Exercise as it relates to Disease/Aerobic exercise versus mindfulness-based stress reduction for social anxiety

This is a critique of the article A randomized trial of MBSR versus aerobic exercise for social anxiety disorder, Published in the Journal of Clinical Psychology (2012)

What Is the Background to This Research?
Anxiety is the most common mental health condition in Australia with approximately 11% of the population experiencing social anxiety during their lifetime. Social anxiety disorder is characterised by excess worry during performance situations or social interactions and a focus on the perceived deficient aspects of one’s personality.

Traditional therapies such as pharmacotherapy and cognitive behavioural therapy are most common but some individuals are unresponsive or unable to access these treatments. This has led to a recent shift in the search for non-traditional therapies such as Mindfulness Based Stress Reduction (MBSR) and aerobic exercise.

There is very limited research on the effect of exercise on social anxiety disorder and findings from mixed samples of anxiety disorders cannot be generalised for specific disorders.

Where Is the Research From?
This research was conducted at Stanford University and was published in the Journal of Clinical Psychology. The research was financially supported by grants to author James Gross from the National Institute of Mental Health and the National Centre for Complementary and Integrative Health Care. This financial support is unlikely to have led to biases in the findings and the authors declared no conflicts of interest and no personal or financial affiliations.

Author James Gross is a Professor of Psychology and Director of the Stanford Psychophysiology Laboratory and has published several articles on psychology and psychiatric conditions both before and since publishing this article.

What Kind of Research Was This?
This research was a randomised trial with two control groups. The intervention groups were randomised but the control groups were not. This reduces the reliability of the data. A randomised controlled trial of both intervention and control groups would have provided more reliable results as this is the gold standard for evidence collection.

This study relied on self-reported data and this may have reduced the reliability and validity compared to measured data.

What Did the Research Involve?
Fifty-six adults diagnosed with social anxiety disorder were randomised to complete an 8-week intervention of either MBSR (n=31) or aerobic exercise (n=25) intervention. Two control groups were used for comparison of results, one healthy group of adults with no history of psychiatric problems (n=48) and a group of adults with untreated social anxiety disorder (n=29). These groups were all assessed using the same measures to ensure consistency. Participants were excluded if they had previously completed an MBSR course or undertook regular (≥3 times per week for ≥2 months) practice of meditation or exercise. There were no significant differences between the intervention and control groups at baseline.

Throughout the 8-week intervention the MBSR group participated in a weekly 2.5-hour group class, 1-day meditation retreat and daily home practice. The participants were trained in formal meditation practice and the instructors had an average of 15.7 years teaching experience.

The aerobic exercise group were provided a 2-month gym membership to a gym of the participants’ choice. Participants were required to complete at least two individual aerobic sessions at moderate intensity and one group aerobic session (not meditation or yoga) each week.

All participants of the intervention groups received a weekly phone call to monitor practice and address obstacles. Data about anxiety state was collected pre-intervention, immediately post-intervention and 3-months post-intervention. Participants also reported measures of clinical symptoms and well-being including measurement against the Kentucky Inventory of Mindfulness Scale.

There were several limitations of this study. The reliance on self-reported data may have led to biases or inaccurate reporting, reducing the validity of the results. This study required participants to contact the researchers to participate in the study. This may have discouraged potential participants with severe social anxiety from participating. It would be beneficial to include participants of a broad range of social anxiety disorder symptom levels as the results found may not be generalisable to the remainder of the population with social anxiety disorder due to its limited inclusion criteria. The untreated social anxiety disorder group used as a control was not randomised with the MBSR and aerobic exercise intervention groups. Randomisation of all participants with social anxiety disorder would have increased the reliability and validity of the results.

What Were the Basic Results?
Both interventions were associated with increased mindfulness when compared to the control groups. Comparison of the MBSR group to the untreated social anxiety disorder control showed a decrease in symptoms of social anxiety and perceived stress. Changes in depression, self-compassion and self-esteem were not statistically significant. Comparison of the aerobic exercise group to the untreated social anxiety disorder group showed a decrease in clinical symptoms of social anxiety as well as improved self-compassion. Differences in other measures were not statistically significant.

Both the MBSR and aerobic exercise interventions reduced some clinical symptoms of social anxiety and enhanced some measures of well-being both post-intervention and 3-months post-intervention. Differences between MBSR and aerobic exercise were not statistically significant. The results between the MBSR and aerobic exercise intervention groups were generally comparable and no conclusive results were found regarding the superior non-traditional treatment for social anxiety disorder.

What Conclusions Can We Take From this Research?
Based on the evidence provided, MBSR and aerobic exercise reduce clinical symptoms and improve well-being in people with social anxiety disorder. Neither intervention was successful in improving all aspects of social anxiety disorder. These treatment options are likely to be most effective when combined with traditional therapies such as pharmacotherapy or cognitive behavioural therapy. Further research is needed regarding the combination of traditional and non-traditional therapies for social anxiety disorder.

For people unresponsive or unwilling to undertake traditional therapies, non-traditional therapies may be effective. Subsequent research has suggested that individuals with lower pre-treatment anxiety may find greater improvements with MBSR and individuals with higher pre-treatment anxiety may find greater improvements with aerobic exercise. More recent research has suggested no significant effects of aerobic exercise on social anxiety and to date there is little to no research on the long-term benefits of non-traditional treatments for social anxiety disorder.

Practical Advice
People with social anxiety disorder may find some benefit in Mindfulness-Based Stress Reduction or aerobic exercise. People who experience social anxiety disorder or believe they may be affected, should speak to their GP or a qualified psychologist for individualised treatment which may include traditional or non-traditional therapies.

For individuals unable or unwilling to undertake traditional treatment, non-traditional therapies such as Mindfulness-Based Stress Reduction and aerobic exercise may be effective in reducing symptoms of social anxiety disorder.

Further Information/Resources
Beyond Blue

Anxiety Australia

Mindfulness in Australia

Australia Counselling – MBSR Course