[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.173.36. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.  Arch Gen Psychiatry. 2005;62(6):617-62715939839PubMedGoogle ScholarCrossref
2.
Ruscio AM, Brown TA, Chiu WT, Sareen J, Stein MB, Kessler RC. Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication.  Psychol Med. 2008;38(1):15-2817976249PubMedGoogle ScholarCrossref
3.
Keller MB. Social anxiety disorder clinical course and outcome: review of Harvard/Brown Anxiety Research Project (HARP) findings.  J Clin Psychiatry. 2006;67(12):(suppl 12)  14-1917092191PubMedGoogle Scholar
4.
Mathew SJ, Ho S. Etiology and neurobiology of social anxiety disorder.  J Clin Psychiatry. 2006;67(12):(suppl 12)  9-1317092190PubMedGoogle Scholar
5.
Rapee RM, Spence SH. The etiology of social phobia: empirical evidence and an initial model.  Clin Psychol Rev. 2004;24(7):737-76715501555PubMedGoogle ScholarCrossref
6.
Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, Holt CS, Welkowitz LA, Juster HR, Campeas R, Bruch MA, Cloitre M, Fallon B, Klein DF. Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome.  Arch Gen Psychiatry. 1998;55(12):1133-11419862558PubMedGoogle ScholarCrossref
7.
Davidson JR, Foa EB, Huppert JD, Keefe FJ, Franklin ME, Compton JS, Zhao N, Connor KM, Lynch TR, Gadde KM. Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia.  Arch Gen Psychiatry. 2004;61(10):1005-101315466674PubMedGoogle ScholarCrossref
8.
Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, eds. Social Phobia: Diagnosis, Assessment and Treatment. New York, NY: Guilford Press; 1995:69-93
9.
Clark DM, Ehlers A, McManus F, Hackmann A, Fennell MJV, Campbell H, Flower T, Davenport C, Louis B. Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial.  J Consult Clin Psychol. 2003;71(6):1058-106714622081PubMedGoogle ScholarCrossref
10.
Clark DM, Ehlers A, Hackmann A, McManus F, Fennell M, Grey N, Waddington L, Wild J. Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial.  J Consult Clin Psychol. 2006;74(3):568-57816822113PubMedGoogle ScholarCrossref
11.
Stangier U, Heidenreich T, Peitz M, Lauterbach W, Clark DM. Cognitive therapy for social phobia: individual versus group treatment.  Behav Res Ther. 2003;41(9):991-100712914803PubMedGoogle ScholarCrossref
12.
Mörtberg E, Clark DM, Sundin O, Aberg Wistedt A. Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: a randomized controlled trial.  Acta Psychiatr Scand. 2007;115(2):142-15417244178PubMedGoogle ScholarCrossref
13.
Alden LE, Taylor CT. Interpersonal processes in social phobia.  Clin Psychol Rev. 2004;24(7):857-88215501559PubMedGoogle ScholarCrossref
14.
Klerman GL, Weissman MM, Rounsaville BA, Chevron ES. Interpersonal Psychotherapy of Depression. New York, NY: Basic Books; 1984
15.
Weissman MM, Markowitz JC, Klerman GL. Comprehensive Guide to Interpersonal Psychotherapy. New York, NY: Basic Books; 2000
16.
Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, Fiester SJ, Parloff MB. National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments.  Arch Gen Psychiatry. 1982;46(11):971-9822684085PubMedGoogle ScholarCrossref
17.
Agras WS, Walsh T, Fairburn CG, Wilson GT, Kraemer HC. A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa.  Arch Gen Psychiatry. 2000;57(5):459-46610807486PubMedGoogle ScholarCrossref
18.
Lipsitz JD, Markowitz JC, Cherry S, Fyer AJ. Open trial of interpersonal psychotherapy for the treatment of social phobia.  Am J Psychiatry. 1999;156(11):1814-181610553749PubMedGoogle Scholar
19.
Lipsitz JD, Gur M, Vermes D, Petkova E, Cheng J, Miller N, Laino J, Liebowitz MR, Fyer AJ. A randomized trial of interpersonal therapy versus supportive therapy for social anxiety disorder.  Depress Anxiety. 2008;25(6):542-55317941096PubMedGoogle ScholarCrossref
20.
Elkin I, Gibbons RD, Shea MT, Sotsky SM, Watkins JT, Pilkonis PA, Hedeker D. Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.  J Consult Clin Psychol. 1995;63(5):841-8477593878PubMedGoogle ScholarCrossref
21.
Fairburn CG, Jones R, Peveler RC, Hope RA, O’Connor M. Psychotherapy and bulimia nervosa: longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy.  Arch Gen Psychiatry. 1993;50(6):419-4288498876PubMedGoogle ScholarCrossref
22.
Borge FM, Hoffart A, Sexton H, Clark DM, Markowitz JC, McManus F. Residential cognitive therapy versus residential interpersonal therapy for social phobia: a randomized clinical trial.  J Anxiety Disord. 2008;22(6):991-101018035519PubMedGoogle ScholarCrossref
23.
Jacobson NS, Hollon SD. Cognitive-behavior therapy versus pharmacotherapy: now that the jury's returned its verdict, it's time to present the rest of the evidence.  J Consult Clin Psychol. 1996;64(1):74-808907086PubMedGoogle ScholarCrossref
24.
Luborsky L, Diguer L, Seligman DA, Rosenthal R, Krause ED, Johnson S, Halperin G, Bishop M, Berman JS, Schweizer E. The researcher's own therapeutic allegiances: a“wild card” in comparisons of treatment efficacy.  Clin Psychol Sci Pract. 1999;6(1):95-106Google ScholarCrossref
25.
Connor KM, Davidson JRT, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the Social Phobia Inventory (SPIN): new self-rating scale.  Br J Psychiatry. 2000;176(4):379-38610827888PubMedGoogle ScholarCrossref
26.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV (Axis I Disorders). Arlington, VA: American Psychiatric Publishing Inc; 1997
27.
First MB, Spitzer RL, Gibbon M, Williams JBW. User's Guide for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Washington, DC: American Psychiatry Press; 1997
28.
Wittchen HU, Zaudig M, Fydrich T. Strukturiertes Klinisches Interview für DSM-IV : SKID, Achse I und Achse II. Göttingen: Hogrefe; 1997
29.
Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatry. 1960;23(1):56-6214399272PubMedGoogle ScholarCrossref
30.
Hamilton M. Hamilton Depression Scale. In: Collegium IPS, ed. Skalen für die Psychiatrie. 4th ed. Weinheim, Germany: Beltz; 1996
31.
Stangier U, Ehlers A, Clark D. Soziale Phobie: Fortschritte der Psychotherapie. Göttingen, Germany: Hogrefe; 2006
32.
Zaider TI, Heimberg RG, Fresco DM, Schneier FR, Liebowitz MR. Evaluation of the Clinical Global Impression Scale among individuals with social anxiety disorder.  Psychol Med. 2003;33(4):611-62212785463PubMedGoogle ScholarCrossref
33.
Liebowitz MR, Heimberg RG, Schneier FR, Hope DA, Davies S, Holt CS, Goetz D, Juster HR, Lin SH, Bruch MA, Marshall RD, Klein DF. Cognitive-behavioral group therapy versus phenelzine in social phobia: long-term outcome.  Depress Anxiety. 1999;10(3):89-9810604081PubMedGoogle ScholarCrossref
34.
Liebowitz MR. Social phobia.  Mod Probl Pharmacopsychiatry. 1987;22:141-1732885745PubMedGoogle Scholar
35.
Stangier U, Heidenreich T. Liebowitz Social Anxiety Scale. In: Collegium IPS, ed. Internationale Skalen für Psychiatrie. 5th ed. Weinheim, Germany: Beltz; 2005
36.
Mennin DS, Fresco DM, Heimberg RG, Schneier FR, Davies SO, Liebowitz MR. Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale.  J Anxiety Disord. 2002;16(6):661-67312405524PubMedGoogle ScholarCrossref
37.
Turner SM, Beidel DC, Dancu CV, Stanley MA. An empirically derived inventory to measure social fears and anxiety: the Social Phobia and Anxiety Inventory.  Psychol Assess. 1989;1(1):35-40Google ScholarCrossref
38.
Borkovec TD, Nau SD. Credibility of analogue therapy rationales.  J Behav Ther Exp Psychiatry. 1972;3(4):257-260Google ScholarCrossref
39.
Flückiger C, Regli D, Zwahlen D, Hostettler S, Caspar F. The Bernese Post-Session Report: therapists' and patients' version: an instrument for the assessment of psychotherapy processes [in German].  Z Klin Psychol Psychother. 2010;39(2):71-79Google ScholarCrossref
40.
Hofmann SG, Smits JAJ. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials.  J Clin Psychiatry. 2008;69(4):621-63218363421PubMedGoogle ScholarCrossref
41.
Acarturk C, Cuijpers P, van Straten A, de Graaf R. Psychological treatment of social anxiety disorder: a meta-analysis.  Psychol Med. 2009;39(2):241-25418507874PubMedGoogle ScholarCrossref
42.
Ipser JC, Kariuki CM, Stein DJ. Pharmacotherapy for social anxiety disorder: a systematic review.  Expert Rev Neurother. 2008;8(2):235-25718271710PubMedGoogle ScholarCrossref
43.
Hofmann SG. Self-focused attention before and after treatment of social phobia.  Behav Res Ther. 2000;38(7):717-72510875193PubMedGoogle ScholarCrossref
44.
Hirsch CR, Clark DM, Mathews A, Williams R. Self-images play a causal role in social phobia.  Behav Res Ther. 2003;41(8):909-92112880646PubMedGoogle ScholarCrossref
45.
Amir N, Foa EB, Coles ME. Implicit memory bias for threat-relevant information in individuals with generalized social phobia.  J Abnorm Psychol. 2000;109(4):713-72011195995PubMedGoogle ScholarCrossref
46.
McManus F, Sacadura C, Clark DM. Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor.  J Behav Ther Exp Psychiatry. 2008;39(2):147-16117433252PubMedGoogle ScholarCrossref
47.
Hofmann SG. Cognitive mediation of treatment change in social phobia.  J Consult Clin Psychol. 2004;72(3):393-39915279523PubMedGoogle Scholar
48.
McManus F, Clark DM, Grey N, Wild J, Hirsch C, Fennell M, Hackmann A, Waddington L, Liness S, Manley J. A demonstration of the efficacy of two of the components of cognitive therapy for social phobia.  J Anxiety Disord. 2009;23(4):496-50319081225PubMedGoogle ScholarCrossref
49.
Harvey AG, Clark DM, Ehlers A, Rapee RM. Social anxiety and self-impression: cognitive preparation enhances the beneficial effects of video feedback following a stressful social task.  Behav Res Ther. 2000;38(12):1183-119211104182PubMedGoogle ScholarCrossref
50.
Wild J, Hackmann A, Clark DM. When the present visits the past: updating traumatic memories in social phobia.  J Behav Ther Exp Psychiatry. 2007;38(4):386-40117765865PubMedGoogle ScholarCrossref
51.
Markowitz JC, Bleiberg KL, Christos P, Levitan E. Solving interpersonal problems correlates with symptom improvement in interpersonal psychotherapy: preliminary findings.  J Nerv Ment Dis. 2006;194(1):15-2016462550PubMedGoogle ScholarCrossref
52.
Neal JA, Edelmann RJ. The etiology of social phobia: toward a developmental profile.  Clin Psychol Rev. 2003;23(6):761-78614529697PubMedGoogle ScholarCrossref
53.
Parker G, Parker I, Brotchie H, Stuart S. Interpersonal psychotherapy for depression? the need to define its ecological niche.  J Affect Disord. 2006;95(1-3):1-1116712944PubMedGoogle ScholarCrossref
54.
Liebowitz MR, Schneier F, Campeas R, Hollander E, Hatterer J, Fyer A, Gorman J, Papp L, Davies S, Gully R, Klein DR. Phenelzine vs atenolol in social phobia: a placebo-controlled comparison.  Arch Gen Psychiatry. 1992;49(4):290-3001558463PubMedGoogle Scholar
55.
Lincoln TM, Rief W. How much do sample characteristics affect the effect size? an investigation of studies testing the treatment effects for social phobia.  J Anxiety Disord. 2004;18(4):515-52915149711PubMedGoogle ScholarCrossref
Original Article
July 2011

Cognitive Therapy vs Interpersonal Psychotherapy in Social Anxiety Disorder: A Randomized Controlled Trial

Author Affiliations

Author Affiliations: Department of Psychology, University of Frankfurt, Frankfurt (Dr Stangier); Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg (Drs Schramm and Berger); Department of Social Work, Health and Nursing, University of Applied Sciences, Esslingen (Dr Heidenreich), Germany; and Department of Psychology, Kings College London, London, England (Dr Clark).

Arch Gen Psychiatry. 2011;68(7):692-700. doi:10.1001/archgenpsychiatry.2011.67
Abstract

Context Cognitive therapy (CT) focuses on the modification of biased information processing and dysfunctional beliefs of social anxiety disorder (SAD). Interpersonal psychotherapy (IPT) aims to change problematic interpersonal behavior patterns that may have an important role in the maintenance of SAD. No direct comparisons of the treatments for SAD in an outpatient setting exist.

Objective To compare the efficacy of CT, IPT, and a waiting-list control (WLC) condition.

Design Randomized controlled trial.

Setting Two academic outpatient treatment sites.

Patients Of 254 potential participants screened, 117 had a primary diagnosis of SAD and were eligible for randomization; 106 participants completed the treatment or waiting phase.

Interventions Treatment comprised 16 individual sessions of either CT or IPT and 1 booster session. Twenty weeks after randomization, posttreatment assessment was conducted and participants in the WLC received 1 of the treatments.

Main Outcome Measures The primary outcome was treatment response on the Clinical Global Impression Improvement Scale as assessed by independent masked evaluators. 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.

Results At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC. Regarding response rates and Liebowitz Social Anxiety Scale scores, CT performed significantly better than did IPT, and both treatments were superior to WLC. At 1-year follow-up, the differences between CT and IPT were largely maintained, with significantly higher response rates in the CT vs the IPT group (68.4% vs 31.6%) and better outcomes on the Liebowitz Social Anxiety Scale. No significant treatment× site interactions were noted.

Conclusions Cognitive therapy and IPT led to considerable improvements that were maintained 1 year after treatment; CT was more efficacious than was IPT in reducing social phobia symptoms.

×