Cognitive behavioral therapy for patients with social anxiety disorder who remain symptomatic following antidepressant treatment: A randomized, assessor-blinded, controlled trial

Naoki Yoshinaga, Satoshi Matsuki, Tomihisa Niitsu, Yasunori Sato, Mari Tanaka, Hanae Ibuki, Rieko Takanashi, Keiko Ohshiro, Fumiyo Ohshima, Kenichi Asano, Osamu Kobori, Kensuke Yoshimura, Yoshiyuki Hirano, Kyoko Sawaguchi, Masaya Koshizaka, Hideki Hanaoka, Akiko Nakagawa, Michiko Nakazato, Masaomi Iyo, Eiji Shimizu

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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.

Original languageEnglish
Pages (from-to)208-217
Number of pages10
JournalPsychotherapy and Psychosomatics
Volume85
Issue number4
DOIs
Publication statusPublished - 2016 Jun 14
Externally publishedYes

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Keywords

  • Antidepressant
  • Cognitive behavioral therapy
  • Cognitive therapy
  • Randomized controlled trial
  • Residual symptoms
  • Social anxiety
  • Social phobia

ASJC Scopus subject areas

  • Clinical Psychology
  • Applied Psychology
  • Psychiatry and Mental health

Cite this

Yoshinaga, N., Matsuki, S., Niitsu, T., Sato, Y., Tanaka, M., Ibuki, H., Takanashi, R., Ohshiro, K., Ohshima, F., Asano, K., Kobori, O., Yoshimura, K., Hirano, Y., Sawaguchi, K., Koshizaka, M., Hanaoka, H., Nakagawa, A., Nakazato, M., Iyo, M., & Shimizu, E. (2016). Cognitive behavioral therapy for patients with social anxiety disorder who remain symptomatic following antidepressant treatment: A randomized, assessor-blinded, controlled trial. Psychotherapy and Psychosomatics, 85(4), 208-217. https://doi.org/10.1159/000444221