimaging assessments. Compared with baseline, MBSR completers showed improvement in anxiety and depression symptoms and self-esteem. During the breath-focused attention task (but not the distraction-focused attention task), they also showed (a) decreased negative emotion experience, (b) reduced amygdala activity, and (c) increased activity in brain regions implicated in attentional deployment. MBSR training in patients with SAD may reduce emotional reactivity while enhancing emotion regulation. These changes might facilitate reduction in SAD-related avoidance behaviors, clinical symptoms, and automatic emotional reactivity to negative self-beliefs in adults with SAD.

Figure 1

Structure for breath- and distraction-focused attention trials and asterisk counting trials. (A) Reacting to a negative self-belief followed by a cue to implement breath-focused or distraction-focused attention regulation while the same negative self-belief remains on the screen. (B) A single block of asterisk counting.

Figure 2

Negative emotion experience ratings pre- and post-mindfulness-based stress reduction (MBSR). The negative emotion ratings (How negative? 1 = not at all, 2 = slight, 3 = moderate, 4 = very much) when reacting to negative self-beliefs and when regulating using breath-focused attention and distraction-focused attention during the fMRI experimental task pre- and again post-MBSR. Ratings for reacting to negative self-beliefs were collected post-fMRI. * p < .01. Error bars represent standard error of the mean.

Figure 3

Greater blood oxygenation level-dependent (BOLD) contrast responses at baseline for the contrast of reacting to negative self-beliefs versus asterisk counting. Thresholded at t ≥ 3.69, voxel p < .005, cluster volume ≥ 163 mm³, cluster p < .01. dmPFC = dorsomedial prefrontal cortex; mPFC = medial prefrontal cortex; vmPFC = ventromedial prefrontal cortex; pCG = posterior cingulate gyrus; Amyg = amygdala; PHG = parahippocampal gyrus. x refers to the location of the sagittal slice (−= left; + = right). z refers to the location of the axial slice (−= inferior; + = superior).

Figure 4

Greater blood oxygenation level-dependent (BOLD) contrast responses for post-versus pre-mindfulness-based stress reduction (MBSR) for the contrast of breath-focused attention versus reacting to negative self-beliefs. Thresholded at t ≥ 3.21, voxel p < .005, cluster volume ≥ 163 mm³, cluster p < .01. MOG = middle occipital gyrus; PHG = parahippocampal gyrus; IPL = inferior parietal lobule; SPL = superior parietal lobule. x refers to the location of the sagittal slice (−= left; + = right). z refers to the location of the axial slice (−= inferior; + = superior).

Figure 5

Right dorsal amygdala blood oxygenation level-dependent (BOLD) contrast signal time series during reacting to negative self-beliefs and breath-focused attention in social phobics (SP) at both pre- and post-mindfulness-based stress reduction (MBSR). * p < .05. Rate = negative emotion rating; React = reacting to the negative self-belief; Breath-Focus = instruction to focus attention on breath sensation.