Treatment of social phobia : Development of a method and comparison of treatments

University dissertation from Stockholm : Karolinska Institutet, Department of Clinical Neuroscience

Abstract: Social phobia is a common (13 %) and disabling anxiety disorder associated with considerable social and occupational handicap. It is not likely to remit without treatment. Although the efficacy of cognitive behavioural and pharmacological interventions are relatively well established there is a need for further development, as many patients remain disabled at the end of treatment. There is still a lack of understanding of the factors involved in incomplete treatment responses. In addition, it is important to examine how treatments actually work in clinical practice. The aims of the present thesis were to examine the effectiveness of an intensive (3 weeks) cognitive behavioural group treatment (CBGT) in a pilot study and in a waiting list controlled study. Taking into account some recent developments in psychological treatment the intensive CBGT was modified (and renamed intensive group cognitive treatment /IGCT/) and compared to individual cognitive therapy (ICT) and treatment as usual (TAU), involving medication, in a randomized controlled study of 100 patients. Finally, a trait-based study of personality patterns before and after treatment was conducted aiming to outline personality characteristics in patients with social phobia, and patterns of change following treatment. The result of the pilot study as well of the waiting list controlled study showed that patients improved significantly after three weeks of treatment, with reduced levels of social phobia related symptoms. The treatment effects were maintained at one year post-treatment. The efficacy of the intensive treatment was further confirmed in the randomized, controlled trial of IGCT, ICT and TAU. ICT was, however, more effective than IGCT and TAU, which showed equal efficacy. The personality patterns of patients were characterised by pronounced levels of harm avoidance and character traits associated with personality disorders. Dysfunctional traits were changed following treatments: however, nonresponders still exhibited high levels of harm avoidance. To conclude, brief intensive group treatment is a feasible and effective option in the treatment of social phobia in routine psychiatric practice. It works fast and shows maintained or improved effects at one year post-treatment. IGCT, ICT and TAU are all effective and enduring treatments for social phobia. However, ICT is superior to IGCT and TAU. The 3-week IGCT seems to be more accepted and is as effective as the 12-month medication focused TAU. Pronounced harm avoidance is a general vulnerability trait in patients with social phobia and may be a general predictor of poor treatment response. Further studies are needed for additional understanding of factors contributing to incomplete treatments responses.

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