1. Self-help for Social Anxiety:
Preliminary Results on a Mindfulness and Acceptance-Based Approach
Nancy Kocovski,1 Jan Fleming,2 Meagan MacKenzie,3 Alison Flett,1 Rebecca Blackie1
1Wilfrid Laurier University, 2The Mindfulness Clinic, 3Ryerson University
Introduction
Restricted Access to Treatment for Social Anxiety
Social anxiety is often times a debilitating condition given its established association with social isolation, reduced quality of life, and impaired social and occupational functioning (see Steinert et al., 2013, for review)
Many individuals are not able to access empirically supported treatment for social anxiety for various reasons (e.g., financial, lack of availability, stigma, etc.)
Self-help interventions may be one way in which this underserved population is more readily able to access treatment
Benefits of Mindfulness and Acceptance-based Interventions
These interventions encourage people to take a mindful, accepting stance to experienced thoughts and feelings
Research has shown that mindfulness and acceptance-based interventions (MABIs) are nearly equivalent compared to traditional cognitive-behavioral therapy (CBT) with respect to improvements in social anxiety and positive mental health outcomes (Faucher et al., 2016; Kocovski et al., 2013)
Given that these promising treatments may not be accessible to all who want them, the present study sought to explore whether treatment delivered in an alternative (self-help book) format would be effective
Participants were assigned to self-help (book) condition or wait-list control
Hypotheses
It was expected that compared to those in the control condition, those assigned to the self-help condition would experience significantly less social anxiety, depression, fusion with thoughts, and greater mindfulness and self- compassion at post-treatment, and the one-month follow-up.
Method (continued)
Procedure
Participants in the self-help condition were given a book (Fleming & Kocovski, 2013) containing an 8-week plan of exercises to alleviate social anxiety and shyness, which included strategies on mindfulness practice, values and goals, defusion, and exposure.
Participants in the wait-list control received the book at the end of 12 weeks.
Results (continued)
HLM Results (cont’d)
All final HLM models were estimated with restricted maximum likelihood estimation.
As shown in Table 1, condition significantly predicted the slopes of time for each dependent variable, with one exception The FMI (mindfulness) was only approaching significance.
Means and standard deviations per condition, across each time point are presented in Table 2.
Table 2. Differences between conditions across time
Book Condition
Control Condition
Variable M SD
SPIN
Time 1
59.38
14.10
58.77
14.37
Time 2
51.50
12.06
57.84
14.32
Time 3
47.57
12.83
57.34
14.34
BDI-II
20.55
13.24
24.73
11.79
17.52
11.64
24.32
12.23
14.68
11.91
24.12
14.87
FMI
30.54
7.41
26.78
6.94
33.99
7.00
28.36
5.58
35.71
7.66
29.14
7.90
CFQ
34.94
10.69
34.70
9.32
29.99
8.84
34.42
8.38
27.52
8.57
33.87
8.96
SCS
70.40
12.00
64.83
11.66
78.02
15.32
65.83
12.14
81.83
14.33
66.33
12.80
Book Condition
n = 60
Time 3
(12-weeks)
n = 49
Time 2
(8-weeks)
n = 48
Time 1 Baseline Assessment
Control
Condition
n = 57
Time 2
(8-weeks)
n = 46
Time 3
(12-weeks)
n = 45
Results
Book Completion
60.42% of participants fully read each of the chapters
4.17% read at least 50% of the book
20.83% read less than 50% of the book
10.42% did not read any of the book
4.16% did not answer
Feedback on Book
At time 2, participants either agreed or strongly agreed that the book was helpful (80.0%), helped them become more mindful (75.6%), and helped with their social anxiety (66.6%).
At time 3, participants either agreed or strongly agreed that they were satisfied with the book (72.3%), found the book helped with their social anxiety (53.1%), and continued to use the strategies they learned (55.3%).
Hierarchical Linear Modeling (HLM)
Table 1. Between-Groups Comparisons on Slopes of Time.
Note. Random effects were not significant in any model. Coeff. = coefficient.
Discussion
As expected, those in the book condition experienced significant reductions in social anxiety, depression, and fusion with thoughts, as well as significant increases in self-compassion, and marginal increases in mindfulness, compared to those in the wait-list control condition.
A very large proportion in the slopes of time for social anxiety were accounted for by condition, suggesting the book played a very large role in reducing social anxiety over time.
However, only a small proportion in the slopes of time for mindfulness were explained by condition. Future research is needed to investigate the mechanisms of change. Change in the dependent variables over the 8 weeks will also be investigated.
Limitations: all measures were self-report.
Given the difficulties accessing treatment for some socially anxious individuals, a mindfulness and acceptance self-help approach may be useful
Method
Participants
Community participants (N = 117) wanting help with social anxiety or shyness were recruited via flyers and online posts.
Participants’ ages ranged from (M = 23.63, SD = 6.88), with the majority being female (71.79%), and single/not married (83.76%).
Ethnicity/Race: Caucasian (56.4%), Asian (23.9%), Indian/South Asian (8.5%), Middle Eastern (3.4%) Hispanic (1.7%), Native Canadian (1.7%), Mixed/Other (4.3%).
Measures:
Social Phobia Inventory (SPIN; Connor K. M. et al., 2000)
Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996)
Freiburg Mindfulness Inventory (FMI; Walach et al., 2006)
Cognitive Fusion Questionnaire (CFQ; Gillanders et al., 2014)
Self-Compassion Scale (SCS; Neff, 2003)
Measure
Coeff. SE t p d
% variance in slopes of time explained by condition
SPIN
-3.47
0.74
-4.68
<.001
90.76%
BDI-II
-2.63
0.86
-3.07
0.39
38.26%
FMI
0.94
0.51
1.82
.07
0.36
4.51%
CFQ
-2.20
0.60
-3.64
0.61
20.86%
SCS
3.31
0.79
4.17
0.82
23.39%
Variable
Trait-RNT
RSQ-Rum
RSQ-Dist
SIAS
BDI-II
ERQ-ES
ERQ-CR
SARQ-T
.72*
.56*
.02
.54*
.41*
.38*
.07
SARQ-S
.69*
-.02
.42*
.49*
.34*
-.07
Acknowledgements
The authors gratefully acknowledge financial support awarded to the first author from the Ministry of Research and Innovation and from a grant partly funded by Laurier Operating funds.