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Group CBT for Social Anxiety Disorder: A Meta-Analysis

OBJECTIVE: A few meta-analyses have examined psychological treatments for a social anxiety disorder (SAD). This is the first meta-analysis that examines the effects of cognitive behavioural group therapies (CBGT) for SAD compared to control on symptoms of anxiety.

METHOD: After a systematic literature search in PubMed, Cochrane, PsychINFO and Embase was conducted; eleven studies were identified that met the inclusion criteria. The studies had to be randomized controlled studies in which individuals with a diagnosed SAD were treated with cognitive-behavioural group therapy (CBGT) and compared with a control group. The overall quality of the studies was moderate.

RESULTS: The pooled effect size indicated that the difference between intervention and control conditions was 0.53 (96% CI: 0.33-0.73), in favour of the intervention. This corresponds to a NNT 3.24. Heterogeneity was low to moderately high in all analyses. There was some indication of publication bias.

CONCLUSIONS: It was found that psychological group-treatments CBGT are more effective than control conditions in patients with SAD. Since heterogeneity between studies was high, more research comparing group psychotherapies for SAD to control is needed.

Wersebe, H., Sijbrandij, M., & Cuijpers, P. (January 01, 2013). Psychological group-treatments of social anxiety disorder: a meta-analysis. Plos One, 8, 11.)

CBT Reduces Shame in Individuals with Social Anxiety Disorder

According to a recent study published in Plos One, cognitive behavior therapy (CBT) may help reduce experiences of shame (specifically associated with how individuals judge themselves) among patients diagnosed with social anxiety disorder (SAD.) Participants (n= 161) in the current study were initially evaluated for experiences of shame, guilt, depression, and social anxiety. Participants diagnosed with SAD (n=67) were assigned to a CBT treatment condition; the remaining participants (n=94) were assigned to two samples of healthy controls. According to results, shame, social anxiety, and depressive symptoms were each associated in participants with SAD. Further, shame was shown to be elevated among SAD patients compared to the main healthy control. Following treatment, shame significantly reduced among participants with SAD. These findings suggest that shame and social anxiety are associated, that socially anxious patients may be more likely to experience shame than patients without social anxiety, and that CBT treatment can help reduce shame among individuals with SAD.

Hedman, E., Strom, P., Stunkel, A., & Mortberg, E. (April 19, 2013). Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms. Plos One, 8, 4.

Group CBT is Effective for Generalized Social Anxiety Disorder in Japan

According to a recent study published in Neuropsychiatric Disease and Treatment, cognitive behavior therapy (CBT) effectively reduces symptoms of generalized social anxiety disorder (SAD) and improves quality of life among Japanese patients for up to a year post-treatment. The present study aimed to identify the long-term efficacy and predictors of group CBT among patients diagnosed with SAD in a naturalistic setting in Japan. From July 2003 to August 2010, outpatient participants (n=113) received 12-20 group-based CBT sessions and were assessed at 1-year follow up points. The researchers then compared treatment completers to those who had dropped out. According to results, group-based CBT significantly reduced symptoms of SAD among patients, and these improvements were maintained for up to one year post-treatment.

Kawaguchi, A, Watanabe, N, Nakano, Y, et al. (2013). Group cognitive behavioral therapy for patients with generalized social anxiety disorder in japan: Outcomes at 1-year follow up and outcome predictors. Neuropsychiatric Disease and Treatment, 9, 267-275.

CBT Is Effective For Social Anxiety Disorder

According to a recent study published in Behaviour Research and Therapy, modifying maladaptive beliefs via cognitive behavior therapy (CBT) can significantly reduce the severity of Social Anxiety Disorder (SAD) symptoms. In the current study, researchers sought to determine, specifically, whether belief modification via CBT mediates treatment effects for SAD. Participants (47 adults) who met criteria for SAD were randomly assigned to either a CBT treatment condition (16 hour-long, weekly sessions of manualized CBT) or a waitlist control condition. Maladaptive interpersonal beliefs as well as the emotional and behavioral components of social anxiety were measured at baseline and post-treatment. Results showed that maladaptive beliefs were associated with SAD at baseline and post-treatment, that CBT significantly reduce those beliefs, and that reducing maladaptive beliefs accounted for reductions in social anxiety symptoms following CBT treatment.  These findings suggest that belief change is critical to effective CBT treatment for social anxiety disorder.

Boden, M. T., John, O. P., Goldin, P. R., Werner, K., Heimberg, R.G., & Gross, J. J. (2012). The role of maladaptive beliefs in cognitive-behavioral therapy: Evidence from social anxiety disorder. Behaviour Research and Therapy, 50, 287-291.

From Kafka to Cognitive Behavioral Therapy: Using Trial-Based Thought Records on Patients with Social Anxiety Disorder

A recent study investigated the efficacy of Trial-Based Thought Records (TBTR) as an alternative to conventional Cognitive Therapy in the treatment of patients with generalized Social Anxiety Disorder (SAD).  SAD is the most common form of anxiety disorder and an important target of therapy is the modification of patients’ negative core beliefs.  Based on the idea of “self-accusation” suggested in Kafka’s The Trial, Dr. Irismar Reis de Oliveira devised the TBTR intervention in which patients become their own prosecutor and defender in a trial against their negative core beliefs.  TBTR mimics a trial and one technique involves asking patients to report evidence supporting their negative core beliefs, then form an argument against them, and then repeat the process with new evidence. 

The present pilot study looks at the efficacy of TBTR in a randomized population of people with generalized Social Anxiety Disorder.  36 patients with SAD were randomly assigned to either the conventional CT treatment (control group) or the TBTR treatment (experimental group).  Five trained CT-therapists conducted 12, one hour long sessions in a period of 14 weeks following either CT or TBTR manuals.  Patients were asked to fill out a series of self-report measures throughout the treatment and during a 12 month follow-up.  The study showed that TBTR is at least as efficacious as traditional CT; however, patients that underwent TBTR scored lower on the Fear of Negative Evaluation scale than patients with regular CT. 

Alternative and supplementary treatment models are needed to increase the effectiveness of CT for SAD.  This study suggests the advisability of further investigation of Trial-Based Cognitive Therapy and the Trial-Based Thought Record.

De Oliveira, I.  (2011). Kafka’s trial dilemma: Proposal of a practical solution to Joseph K.’s unknown accusation.  Medical Hypotheses. (in press).

De Oliveira, I. R., Powell, V. B., Wenzel, A., Caldas, M., Seixas, C., Almeida, C., Bonfim, T., Grangeon, M. C., Castro, M., Galvao, A., Moraes, R., & Sudak, D.  (2011).  Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia: A randomized controlled study.  Journal of Clinical Pharmacy and Therapeutics.

Japan: Social Anxiety Disorder shows positive response to group CBT

A study in BMC Psychiatry reported that the use of cognitive behavioral therapy (CBT) for Social Anxiety Disorder (SAD) was well established in Europe and North America but little was known about its effectiveness in non-Western cultures.

A pilot study of group CBT for SAD was conducted in Japan (groups of 3 or 4; average number of sessions per group was 15). The CBT methods included psychoeducation regarding anxiety, experiments to reduce safety behaviors, cognitive restructuring for dysfunctional assumptions, and others. Where needed, co-administration of antidepressants and benzodiazepines was allowed.

The researchers found a significant reduction in symptoms pre- to post-treatment, and concluded that group CBT “can bring about a similar degree of symptom reduction among Japanese patients with SAD as among Western patients.”

Study authors: J. Chen, Y. Nakano, T. Ietzugu, S. Ogawa, et al.