Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.

Gould, Robert A.; Buckminster, Susan; Pollack, Mark H.; Otto, Michael W.; Massachusetts, Liang Yap

doi:10.1111/j.1468-2850.1997.tb00123.x

Cited by 308 publications

(272 citation statements)

References 63 publications

(122 reference statements)

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“…Another effective form of intervention is exposure therapy without any explicit cognitive intervention (Feske & Chambless, 1995;Gould et al, 1997;Taylor, 1996). Despite the demonstrated efficacy of these interventions, very little is known about the underlying variables that lead to treatment change (Hofmann, 2000b).…”

Section: Discussionmentioning

confidence: 99%

Cognitive Mediation of Treatment Change in Social Phobia.

Hofmann¹

2004

Journal of Consulting and Clinical Psychology

261

126

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Ninety individuals with social phobia (social anxiety disorder) participated in a randomized controlled trial and completed cognitive-behavioral group therapy, exposure group therapy without explicit cognitive interventions, or a wait-list control condition. Both treatments were superior to the wait-list group in reducing social anxiety but did not differ from one another at posttest. Changes in estimated social cost mediated treatment changes in both treatment conditions from pre-to posttest. However, only participants who received cognitive-behavioral therapy showed continued improvement from posttest to 6-month follow-up, which was associated with a reduction of estimated social cost from pretest to posttest. These results suggest that cognitive intervention leads to better maintenance of treatment gains, which is mediated through changes in estimated social cost.Social phobia is the most common type of anxiety disorder and the third most common mental disorder in the U.S. population (Kessler et al., 1994). Numerous studies have demonstrated the efficacy of psychological treatments for social phobia, especially cognitive-behavioral therapy and exposure therapy (e.g., Clark et al., 2003;Feske & Chambless, 1995;Heimberg et al., 1998;Taylor, 1996). It has been argued that social phobia treatments involving explicit cognitive strategies should be superior to pure exposure therapy because cognitive interventions are directly aimed at changing dysfunctional thinking (Butler, 1985;Butler, Cullington, Munby, Amies, & Gelder, 1984;Stopa & Clark, 1993). This assumption, however, is not clearly supported by the empirical data. There are eight controlled clinical studies in the literature in which investigators directly compared cognitive-behavioral therapy with exposure therapy without explicit cognitive interventions (Butler et al., 1984;Emmelkamp, Mersch, Vissia, & van der Helm, 1985;Gelernter et al., 1991;Hope, Heimberg, & Bruch, 1995;Mattick & Peters, 1988;Mattick, Peters, & Clark, 1989;Scholing & Emmelkamp, 1993a, 1993b. In only two of the trials did the effects of cognitive-behavioral therapy exceed those of exposure alone at posttreatment (Butler et al., 1984;Mattick & Peters, 1988). Furthermore, a number of meta-analyses suggested that both cognitive-behavioral therapy and exposure therapy produce very similar dropouts and pre/post and pre/follow-up effects for self-report measures of social phobia, cognitive symptoms, and depressed-anxious mood (Feske & Chambless, 1995;Gould, Buckminster, Pollack, Otto, & Yap, 1997;Taylor, 1996). Finally, the results of a dismantling study conducted by Hope, Heimberg, and Bruch (1995) suggest that exposure alone is at least as effective as exposure plus cognitive intervention in the treatment of social phobia.These findings raise important questions about the mechanism of treatment changes and the variables that are involved in this change process (i.e., the mediators of change). The cognitive model of social phobia posits that certain beliefs about the social situation...

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Section: Discussionmentioning

confidence: 99%

Cognitive Mediation of Treatment Change in Social Phobia.

Hofmann¹

2004

Journal of Consulting and Clinical Psychology

261

126

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“…A number of meta-analyses have led to contradictory results regarding the efficacy of the psychological and pharmacological treatment of anxiety disorders (Clum et al 1993;Cox et al 1992a,b;Fedoroff and Taylor 2001;Foa 2000;Furukawa et al 2006;Gould et al 1997;Mattick et al 1990;Mitte 2005;van Balkom et al 1997;Westen and Morrison 2001). The main reasons for these inconsistent results seem to be the inclusion of heterogeneous studies and influences of selection biases (see also Klein 2000).…”

Section: Monoamine Oxidase Inhibitors (Maoi)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

712

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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“…One place where a session-by-session measure of change may be useful is to improve our understanding of cognitive-behavioral therapy (CBT) for social anxiety disorder. Several meta-analyses have been conduced which demonstrate the efficacy of CBT for social anxiety disorder (i.e., Fedoroff & Taylor, 2001;Gould, Buckminster, Pollack, Otto, & Yap, 1997); however, less is known about how CBT works. By measuring change frequently throughout treatment, it may be possibly to identify which elements of treatment are contributing to client change.…”

mentioning

confidence: 99%

Assessing Client Progress Session by Session in the Treatment of Social Anxiety Disorder: The Social Anxiety Session Change Index

Hayes

Miller

Hope

et al. 2008

Cognitive and Behavioral Practice

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Frequent assessment during therapy can improve treatments and provide accountability. However, clinicians often do not monitor progress because of the time it takes to administer and score assessments. In response, the Social Anxiety Session Change Index (SASCI) was developed. The SASCI is a short, easily administered rating of subjective improvement that asks clients with social anxiety disorder how much they have changed since the beginning of therapy. Change on the SASCI was related to change in fear of negative evaluation, a core aspect of social anxiety, and to clinician-rated improvement, but not to ratings of anxiety sensitivity or depression. Because it is brief and easily interpretable, the SASCI can be used in a variety of clinical settings to monitor change across therapy. The SASCI is presented along with examples of how the information gathered from frequent administration can inform clinical practice. Barlow, Hayes, and Nelson (1984) highlight three key reasons why clinicians should measure their clients' change across therapy: to improve treatment, to enhance clinical science, and to provide accountability. In short, these authors posit that assessing change during treatment allows modifications in the treatment procedure to enhance results; gives scientist-practitioners a better understanding of effective treatment techniques; and provides evidence of treatment effectiveness to insurance companies and other third-party payers. Research has shown that tracking clients' progress can improve outcome (see Lambert et al., 2003). A brief weekly progress update would allow for an efficient and sensitive method to NIH Public Access Author ManuscriptCogn Behav Pract. Author manuscript; available in PMC 2014 July 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript assess client improvement or relapse from week to week. Changes from the previous week could be used as a tool in session to either investigate what worked well over the week, or to make adjustments if needed. Further, researchers could utilize a session-by-session measure as a way to understand the elements and processes of treatment that lead to change. In addition, therapists have reported that they are interested in using such data to improve their services (e.g., Bickman et al., 2000). However, one of the primary difficulties in utilizing regular assessments in clinical settings is the time required to administer, score, and interpret frequent assessments. In our own work with social anxiety disorder, we found the need for an efficient instrument for ongoing assessment of change, but nothing was available. In response, we developed a brief measure of subjective change that can be administered, interpreted, and utilized in busy clinical practices and research settings.Traditionally, treatment research has focused on changes in symptoms from pretreatment to posttreatment (Kazdin, 2003). Whereas this approach provides a global account of the efficacy of the treatment, it neglects important intermediate steps ...

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Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.

Cited by 308 publications

References 63 publications

Cognitive Mediation of Treatment Change in Social Phobia.

Cognitive Mediation of Treatment Change in Social Phobia.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Assessing Client Progress Session by Session in the Treatment of Social Anxiety Disorder: The Social Anxiety Session Change Index

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