Comparison of the Efficacy of Cognitive-Behavioral Therapy and Mindfulness Therapy on Negative ruminationand Social Sefl-efficacy in Social Anxiety Disorder Patients

1.Introduction Social anxiety disorder is defined as anxiety caused by being evaluated in real or mental social situations. (1). The disorder is also associated with important psychological constructs such as rumination (6, 7). In this regard, review research shows that rumination has several negative consequences, including exacerbating psychological vulnerability by magnifying and prolonging negative moods and interfering with problem solving, increasing anxiety, depression, psychosis, insomnia, and impulsive behaviors. Involvement in treatment and limitation of the effectiveness of psychological interventions and intensification and maintenance of physiological stress responses (10). In addition to rumination, another psychological construct associated with social anxiety is social self-efficacy (11). Self-efficacy refers to an individual's beliefs about his or her ability to perform tasks, responsibilities, and future success (12). And indicates the assessment of individuals of their ability to establish and maintain interpersonal relationships (13). Research shows that interventions that increase social self-efficacy reduce the symptoms of social anxiety (11). In general, the widespread prevalence of social anxiety, along with its disabilities and problems and the psychological, emotional and economic costs that it imposes on the individual and society, indicate the need to address the explanatory patterns and treatment methods of this disorder. Cognitive-behavioral therapy is one of the most widely used therapies for reducing negative emotions in people with social anxiety disorder (16, 17). This treatment tries to reduce negative cognitive components by reducing physiological arousal in social situations, using cognitive reconstruction, reforming the information processing system, and reducing negative thoughts about oneself (18). Among the various therapies that were examined, the findings of various studies have considered the treatment of mindfulness as a useful intervention in people with social anxiety, while emphasizing further research in this regard (20). Correlation results also show that increased mindfulness is associated with reduced symptoms of social anxiety and better performance (21). Research background indicates that some studies have examined the effectiveness of cognitive-behavioral therapy on reducing negative rumination (27, 28) and increasing social self-efficacy (19) and some have examined the effectiveness of mindfulness therapy on rumination (29, 30). And 31); And increase social self-efficacy (32, 33) and have shown that mindfulness therapy is able to significantly change these variables in individuals. But so far no research has compared the effectiveness of these two methods on negative rumination and social self-efficacy in people with social anxiety disorder. Based on the above, the researcher seeks to answer the question whether there is a difference between the effectiveness of cognitive-behavioral therapy and mindfulness therapy on negative rumination and social self-efficacy in people with social anxiety disorder? 2.Method For the present quasi-experimental study, which was performed with a pre-test, post-test design, among the patients who had referred to the psychological clinics of Shiraz in 1398 with a complaint of social anxiety disorder. Forty-five individuals were selected as a sample after a measurement with the social anxiety scale of Connor et al. (2000) based on the cut-off line score and were randomly divided into 3 groups: cognitive-behavioral therapy, mindfulness therapy and control. Then, cognitive-behavioral protocol (Hoffman and Otto, 2008) and acceptance and mindfulness protocol (Fleming and Kokowski, 2007) were used to perform the interventions. Data were also collected through the rumination scale (Nolen Hooksma and Murrow, 1991) and social self-efficacy (Smith and Betz, 2000). At the end of the training courses in the groups, the subjects of all three groups were retested. In order to test the data, multivariate analysis of covariance and Bonferroni post hoc test were used. 3.Results The results of multivariate analysis of covariance showed that there is a significant difference between the groups of cognitive-behavioral therapy and mindfulness and control in at least one of the dependent variables (Table 3). On the other hand, the results of analysis of covariance by modulating the effect of pre-test showed that there is a significant difference in rumination between the three groups. This means that cognitive-behavioral therapies and mindfulness have a significant effect on rumination and its components. The results of Bonferroni post hoc test showed that the difference between the mean rumination and its components, with the exception of the self-centered rumination component (cognitive-behavioral therapy was not significant) in the two experimental groups with the control group was significant. This finding also shows that cognitive-behavioral therapy and mindfulness did not have different efficiencies in the components of symptom-based rumination and antecedent-consequence rumination. However, in the field of rumination variable and self-centered rumination component, mindfulness therapy has been more effective than cognitive-behavioral therapy (Table 4). Regarding the effectiveness of cognitive-behavioral therapy and mindfulness-based therapy on social self-efficacy in people with social anxiety, the results of social self-efficacy test were significant according to the type of group (F = 17.13, df = 2, P = 0.001). . Thus, the experimental groups had more increase than the control group. The effect of interventions was 0.45; This means that these treatments have a positive effect on increasing social self-efficacy. Also, to compare the scores of research variables in the three groups, the Benferoni post hoc test was used, which shows that the difference between the mean of the social self-efficacy variable of the two experimental groups with the control group is significant. This finding also shows that in this variable, mindfulness therapy was more effective than cognitive-behavioral therapy (Table 5). 4.Discussion According to the results of the present study in explaining the effectiveness of group cognitive-behavioral therapy on reducing rumination, it can be said that patients with social anxiety disorder often before confronting a socially anxious situation during confrontation and even after encountering rumination about their failure and How they were seen to be seen by others, and the same rumination causes them to continue to be anxious (41). In cognitive-behavioral therapy, the cognitive reconstruction technique is used. Cognitive reconstruction strategies allow beliefs, assumptions, and expectations to be examined in order to understand their rationale and usefulness (42). In this study, we first tried to give full awareness to people in social situations and become fully aware of this process, and then worked on their non-judgmental acceptance, which ultimately led to a reduction in negative rumination of individuals. Therefore, the significant effect of mindfulness on reducing negative rumination seems logical and acceptable. Regarding the comparison of the effectiveness of cognitive-behavioral therapy and mindfulness-based therapy on social self-efficacy, the results showed that mindfulness therapy was more effective than cognitive-behavioral therapy. In this treatment, the therapist tries to provide the patient with information that he or she has previously ignored; As a result, one can correct and misinterpret one's own perceptions of environmental events and adopt new perspectives. In cognitive-behavioral therapy, the therapist uses techniques that inform clients about the relationship between focus and anxiety and teach them not to forget to pay attention to their duty in social situations. Ultimately, this can reduce negative thoughts and increase social self-efficacy and overall reduce social anxiety (49). Mindfulness helps individuals make informed decisions and communicate effectively by increasing psychosocial and interpersonal skills; Develop coping and personal management skills and lead a healthy and productive life to guide personal behavior and behavior related to others as well as behavior related to the environment in a way that leads to improved social functioning. On the other hand, the current therapeutic intervention with individual factors such as motivational components, empowers the person against psychological stress without considering the stressor as a threat, and leads to psychological well-being and improved performance in therapeutic tasks and also increases self-efficacy. Becomes individual and social (31).