Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

Abstract

Background: Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. Methods: This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. Results: Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. Conclusions: Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.

Development and evaluation of a modified brief assertiveness training for nurses in the workplace: a single-group feasibility study

“…Therefore, participants were encouraged to practice assertive behaviors between sessions as homework using homework sheets prepared by the researchers (participants recorded their practice situation, how they acted assertively, results, what they have learned, etc.). Finally, we incorporated CBT techniques into the program [39, 40]. CBT is based on the principle that thoughts and perceptions can impact our feelings and behavior, and looks at ways to reassess negative thoughts so individuals can learn more flexible, positive ways of thinking that will subsequently influence their behaviors.…”

Methodological Recommendations for Trials of Psychological Interventions

“…The Sequential Multiple Assignment Randomized Trial (SMART) involves multiple intervention stages; each stage corresponds to one of the critical decisions and the participant is randomly reassigned to one of the intervention options [46]. Examples are adaptive interventions that followed nonresponse to initial treatment (whether pharmacotherapy or psychotherapy or both) in mood [47][48][49] and anxiety disorders [50][51][52]. The conceptual assumption is that after testing a standard treatment in a group of patients we are left with a fairly homogeneous group characterized by resistance.…”

Is modified brief assertiveness training for nurses effective? A single-group study with long-term follow-up

“…The main training content included basic knowledge about assertiveness (e.g., what assertiveness is, the right to assert oneself and communication patterns), how to make requests, how to decline requests, and how to give and receive praise. In addition, Thought Challenging Record (one of the cognitive restructuring techniques in cognitive behavioural therapy [CBT]) was applied to modify nurses’ excessive fear of negative evaluation so as to promote assertive action before entering social situations (Beck, Rush, Shaw, & Emery, ; Yoshinaga et al., ). The participants were encouraged to practice assertive behaviours between sessions as homework.…”