If all you did was watch TV, you might think social anxiety disorder was as prevalent as depression — or as big a problem. Also called social phobia, social anxiety disorder is often treated first with medications, such as an SSRI antidepressant (you know, regulars like Paxil or Prozac). Psychotherapy is also an option — it’s just not as popular as medication.
In a randomized controlled research study published recently, two psychological interventions were put head to head to see which one would come out on top.
Cognitive therapy (CT) focuses on the modification of biased information processing and dysfunctional beliefs of social anxiety disorder. Interpersonal psychotherapy (IPT) aims to change problematic interpersonal behavior patterns that may have an important role in the maintenance of the problem.
According to the researchers, no previous direct comparison of these two treatment options exists.
In psychotherapy research, often researchers use a condition called a “waiting-list control” group. This group is told they will get treatment in a short time, but they have to be placed on a waiting list because no therapists are readily available. This allows the researchers to test to see if it’s time alone that will result in a person’s condition improving (rather than the therapy treatment).
A total of 117 subjects were gathered from two outpatient treatment centers, and out of those, 106 completed the study.
How was the study conducted?
Treatment comprised 16 individual sessions of either cognitive therapy or interpersonal therapy and one booster session. Twenty weeks after randomization, posttreatment assessment was conducted and participants in the control group received one of the treatments.
The primary outcome was treatment response on the Clinical Global Impression Improvement Scale, as assessed by independent evaluators [blinded to treatment conditions].
The secondary outcome measures were independent assessor ratings using the Liebowitz Social Anxiety Scale, the Hamilton Rating Scale for Depression, and patient self-ratings of SAD symptoms.
What were the results? At the end of the study, the cognitive therapy group have a nearly 66 percent response rate while the interpersonal therapy group had a 42 percent response rate. The control group, in comparison, had only a 7 percent response rate — meaning that just waiting for the problem to resolve on its own is significantly less effective than getting treatment for it.
In the specific measurement of social anxiety disorder, cognitive therapy significantly outperformed interpersonal therapy. Both treatment conditions significantly improved social anxiety symptoms in comparison to the control group.
This study also did something special a lot of studies don’t do — a one year followup. It’s all well and good to measure the effects of a treatment immediately when the study ends. But a one-year followup tells us whether the treatment “sticks” or not.
At the follow-up, the differences between CT and IPT were largely maintained, according to the researchers. The cognitive therapy group again came out on top with significantly higher response rates (68 percent) versus the interpersonal therapy group (32 percent)
The cognitive therapy group also had better outcomes on the Liebowitz Social Anxiety Scale at the one year followup.
So there you have it. For social anxiety disorder, cognitive therapy is the therapy of choice — it’ll give you great results in just 16 weeks. And not results dependent upon taking a medication for a year or two — results that are long-lasting and permanent.
Reference
Stangier U, Schramm E, Heidenreich T, Berger M, Clark DM. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Arch Gen Psychiatry, 68, 692-700.
10 comments
John,
Great article. As a therapist who relies heavily on cognitive therapy with various disorders, it is encouraging to know that cognitive therapy is producing these types of results. It validates my belief in the effectiveness of this therapeutic technique with social anxiety disorder, as this has been my experience in clinical settings, we well.
Perri
Interesting results. I have bipolar disorder therefore I am on medication, but I also have social anxiety disorder. I have taken part in CBT with different therapists a number of times over recent years and have experienced no change in my social anxiety. I feel all CBTed out! On the other hand IPT has helped me considerably.
CBT will win every time in a study like this. IPT is only going to be given a fair shot if the relationship is well established. IPT without a well-established relationship isn’t IPT!
I completely agree with PsychReader.
This study is over-reaching in its conclusions! At best it can conclude that CBT works better in GROUP therapy, which makes sense because of the more psychoeducational approach. Interpersonal therapy depends on the relationship, which may NOT be as effective in a group setting. Therefore, I disagree with the conclusions that CBT is always better than an interpersonal approach.
Thanks for the article.
How were therapist effects controlled for? I recommend good therapists with a track record of success ..over a specific model of therapy. Relationship factor trumps adherence to a particular Tx protocol in the change process.
Thanks,
Greg
I have battled SAD all my life (I am 51). Nothing has worked. Not CBT, not IPT, not medication, nothing. Psychotherapy for SAD is nothing but a fraud.
I’m a 52 year old with social anxiety disorder and had it as a kid. I.e., I was born with it. Fortunately my GP recognized that and put me on Paxil 5 years ago. I take 60 mg a day but the odd thing is I feel like I could quit it. It makes me feel normal.
I’m more much more talkative with strangers, I no longer frequent raging anger, and I quit drinking one year ago. Paxil got rid of my forever present alcohol cravings. I no longer even think about drinking on the weekends whereas before Paxil I’d plan in my mind how I would drink on Friday and or Saturday.
Fortunately, my GP recognized I was self medicating my SAD with alcohol.
I truly don’t think CBT can achieve all of the above. My SAD has been cured with Paxil alone.
Interesting, Social phobia is one of my biggest problems and have tried medication to no effect. A psychotherapist advised after talking to me that I should totally accept the situation rather than fight it. Sounds simple? It changed my life forever.
I find all of the comments just as interesting as the article….sounds like different therapies work for different people. CBT is the therapy of choice for OCD, and now it seems to be at the top of the list for SAD also. It seems to be the number one treatment for anxiety disorders.
It’s not the #1 treatment if it doesn’t work for me.
It’s not the #1 treatment if it doesn’t work for my Uncle Bob.
And it’s not the #1 treatment if it doesn’t work for YOU.
There’s no silver bullet. You have to be willing to risk a treatment failing, until you find the one that’s right for you.
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