November 19 | 11:00 AM – 12 Noon | Celestin D&E, Level 3

Social Anxiety Disorder: The Role of Emotion (Dys)Regulation in Its Nature and Treatment

Richard G. Heimberg, Ph.D., Thaddeus L. Bolton Professor Emeritus, Department of Psychology, Temple University

Lifetime AchievementRick Heimberg received his Ph.D. from Florida State University in 1977.  He was, until his recent retirement, Thaddeus L. Bolton Professor of Psychology at Temple University, where he also directed the Adult Anxiety Clinic of Temple. For the past four decades, he has been one of the world’s most prominent researchers in the study of the nature and treatment of social anxiety disorder and his Managing Social Anxiety program (coauthored with Debra Hope and Cynthia Turk) is a one of the leading approaches to its treatment. Dr. Heimberg has also made contributions to the study of generalized anxiety disorder and anxiety about going to the dentist. Together with his several collaborators, postdoctoral fellows, and doctoral students at Temple University and the University at Albany, SUNY, he has published 14 books and nearly 500 articles and chapters on these topics. His work has been cited more than 60,000 times. His research accomplishments have been recognized by Lifetime Achievement Awards from the Academy of Cognitive and Behavioral Therapies and the Philadelphia Behavior Therapy Association, as well as awards from the American Society for Group Work and Temple and Florida State Universities. He also received the Jerilyn Ross Clinician Advocate Award from the Anxiety and Depression Association of America.

Dr. Heimberg first came to the ABCT convention in 1976, and he has been an involved member ever since. Among numerous other posts, he has served as President, Representative-at-Large, Chair of the Continuing Education Committee, Workshop Coordinator, and as Editor of Behavior Therapy (for which he received ABCT’s Outstanding Service Award). He also served as President of the Society for a Science of Clinical Psychology (SSCP). He was the first recipient of ABCT’s Outstanding Mentor Award, and he has received similar awards from the Society of Clinical Psychology, SSCP, and the American Psychological Association of Graduate Students for his commitment to the education and training of doctoral students in clinical psychology.

Categories: Adult Anxiety, Treatment – CBT, Treatment – Mindfulness & Acceptance
Keywords: Adult, CBT, Mindfulness, Social Anxiety

Participants earn 1 CE credit

Social anxiety disorder (SAD) is highly prevalent and associated with significant impairment. It is, by definition, associated with an excess of anxiety, but it is also associated with other difficulties in the regulation of emotion, which have received much less attention. Primarily using data from two randomized controlled trials evaluating Cognitive Behavioral Therapy for the treatment of SAD (one versus Waiting List and the other versus Mindfulness-Based Stress Reduction and Waiting List), I will describe the relationships of several emotion variables, including cognitive reappraisal, expressive suppression, emotion theory, empathy, and anger to SAD and its treatment.

Outline:

  • Acknowledgements and disclosures
  • Definition of social anxiety disorder (SAD), prevalence, impairment, comorbidity
  • SAD and anger
    • Anger and anger suppression in SAD
    • Latent anger profiles in patients with SAD
  • Emotion regulation
    • Gross’s Process Model
    • Emotion Regulation Interview
  • First randomized controlled trial – CBT vs waiting list
    • CBT efficacy
    • Role of cognitive reappraisal self-efficacy
    • Weekly changes in emotion regulation and social anxiety
  • Second randomized controlled trial – CBT vs MBSR vs WL
    • CBT/MBSR efficacy
    • Similarities and differences in outcome
    • Role of cognitive reappraisal self-efficacy and frequency
    • Weekly changes in cognitive reappraisal, mindfulness, and acceptance
  • Entity vs incremental theory of emotion in SAD
    • Decrease in entity beliefs predicts reduction of social anxiety in CBT
  • Deficits in positive affective empathy in SAD
    • Increases in positive affective empathy in CBT, but not MBSR/WL
    • Changes in positive affective empathy mediated improvements in social anxiety in CBT
  • SAD treatment and anger redux
    • Anger suppression and expression moderate effects of CBT vs MBSR
    • CBT greater efficacy at higher levels of anger suppression (post-treatment) and anger expression (follow-up)
  • Effects of CBT on neural dynamics of cognitive reappraisal of negative self-beliefs (First RCT)
    • Task description – react vs reappraise
    • Emotion ratings
    • Change in BOLD response in DMPFC and left DLPFC in CBT but not WL
    • Regions implicated in cognitive control of emotion/downregulating negative emotion
    • DMPFC – increased early response in CBT group after treatment (enhanced ability to access and implement appraisal strategies?)
  • Closing comments 

At the end of this session, the learner will be able to:

  • Define social anxiety disorder and describe its prevalence and associated impairment.
  • Describe patterns of emotion dysregulation (cognitive reappraisal, expressive suppression, entity theory of emotion) demonstrated by individuals with social anxiety disorder.
  • Describe the potential role of emotion (dys)regulation in the outcome of cognitive-behavioral treatment for social anxiety disorder.

Recommended Readings:

Heimberg, R.G., Brozovich, F.A., & Rapee, R.M. (2014). A cognitive-behavioral model of social anxiety disorder. In S.G. Hofmann & P.M. DiBartolo (Eds.). Social anxiety: Clinical, developmental, and social perspectives (3rd edition, pp. 705-728). Waltham, MA: Academic Press. doi:10.1016/B978-0-12-394427-6.00024-8

Goldin, P.R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H., Heimberg, R.G., & Gross, J.J. (2012).  Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 80, 1034-1040.  doi: 10.1037/a0028555

Goldin, P.R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R.G., & Gross, J.J.  (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial.  Journal of Consulting and Clinical Psychology, 84, 427-437. doi: 10.1037/ccp0000092

Goldin, P.R., Morrison, A.S., Jazaieri, H., Heimberg, R.G., & Gross, J.J.  (2017). Trajectories of social anxiety, cognitive reappraisal and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behaviour Research and Therapy, 97, 1-13. doi:10.1016/j.brat.2017.06.001

Kuo, J.R., Zeifman, R.J., Morrison, A.S., Heimberg, R.G., Goldin, P.R., & Gross, J.J. (2021). 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. Journal of Affective Disorders, 287, 127-135. doi:10.1016/j.jad.2021.02.022

Morrison, A.S., Mateen, M.A., Brozovich, F.A., Zaki, J., Goldin, P.R., Heimberg, R.G., & Gross, J.J.  (2019). Changes in empathy mediate the effects of cognitive behavioral group therapy but not mindfulness-based stress reduction for social anxiety disorder. Behavior Therapy, 56, 1098-1111. doi:10.1016/j.beth.2019.05.005

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