CBT and tDCS Improve Social Anxiety, Depression

SCIENMAG — Tue, 29 Apr 2025 18:58:27 +0000

Efficacy of CBT, intensified tDCS and their combination for reducing clinical symptoms and improving quality of life in social anxiety disorder with comorbid depression: a randomized controlled trial

BMC Psychiatry

volume 25, Article number: 438 (2025)
Cite this article

Background/aim

Social anxiety disorder (SAD) is a common and disabling psychiatric disorder. It is generally treated with medication and psychotherapy such as cognitive-behavioral therapy (CBT). Due to the involvement of cortical and subcortical areas in the pathophysiology of SAD, non-invasive brain stimulation techniques such as transcranial Direct Current Stimulation (tDCS) are potential adjunctive treatment options for SAD. This study aims to assess comparable efficacy of CBT, intensified tDCS, and combined CBT/tDCS on clinical symptoms and quality of life of patients with SAD and comorbid depression.

Methods

In this randomized controlled trial, 37 adults with SAD and comorbid depressive disorder were assigned into three groups: (1) CBT + active tDCS (n = 13), (2) active tDCS alone (n = 12), and (3) CBT + sham tDCS (n = 12). SAD symptoms, depressive states, quality of life and trait worry were assessed with the Liebowitz Social Anxiety Scale, Beck’s Depression Inventory, QOL questionnaire (WHOQOL-BREF), and the Penn State Worry Questionnaire respectively. The active tDCS was an intensified stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) and was applied over the left dorsolateral prefrontal cortex (F3) and medial prefrontal cortex (Fpz). The CBT was provided individually based on the exposure technique at 12–20 sessions, twice a week. All clinical measures were assessed at baseline, after the intervention, and at 3-month follow-up.

Results

SAD symptoms significantly decreased after intervention and follow-up in all groups, with no significant differences between them. However, CBT + tDCS resulted in a numerically larger symptom reduction, significantly exceeding CBT + sham tDCS on the fear scale. Depressive states and trait worry significantly improved in all groups post-intervention and at the 3-month follow-up, with no between-group differences. Quality of life (total scores, physical, and psychological domains) significantly improved after the and at the 3-month follow-up only in the CBT + tDCS and tDCS-alone groups with no between-group differences.

Conclusion

Psychotherapeutic interventions with CBT, intensified tDCS targeting the prefrontal cortex, and the combined CBT-tDCS are effective for alleviating primary and secondary clinical symptoms in individuals with SAD. The combined CBT-tDCS intervention showed superior efficacy in reducing the primary symptoms of SAD.

Trial registration ID

IRCT20220421054607N1, registration date: 19/05/2022, available at: https://irct.behdasht.gov.ir/trial/63119.

Amiri Sararudi, P., Khakpour, M.S., Kazemi, M. et al. Efficacy of CBT, intensified tDCS and their combination for reducing clinical symptoms and improving quality of life in social anxiety disorder with comorbid depression: a randomized controlled trial.
BMC Psychiatry 25, 438 (2025). https://doi.org/10.1186/s12888-025-06866-5

https://doi.org/10.1186/s12888-025-06866-5

Study Finds Nature-Based Activities Effective in Treating Anxiety and Depression

SCIENMAG — Wed, 16 Apr 2025 14:29:52 +0000

In recent years, the exploration of nature-based interventions as viable therapeutic options for mental health has gained considerable attention within the scientific community. A groundbreaking study conducted in Humber and North Yorkshire, England, has definitively demonstrated that structured programmes involving interaction with natural environments can lead to measurable improvements in mental health conditions such as anxiety and depression within a remarkably short timeframe of 12 weeks. This evidence bolsters the argument for integrating green social prescribing into mainstream healthcare services, providing a complementary approach to traditional psychotherapeutic methods.

Green social prescribing refers to the practice where healthcare professionals recommend community-focused, nature-based activities to patients as a supplementary or alternative treatment for mental health challenges. These activities encompass a wide range of engagements, including horticulture, care farming, outdoor mindfulness, aerobic exercises, and creative outdoor crafts. The initiative evaluated in Humber and North Yorkshire represents one of seven ‘test and learn’ pilot sites established by the UK government under its ambitious strategy to transform mental health services nationwide.

The study meticulously assessed over 220 participants, spanning an age range from 18 to 85 years, who suffered from mild to moderate mental health symptoms. Employing established evaluation metrics such as the Office of National Statistics’ personal well-being measures alongside the Hospital Anxiety and Depression Scale (HADS), researchers were able to quantify changes in participants’ psychological states before and after their involvement in these nature-centric programmes. These tools allowed for an evidence-based comparison against traditional interventions.

One of the most significant findings was the correlation between programme duration and therapeutic outcomes. Individuals partaking in longer engagements—specifically nine to twelve weeks—experienced substantially greater improvements in mood and anxiety levels relative to those involved for shorter durations of one to four weeks. Furthermore, the type of activity influenced efficacy; hands-on, interactive tasks related to horticulture and care farming led to superior mental health outcomes compared to passive or less immersive activities like outdoor crafts or exercise.

The therapeutic potential observed rivals that of short-term cognitive behavioural therapy (CBT), a well-established psychological intervention. CBT traditionally involves weekly sessions over a period ranging from six weeks to over a year, aiming to restructure maladaptive thought patterns. The fact that nature-based activities can evoke comparable benefits within a similar or shorter timeframe illuminates a cost-effective, accessible, and scalable intervention that harnesses the intrinsic restorative properties of the environment.

Experts like Professor Peter Coventry of the University of York emphasize that the key to the success of these nature-based programmes lies not simply in exposure to green spaces but in meaningful engagement. Activities such as gardening or care farming promote a deeper connection with nature, rather than passive presence, amplifying their psychological impact. Additionally, these activities foster social bonds by bringing together community members with shared geographical and environmental ties, which can directly counteract feelings of loneliness—often a root cause of anxiety and depression.

The study’s demographic diversity further validates the universal applicability of green social prescribing. Improvements were consistently noted across different age groups and genders, highlighting the broad utility of such interventions. Of particular note, approximately 65% of participants belonged to low socioeconomic backgrounds, thus addressing a critical gap in access to conventional mental health resources and offering an equitable pathway for wellbeing enhancement in underserved populations.

The call for increased investment in green social prescribing is gaining momentum based on these findings. There is a recognized need not just for funding grassroots nature-based initiatives but also for the creation and support of green social prescriber roles within healthcare systems. These professionals serve as vital liaisons, conducting exploratory conversations with patients to assess suitability and tailor recommendations that align with individual interests and mental health needs.

Collaboration was central to this research, with partnerships between academic institutions like the University of York, healthcare bodies such as the NHS Humber and North Yorkshire Integrated Care Board, and community organizations exemplified by The HEY Smile Foundation. This multi-sector approach underlines the complexity and multidimensional nature of implementing innovative mental health strategies that transcend traditional clinical environments.

Clinical leaders, including Dr. Hannah Armitt, advocate for the integration of green social prescribing into routine service delivery frameworks. By connecting statutory health services with local providers of nature-based activities, the healthcare system can harness the therapeutic potential inherent in natural environments, which are abundantly available free resources in regions like Yorkshire and Humber. This paradigm shift encourages a preventive and community-embedded model of mental health care.

Beyond individual benefits, the study highlights a symbiotic relationship between personal wellbeing and community environmental health. Participants engaged in horticulture and care farming not only improved their mental health but also contributed positively to local green spaces, fostering a cycle of mutual reinforcement between human and ecosystem wellness. This holistic perspective aligns with broader public health objectives emphasizing sustainable and preventive care.

Moreover, as healthcare pivots toward community-centered and prevention-focused models, acknowledging and adequately resourcing community organizations emerges as a critical priority. These organizations, pivotal in delivering hands-on activity sessions, require recognition as essential stakeholders within the national health infrastructure. Equipping them with proper support ensures continuity, scalability, and maximized impact of green social prescribing programmes.

In conclusion, the Humber and North Yorkshire study presents compelling evidence for the inclusion of nature-based activities within mental health treatment paradigms. As traditional services grapple with demand and resource constraints, green social prescribing offers a promising, cost-effective complement rooted in the intrinsic healing potential of nature and community connection. The expanding evidence base invites policymakers, clinicians, and researchers to invest further in these interventions and to embrace a broader, more integrative vision of mental health care for the future.

Subject of Research: Nature-based interventions and green social prescribing for mental health improvement

Article Title: Not specified in the source text

News Publication Date: Not specified in the source text

Web References:

References:
Coventry, P. et al., Health & Social Care in the Community (Journal)

Image Credits: Not specified

Keywords: Mental health, Green social prescribing, Horticulture therapy, Care farming, Anxiety, Depression, Community health, Wellbeing, Cognitive behavioural therapy, Nature-based interventions, Social prescribing

mental health treatment options – Science