Abstract
Social anxiety disorder (SAD) is a debilitating and often chronic psychiatric disorder that typically onsets during early adolescence. Cognitive behavior therapy (CBT), the current “gold-standard” treatment for SAD, tends to focus on threat- and fear-based systems hypothesized to maintain the disorder. Despite this targeted approach, SAD ranks among the least responsive anxiety disorders to CBT in adolescent samples, with a considerable proportion of individuals still reporting clinically significant symptoms following treatment, suggesting that the CBT-family of interventions may not fully target precipitating or maintaining factors of the disorder. This gap in efficacy highlights the need to consider new therapeutic modalities. Accordingly, this brief review critically evaluates the emergent literature supporting the use of mindfulness-based interventions (MBIs) for treating adolescent SAD. MBIs may be particularly relevant for addressing maintaining factors within this diagnosis, as they may target and interrupt cycles of avoidance and de-motivation. Despite limitations in the relative lack of randomized controlled trials (RCTs) on this topic, a unique convergence of factors emerge from the extant literature that support the notion that MBIs may hold particular promise for attenuating symptoms of SAD in adolescents. These factors include: (1) MBIs demonstrate the ability to directly engage symptoms of SAD; (2) MBIs also show consistent reduction of anxiety, including symptoms of social anxiety in adolescent populations; and (3) MBIs demonstrate high rates of feasibility and acceptability in anxious adolescent samples. We briefly review each topic and conclude that MBIs are an encouraging treatment approach for reducing symptoms of social anxiety in adolescents. However, given the lack of research within MBIs for adolescent SAD in particular, more research is needed to determine if MBIs are more advantageous than other current treatment approaches.
Highlights
Social anxiety disorder (SAD) is a common and functionally impairing psychiatric disorder marked by fear of one or more social or performance situations (American Psychiatric Association, 2013), and that follows a chronic and generally unremitting course throughout the lifespan if left untreated (Albano and Hayward, 2004; Knappe et al, 2015)
Not employing a SAD sample an additional study by Lu et al (2019) indicated that treatment with mindfulness-based interventions (MBIs) effectively reduced social anxiety symptoms at post-treatment in an 11–13 year old sample. These results provide separate lines of evidence that treatment with MBIs reduces anxiety symptoms in adults; MBIs are effective in reducing anxiety symptoms in adolescents; and that MBIs have the potential to directly engage symptoms that are unique to SAD, along dimensions of positive affect and approach-related emotions, which are known to be significantly diminished in SAD samples (Brown et al, 1998; Kashdan, 2007)
Our focus on MBIs for adolescent social anxiety in this brief review is premised upon prior work highlighting it as a period of heightened SAD-relevant risk; relatively better rates of reduction in SAD and remission in comparison to other Cognitive behavior therapy (CBT) approaches; and a separate body of work demonstrating the potential for MBIs to directly engage hypothesized maintaining factors of SAD in adult samples
Summary
Social anxiety disorder (SAD) is a common and functionally impairing psychiatric disorder marked by fear of one or more social or performance situations (American Psychiatric Association, 2013), and that follows a chronic and generally unremitting course throughout the lifespan if left untreated (Albano and Hayward, 2004; Knappe et al, 2015). Not employing a SAD sample an additional study by Lu et al (2019) indicated that treatment with MBIs effectively reduced social anxiety symptoms at post-treatment in an 11–13 year old sample Together, these results provide separate lines of evidence that treatment with MBIs reduces anxiety symptoms in adults; MBIs are effective in reducing anxiety symptoms in adolescents; and that MBIs have the potential to directly engage symptoms that are unique to SAD, along dimensions of positive affect and approach-related emotions, which are known to be significantly diminished in SAD samples (Brown et al, 1998; Kashdan, 2007)
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