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Psychological treatment of social anxiety disorder: a meta-analysis

Published online by Cambridge University Press:  28 May 2008

C. Acarturk*
Affiliation:
Vrije Universiteit University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
P. Cuijpers
Affiliation:
Vrije Universiteit University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
A. van Straten
Affiliation:
Vrije Universiteit University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
R. de Graaf
Affiliation:
Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
*
*Address for correspondence: C. Acarturk, M.Sc., Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: c.acarturk@psy.vu.nl)

Abstract

Background

Older meta-analyses of the effects of psychological treatments of social anxiety disorder have found that these treatments have moderate to large effects. However, these earlier meta-analyses also included non-randomized studies, and there are many featured studies in this area which were published after the recent meta-analysis.

Method

We conducted a systematic literature search and identified 29 randomized studies examining the effects of psychological treatments, with a total of 1628 subjects. The quality of studies varied. For the analyses, we used the computer program comprehensive meta-analysis (version 2.2.021; Biostat, Englewood, NJ, USA).

Results

The mean effect size on social anxiety measures (47 contrast groups) was 0.70, 0.80 on cognitive measures (26 contrast groups) and 0.70 both on depression (19 contrast groups) and general anxiety measures (16 contrast groups). We found some heterogeneity, so we conducted a series of subgroup analyses for different variables of the studies. Studies with waiting-list control groups had significantly larger effect sizes than studies with placebo and treatment-as-usual control groups. Studies aimed at subjects who met Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for social anxiety disorder had smaller effect sizes than studies in which other inclusion criteria were used.

Conclusions

This study once more makes it clear that psychological treatments of social anxiety disorder are effective in adults, but that they may be less effective in more severe disorders and in studies in which care-as-usual and placebo control groups are used.

Type
Original Articles
Copyright
Copyright © 2008 Cambridge University Press

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References

Akillas, E, Efran, JS (1995). Symptom prescription and reframing: should they be combined? Cognitive Therapy and Research 19, 263279.CrossRefGoogle Scholar
Andersson, G, Carlbring, P, Holmström, A, Sparthan, E, Furmark, T, Nilsson-Ihrfelt, E, Buhrman, M, Ekselius, L (2006). Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology 74, 677686.CrossRefGoogle ScholarPubMed
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychological Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychological Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychological Association: Washington, DC.Google Scholar
Ayres, J, Ayres, FE, Baker, AL, Colby, N, de Blasi, C, Dimke, D, Docken, L, Grubb, J, Hopf, T, Mueller, RD, Sharp, D, Wilcox, AK (1993). Two empirical tests of a videotape designed to reduce public speaking anxiety. Journal of Applied Communication Research 21, 132147.CrossRefGoogle Scholar
Bijl, RV, Zessen, G, van Ravelli, A, de Rijk, C, Langendoen, Y (1998). The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design. Social Psychiatry and Psychiatric Epidemiology 33, 581586.CrossRefGoogle ScholarPubMed
Blomhoff, S, Haug, TT, Hellström, K, Holme, I, Humble, M, Madsbu, HP, Wold, JE (2001). Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. British Journal of Psychiatry: The Journal of Mental Science 179, 2330.CrossRefGoogle ScholarPubMed
Butler, G, Cullington, A, Munby, M, Amies, P, Gelder, M (1984). Exposure and anxiety management in the treatment of social phobia. Journal of Consulting and Clinical Psychology 54, 642650.CrossRefGoogle Scholar
Chambless, DL, Gillis, MM (1993). Cognitive therapy of anxiety disorders. Journal of Consulting and Clinical Psychology 61, 248260.CrossRefGoogle ScholarPubMed
Clark, DB, Agras, WS (1991). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry 148, 598605.Google ScholarPubMed
Clark, DM, Ehlers, A, Hackmann, A, McManus, F, Fennell, M, Grey, N, Waddington, L, Wild, J (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology 74, 568578.CrossRefGoogle ScholarPubMed
Clark, DM, Ehlers, A, McManus, F, Hackmann, A, Fennell, M, Campbell, H, Flower, T, Davenport, C, Louis, B (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology 71, 10581067.CrossRefGoogle ScholarPubMed
Cooper, H, Hedges, LV (1994). The Handbook of Research Synthesis. Russell Sage Foundation: New York.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L (2007). Problem solving therapies for depression: a meta-analysis. European Psychiatry 22, 915.CrossRefGoogle ScholarPubMed
Cunningham, V, Lefkoe, M, Sechrest, L (2006). Eliminating Fears: an intervention that permanently eliminates the fear of public speaking. Clinical Psychology and Psychotherapy 13, 183193.CrossRefGoogle Scholar
Davidson, JRT, Foa, EB, Huppert, JD, Keefe, FJ, Franklin, ME, Compton, JS, Zhao, N, Connor, KM, Lynch, TR, Gadde, KM (2004). Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Archives of General Psychiatry 61, 10051013.CrossRefGoogle ScholarPubMed
Davidson, JRT, Hughes, DL, George, LK, Blazer, DG (1993). The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychological Medicine 23, 709718.CrossRefGoogle ScholarPubMed
Deacon, BJ, Abramowitz, JS (2004). Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. Journal of Clinical Psychology 60, 429441.CrossRefGoogle ScholarPubMed
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455463.CrossRefGoogle ScholarPubMed
Ellis, A, Harper, RA (1975). A New Guide to Rational Living. Wilshire Book Company: North Hollywood, CA.Google Scholar
Fedoroff, IC, Taylor, S (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology 21, 311324.CrossRefGoogle ScholarPubMed
Feske, U, Chambless, DL (1995). Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy 26, 695720.CrossRefGoogle Scholar
Fremouw, WJ, Zitter, RE (1978). A comparison of skills training and cognitive restructuring-relaxation for the treatment of speech anxiety. Behavior Therapy 9, 248259.CrossRefGoogle Scholar
Furmark, T (2002). Social phobia: overview of community surveys. Acta Psychiatrica Scandinavica 105, 8493.CrossRefGoogle ScholarPubMed
Gould, RA, Buckminster, S, Pollack, MH, Otto, MW, Yap, L (1997). Cognitive-behavioral and pharmacological treatment for social phobia: a meta-analysis. Clinical Psychology: Science and Practice 4, 291306.Google Scholar
Grant, BF, Hasin, DS, Blanco, C, Stinson, FS, Chou, SP, Goldstein, RB, Dawson, DA, Smith, S, Saha, TD, Huang, B (2005). The epidemiology of social anxiety disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry 66, 13511361.CrossRefGoogle ScholarPubMed
Gruber, K, Moran, PJ, Roth, WT, Taylor, CB (2001). Computer-assisted cognitive behavioral group therapy for social phobia. Behavior Therapy 32, 155165.CrossRefGoogle Scholar
Harvey, AG, Clark, DM, Ehlers, A, Rapee, RM (2000). Social anxiety and self-impression: cognitive preparation enhances the beneficial effects of video feedback following a stressful social task. Behaviour Research and Therapy 38, 11831192.CrossRefGoogle Scholar
Haynes-Clements, LA, Avery, AW (1984). A cognitive-behavioral approach to social skills training with shy persons. Journal of Clinical Psychology 40, 710713.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Hedges, LV, Olkin, I (1985). Statistical Methods for Meta-analysis. Academic Press: San Diego, CA.Google Scholar
Heimberg, RG (1989). Cognitive and behavioral treatments for social phobia: a critical analysis. Clinical Psychology Review 9, 107128.CrossRefGoogle Scholar
Heimberg, RG, Becker, R, Goldfinger, K, Vermilyea, BA (1985). Treatment of social phobia by exposure, cognitive restructuring, and homework assignments. The Journal of Nervous and Mental Disease 173, 236245.CrossRefGoogle ScholarPubMed
Heimberg, RG, Liebowitz, MR, Hope, DA, Schneier, FR, Holt, CS, Welkowitz, LA, Juster, HR, Campeas, R, Bruch, MA, Cloitre, M, Fallon, B, Klein, DF (1998). Cognitive behavioral group therapy vs phenelzine therapy for social phobia. 12-week outcome. Archives of General Psychiatry 55, 11331141.CrossRefGoogle ScholarPubMed
Higgins, JPT, Green, S (2005). Cochrane Handbook for Systematic Reviews of Interventions [version 4.2.5, updated May 2005]. John Wiley & Sons, Ltd: Chichester, UK.Google Scholar
Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.CrossRefGoogle ScholarPubMed
Hofmann, SG (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology 72, 392399.CrossRefGoogle ScholarPubMed
Jerremalm, A, Jansson, L, Öst, LG (1986). Cognitive and physiological reactivity and the effects of different behavioral methods in the treatment of social phobia. Behaviour Research and Therapy 24, 171180.CrossRefGoogle ScholarPubMed
Kanter, NJ, Goldfried, MR (1979). Relative effectiveness of rational restructuring and self-control desensitization in the reduction of interpersonal anxiety. Behavior Therapy 10, 472490.CrossRefGoogle Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry 51, 819.CrossRefGoogle ScholarPubMed
Kessler, RC, Stein, MB, Berglund, P (1998). Social phobia subtypes in the National Comorbidity Survey. American Journal of Psychiatry 155, 613619.CrossRefGoogle ScholarPubMed
Lipsey, MW, Wilson, DB (1993). The efficacy of psychological, educational and behavioral treatment. American Psychologist 48, 11811209.CrossRefGoogle ScholarPubMed
Magee, WJ, Eaton, WW, Wittchen, HU, McGonagle, KA, Kessler, RC (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry 53, 159168.CrossRefGoogle ScholarPubMed
Mattick, RP, Peters, L, Clarke, JC (1989). Exposure and cognitive restructuring for social phobia: a controlled study. Behavior Therapy 20, 323.CrossRefGoogle Scholar
Mersch, PPA (1995). The treatment of social phobia: the differential effectiveness of exposure in vivo and integration of exposure in vivo, rational emotive therapy and social skills training. Behaviour Research and Therapy 33, 259269.CrossRefGoogle ScholarPubMed
Mörtberg, E, Clark, DM, Sundin, Ö, Wistedt, A (2007). Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: a randomized controlled trial. Acta Psychiatrica Scandinavica 115, 142154.CrossRefGoogle ScholarPubMed
Mörtberg, E, Karlsson, A, Fyring, C, Sundin, Ö (2006). Intensive cognitive-behavioral group treatment (CBGT) of social phobia: a randomized controlled study. Journal of Anxiety Disorders 10, 646660.CrossRefGoogle Scholar
Newman, MG, Hofmann, SG, Trabert, W, Roth, WT, Taylor, CB (1994). Does behavioral treatment of social phobia lead to cognitive changes? Behavior Therapy 25, 503517.CrossRefGoogle Scholar
Oosterbaan, DB, van Balkom, AJLM, Spinhoven, P, van Oppen, P, van Dyck, R (2001). Cognitive therapy versus moclobemide in social phobia: a controlled study. Clinical Psychology and Psychotherapy 8, 263273.CrossRefGoogle Scholar
Patel, A, Knapp, M, Henderson, J, Baldwin, D (2002). The economic consequences of social phobia. Journal of Affective Disorders 68, 221233.CrossRefGoogle ScholarPubMed
Rodebaugh, TL, Holaway, RM, Heimberg, RG (2004). The treatment of social anxiety disorder. Clinical Psychology Review 24, 883908.CrossRefGoogle ScholarPubMed
Salaberria, K, Echeburúa, E (1998). Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia. Behavior Modification 22, 262284.CrossRefGoogle Scholar
Schelver, SR, Gutsch, KU (1983). The effects of self-administered cognitive therapy on social-evaluative anxiety. Journal of Clinical Psychology 39, 658667.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Shaw, P (1979). A comparison of three behaviour therapies in the treatment of social phobia. Journal of Clinical Psychopharmacology 18, 132135.Google Scholar
Smit, F, Cuijpers, P, Oostenbrink, J, Batelaan, N, de Graaf, R, Beekman, A (2006). Excess costs of common mental disorders: population-based cohort study. Journal of Mental Health Policy and Economics 9, 193200.Google Scholar
Smits, JAJ, Powers, MB, Buxkamper, R, Telch, MJ (2006). The efficacy of videotape feedback for enhancing the effects of exposure-based treatment for social anxiety disorder: a controlled investigation. Behaviour Research and Therapy 44, 17731785.CrossRefGoogle ScholarPubMed
Stangier, U, Heidenreich, T, Peitz, M, Lauterbach, W, Clark, DM (2003). Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy 41, 9911007.CrossRefGoogle ScholarPubMed
Stein, MB, Kean, YM (2000). Disability and quality of life in social phobia: epidemiological findings. American Journal of Psychiatry 157, 16061613.CrossRefGoogle Scholar
Stein, MB, Torgrud, LJ, Walker, JR (2000). Social phobia symptoms, subtypes, and severity. Findings from a community survey. Archives of General Psychiatry 57, 10461052.CrossRefGoogle ScholarPubMed
Stravynski, A, Arbel, N, Bounader, J, Gaudette, G, Lachance, L, Borgeat, F, Fabian, J, Lamontagne, Y, Sidoun, P, Todorov, C (2000). Social phobia treated as a problem in social funcstioning: a controlled comparison of two behavioural group approaches. Acta Psychiatrica Scandinavica 102, 188198.CrossRefGoogle ScholarPubMed
Taylor, S (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behavior Therapy and Experimental Psychiatry 27, 19.CrossRefGoogle ScholarPubMed
Turner, SM, Beidel, DC, Jacob, RG (1994). Social phobia: a comparison of behavior therapy and atenolol. Journal of Consulting and Clinical Psychology 62, 350358.CrossRefGoogle ScholarPubMed
Watson, D, Friend, R (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology 33, 448457.CrossRefGoogle ScholarPubMed
Wittchen, HU, Fuetsch, M, Sonntag, H, Muller, N, Liebowitz, M (2000). Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. European Psychiatry 15, 4658.CrossRefGoogle ScholarPubMed