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Psychological treatment of social anxiety disorder: a meta-analysis

  • C. Acarturk (a1), P. Cuijpers (a1) (a2), A. van Straten (a1) and R. de Graaf (a2)

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.


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).


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.


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.

Corresponding author
*Address for correspondence: C. Acarturk, M.Sc., Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email:
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Akillas E, Efran JS (1995). Symptom prescription and reframing: should they be combined? Cognitive Therapy and Research 19, 263279.
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.
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychological Association: Washington, DC.
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychological Association: Washington, DC.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychological Association: Washington, DC.
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.
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.
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.
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.
Chambless DL, Gillis MM (1993). Cognitive therapy of anxiety disorders. Journal of Consulting and Clinical Psychology 61, 248260.
Clark DB, Agras WS (1991). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry 148, 598605.
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.
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.
Cooper H, Hedges LV (1994). The Handbook of Research Synthesis. Russell Sage Foundation: New York.
Cuijpers P, van Straten A, Warmerdam L (2007). Problem solving therapies for depression: a meta-analysis. European Psychiatry 22, 915.
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.
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.
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.
Deacon BJ, Abramowitz JS (2004). Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. Journal of Clinical Psychology 60, 429441.
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.
Ellis A, Harper RA (1975). A New Guide to Rational Living. Wilshire Book Company: North Hollywood, CA.
Fedoroff IC, Taylor S (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology 21, 311324.
Feske U, Chambless DL (1995). Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy 26, 695720.
Fremouw WJ, Zitter RE (1978). A comparison of skills training and cognitive restructuring-relaxation for the treatment of speech anxiety. Behavior Therapy 9, 248259.
Furmark T (2002). Social phobia: overview of community surveys. Acta Psychiatrica Scandinavica 105, 8493.
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.
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.
Gruber K, Moran PJ, Roth WT, Taylor CB (2001). Computer-assisted cognitive behavioral group therapy for social phobia. Behavior Therapy 32, 155165.
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.
Haynes-Clements LA, Avery AW (1984). A cognitive-behavioral approach to social skills training with shy persons. Journal of Clinical Psychology 40, 710713.
Hedges LV, Olkin I (1985). Statistical Methods for Meta-analysis. Academic Press: San Diego, CA.
Heimberg RG (1989). Cognitive and behavioral treatments for social phobia: a critical analysis. Clinical Psychology Review 9, 107128.
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.
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.
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.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.
Hofmann SG (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology 72, 392399.
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.
Kanter NJ, Goldfried MR (1979). Relative effectiveness of rational restructuring and self-control desensitization in the reduction of interpersonal anxiety. Behavior Therapy 10, 472490.
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.
Kessler RC, Stein MB, Berglund P (1998). Social phobia subtypes in the National Comorbidity Survey. American Journal of Psychiatry 155, 613619.
Lipsey MW, Wilson DB (1993). The efficacy of psychological, educational and behavioral treatment. American Psychologist 48, 11811209.
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.
Mattick RP, Peters L, Clarke JC (1989). Exposure and cognitive restructuring for social phobia: a controlled study. Behavior Therapy 20, 323.
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.
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.
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.
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.
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.
Patel A, Knapp M, Henderson J, Baldwin D (2002). The economic consequences of social phobia. Journal of Affective Disorders 68, 221233.
Rodebaugh TL, Holaway RM, Heimberg RG (2004). The treatment of social anxiety disorder. Clinical Psychology Review 24, 883908.
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.
Schelver SR, Gutsch KU (1983). The effects of self-administered cognitive therapy on social-evaluative anxiety. Journal of Clinical Psychology 39, 658667.
Shaw P (1979). A comparison of three behaviour therapies in the treatment of social phobia. Journal of Clinical Psychopharmacology 18, 132135.
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.
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.
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.
Stein MB, Kean YM (2000). Disability and quality of life in social phobia: epidemiological findings. American Journal of Psychiatry 157, 16061613.
Stein MB, Torgrud LJ, Walker JR (2000). Social phobia symptoms, subtypes, and severity. Findings from a community survey. Archives of General Psychiatry 57, 10461052.
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.
Taylor S (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behavior Therapy and Experimental Psychiatry 27, 19.
Turner SM, Beidel DC, Jacob RG (1994). Social phobia: a comparison of behavior therapy and atenolol. Journal of Consulting and Clinical Psychology 62, 350358.
Watson D, Friend R (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology 33, 448457.
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.
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