Sleep quality and treatment of social anxiety disorder

ABSTRACT

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive–behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment.

Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs.

Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment.

Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety.

Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.

KEYWORDS:

• Social anxiety disorder
• treatment
• sleep quality
• mindfulness-based stress reduction
• cognitive-behavior therapy

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, Richard G. Heimberg. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

ORCID

Richard G. Heimberg http://orcid.org/0000-0003-4750-2158

Notes

1 These numbers exclude one group randomized to MBSR, for which adherence ratings indicated non-adherence to the treatment protocol.

2 At the suggestion of an anonymous reviewer, we ran the same moderation analyses with six of the seven PSQI subscale scores (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) in addition to the total PSQI score. Results for all analyses were also non-significant, with no specific components of the PSQI at baseline moderating the relationship between treatment condition and post-treatment social anxiety. We do not report full details of these post hoc analyses here but will provide them to interested parties on request.

Additional information

Funding

This research was supported by an National Institute of Mental Health Grant R01 MH092416, awarded to James J. Gross. Richard G. Heimberg is the author of the commercially available CBT protocol which was utilized in this study.