Social Anxiety Disorder: Cognitive Therapy or Interpersonal Therapy?

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.