Talk therapy helps people with social anxiety

Psychotherapy triggers changes in the brains of people with social anxiety disorder.

Medication and psychotherapy are used to treat people with social anxiety, a common disorder in which people experience overwhelming fears of interacting with others and expectations of being harshly judged. But there's been far less research on the neurological effects of psychotherapy (talk therapy) than on medication-induced brain changes.

To look into the efficacy of talk therapy for treating social anxiety and track the brain changes while people were going through psychotherapy, researchers studied 25 adults from Canada with social anxiety disorder who underwent 12 weekly sessions of group cognitive behaviour therapy, which is meant to help patients identify and challenge their unhealthy thinking patterns that perpetuate the behaviour. These clinical group participants were compared to two control groups who tested either extremely high or low for symptoms of social anxiety but received no psychotherapy.

All of the participants underwent a series of electroencephalograms (EEGs), which measure brain electrical interactions. The researchers focused on the amount of delta-beta coupling, which increases with rising anxiety. The patients were given four EEGs - two before treatment, one halfway through, and one two weeks after the final session. The researchers collected EEG measures of the participants at rest, and then during a stressful exercise: a short preparation for an impromptu speech on a hot topic, such as capital punishment or same-sex marriage; participants were told the speech would be presented before two people and videotaped. In addition, comprehensive assessments were made of patients' fear and anxiety.

Before treatment, the clinical group's delta-beta correlations were similar to those of the high-anxiety control group and much higher than those of the low-anxiety control group. When measured at a point about midway through psychotherapy, improvements in the patients' brains matched symptom improvement reported by both doctors and patients. After they completed psychotherapy, the patients' EEG results were similar to those of the low-anxiety group.

This study might alter perceptions of therapy as people tend to think that talk therapy is not 'real,' while associating medications with hard science, and physiologic change. It is also an important first step toward understanding the biology of anxiety and developing better treatments.