Disorders - Social phobia
In-Albon, T., Schneider, S.
Background: The present study compared the efficacy of psychotherapy for
childhood anxiety disorders (excluding trials solely treating post-traumatic stress disorder or obsessive-compulsive disorder). Methods: The meta-
analysis included studies that met the basic CONSORT (consolidated standards of reporting trials) criteria. Several outcome variables (e.g. effect
sizes, percentage of recovery) were analyzed using completer and intent-to-treat analyses during post-treatment and follow-up assessment. Twenty-four
studies published by March 2005 were included in this meta-analysis. Results: In all the included studies, the active treatment condition was
cognitive-behavioral. The overall mean effect of treatment was 0.86. No differences in outcome were found between individual and group treatments or
child- and family-focused treatments. Follow-up data demonstrated that treatment gains were maintained up to several years after treatment.
Conclusions: These findings provide evidence that anxiety disorders in children can be treated efficaciously. The gathered data support the clinical
utility of cognitive-behavioral therapy in this regard. Randomized controlled trial studies investigating treatments other than cognitive-behavioral
therapy are missing. Copyright copyright 2007 S. Karger AG.
Psychotherapy & Psychosomatics., 76(1) : 15-24
- Year: 2007
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Panic
Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
March, J. S., Entusah, A. R., Rynn, M., Albano, A. M., Tourian, K. A.
Background: Social
anxiety disorder, which occurs in 2% to 5% of children and adolescents, is associated with significant distress and functional impairment. Methods:
The objective of the randomized, masked controlled trial conducted in 48 academic and community centers in the United States was to evaluate the
efficacy of venlafaxine ER in children and adolescents with generalized social anxiety disorder. A volunteer sample of 293 outpatients, age 8 to 17,
who met diagnostic criteria for social anxiety disorder and were enrolled between February 2000 and March 2003 participated. Venlafaxine ER or
placebo was titrated from a starting dose of 37.5 mg to a maximum dose of 225 mg over 16 weeks. The primary dependent measures were the Social
Anxiety Scale, child or adolescent version (SAS-CA) and for responder analysis, a (dichotomized) Clinical Global Impressions-Improvement (CGI-I)
score. Results: Compared with placebo, intent-to-treat random regression analyses indicated a statistically significant advantage for venlafaxine ER
(p = .001) on the SAS-CA. On the CGI-I responder analysis, 56% (95% confidence interval [CI], 47%-64%) of venlafaxine ER treated subjects responded,
which was statistically superior to placebo (37% [95% CI, 29%-45%]). Three venlafaxine ER and no placebo patients developed treatment-emergent
suicidality; there were no completed suicides. Conclusions: Venlafaxine ER is an effective and reasonably well-tolerated treatment for generalized
social anxiety disorder in children and adolescents. As with other antidepressants, careful clinical monitoring for adverse events, including
treatment-emergent suicidality, is essential. copyright 2007 Society of Biological Psychiatry.
Biological
Psychiatry., 62(10) : 1149-1154
- Year: 2007
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)
Warner, C. M., Fisher, P. H., Shrout, P.
E., Rathor, S., Klein, R. G.
Background: Anxiety disorders are often undetected and untreated in adolescents. This study evaluates the relative efficacy of a
school-based, cognitive-behavioral intervention compared to an educational-supportive treatment for adolescents with social anxiety disorder.
Methods: Thirty-six students (30 females), ages 14 to 16, were randomized to a 12-week specific intervention, Skills for Social and Academic Success
(SASS), or a credible attention control matched for structure and contact, conducted in school. Results: Independent evaluations and adolescent
self-reports indicated significant reduction in social anxiety for SASS compared to the control group. Parent reports of their children's social
anxiety did not discriminate between treatments. In the specific intervention, 59%, compared to 0% in the control, no longer met criteria for social
anxiety disorder following treatment. Superiority of the SASS intervention was maintained 6 months after treatment cessation. Conclusions: The study
provides evidence that intervention for social anxiety disorder that emphasizes exposure and social skills is efficacious. Results indicate that
clinical improvement is sustained for at least 6 months, and that, overall, adolescents with social anxiety disorder do not respond to non-specific
treatment. This investigation has public health implications by demonstrating that effective interventions can be transported to nonclinical
settings. copyright 2007 The Authors Journal compilation copyright 2007 Association for Child and Adolescent Mental Health.
Journal of Child
Psychology & Psychiatry & Allied Disciplines., 48(7) : 676-686
- Year: 2007
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Garcia-Lopez, L. J., Olivares, J., Beidel, D., Albano, A. M., Turner, S., Rosa, A. I.
Few studies have reported long-term
follow-up data in adults and even fewer in adolescents. The purpose of this work is to report on the longest follow-up assessment in the literature
on treatments for adolescents with social phobia. A 5-year follow-up assessment was conducted with subjects who originally received either Cognitive
Behavioral Group Therapy for Adolescents (CBGT-A), Social Effectiveness Therapy for Adolescents - Spanish version (SET-Asv), or Intervencion en
Adolescentes con Fobia Social - Treatment for Adolescents with Social Phobia (IAFS) in a controlled clinical trial. Twenty-three subjects completing
the treatment conditions were available for the 5-year follow-up. Results demonstrate that subjects treated either with CBGT-A, SET-Asv and IAFS
continued to maintain their gains after treatments were terminated. Either the CBGT-A, SET-Asv and IAFS can provide lasting effects to the majority
of adolescents with social anxiety. Issues that may contribute to future research and clinical implications are discussed. copyright 2005 Elsevier
Inc. All rights reserved.
Journal of Anxiety
Disorders., 20(2) : 175-191
- Year: 2006
- Problem: Social phobia (social anxiety disorder)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Baer, S., Garland, EJ.
Objective: A pilot study to evaluate the efficacy of a
cognitive-behavioral group therapy program for adolescents with social phobia, simplified both in terms of time and labor intensity from a previously
studied program (Social Effectiveness Therapy for Children and Adolescents) to be more appropriate for a community outpatient psychiatric setting.
Method: Twelve adolescents with social phobia (ages 13-18), diagnosed by DSM-IV criteria and confirmed with Anxiety Disorders Interview Schedule for
Children assessment, were randomly assigned to treatment (n = 6) and waitlist (n = 6) groups. The waitlist group was subsequently treated, and
results were included in the data analysis. Assessments, including Anxiety Disorders Interview Schedule for Children interviews and self-report
Social Phobia and Anxiety Inventory and Beck Depression Inventory II questionnaires, were performed at baseline and immediately after treatment or
waitlist. Results: All subjects completed the treatment program. Compared with the waitlist group, treated subjects showed significantly greater
improvement in both examiner-evaluated (Anxiety Disorders Interview Schedule for Children) and self-reported (Social Phobia and Anxiety Inventory)
symptoms of social anxiety (effect sizes [d], 1.63 and 0.85, respectively). No significant change was seen in Beck Depression Inventory II scores for
treatment or waitlist groups. Conclusions: This study provides support for the use of simplified cognitive-behavioral interventions for adolescents
with social phobia that are practical for community psychiatric settings. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal
abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 44(3) : 258-264
- Year: 2005
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Bernstein, G. A., Layne, A. E., Egan, E. A., Tennison, D.
M.
Objective: To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT)
for children, group CBT for children plus parent training group, and no-treatment control. Method: Students (7-11 years old) in three elementary
schools (N = 453) were screened using the Multidimensional Anxiety Scale for Children and teacher nomination. Subsequently, 101 identified children
and their parents completed the Anxiety Disorders Interview Schedule for DSM-IV, Child Version. Children with features or DSM-IV diagnoses of
separation anxiety disorder, generalized anxiety disorder, and/or social phobia (n = 61) were randomized by school to one of three conditions. Active
treatments were nine weekly sessions of either group CBT or group CBT plus concurrent parent training. Results: Clinician-report, child-report, and
parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group. Effect size was 0.58
for change in composite clinician severity rating, the primary outcome measure, favoring collapsed CBT conditions compared with control. In addition,
several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over group CBT alone. Conclusions:
Both active CBT treatments were more effective than the no-treatment control condition in decreasing child anxiety symptoms and associated
impairment. When parent training was combined with child group CBT, there were some additional benefits for the children. copyright2005 by the
American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 44(11) : 1118-
1127
- Year: 2005
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Siqueland,
L., Rynn, M., Diamond, G. S.
The goals of these two studies were to assess the
acceptability and feasibility as well as to gather preliminary efficacy data on a modified combination cognitive behavioral (CBT) and attachment
based family therapy (ABFT) for adolescents (ages 12-18), with the primary diagnosis of generalized (GAD), social phobia (SP), and separation (SAD)
anxiety disorders. In Phase I, CBT was modified for an adolescent population and ABFT was modified for working with anxious adolescents in
combination with CBT. Therapists were trained for both conditions and eight patients were treated as an open trial pilot of combined CBT-ABFT with
positive results. In Phase II, 11 adolescents were randomly assigned to CBT alone or CBT and family based treatment (CBT-ABFT). Participants were
evaluated at pre, post, and 6-9 months follow-up assessing diagnosis, psychiatric symptoms and family functioning. Results indicated significant
decreases in anxiety and depressive symptoms by both clinical evaluator and self-reports with no significant differences by treatment. Sixty-seven
percent of adolescents in CBT no longer met criteria for their primary diagnosis at post treatment as compared to 40% in CBT-ABFT with continued
improvement of 100 and 80% at follow-up with no significant differences between treatments. Both CBT and CBT-ABFT appear to be promising treatments
for anxious adolescents and more treatment development and evaluation is needed. copyright 2004 Elsevier Inc. All rights reserved.
Journal of Anxiety Disorders., 19(4) : 361-
381
- Year: 2005
- Problem: Anxiety Disorders (any), Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy
Muehlbacher,
Moritz, Nickel, Marius K., Nickel, Cerstin, Kettler, Christian, Lahmann, Claas, Pedrosa Gil, Francisco, Leiberich, Peter K., et-al
Social phobia is an anxiety disorder
characterized by extreme fear and phobic avoidance of social and performance situations and by a relatively poor health-related quality of life. The
goal of this study was to compare the efficacy of mirtazapine versus placebo in the treatment of patients with social phobia. In 2004, we conducted a
randomized, double-blind, placebo-controlled study of mirtazapine in 66 female subjects from the general population meeting the criteria for social
phobia. The subjects were randomly assigned in a 1:1 manner to mirtazapine (n = 33) or placebo (n = 33). The treatment lasted 10 weeks. Seven
patients dropped out. Primary outcome measures were self-reported changes on the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and Health
Survey (SF-36). In comparison with the placebo group and according to the intent-to-treat principle, significant differences on the Social Phobia
Inventory and Liebowitz Social Anxiety Scale scales (all P < 0.001), as well as on most (5 from 8) scales of SF-36 (all P < 0.001), were observed in
the mirtazapine-treated subjects. All patients tolerated mirtazapine relatively well. Mirtazapine appears to be an effective agent in the treatment
of social phobia in women and in the improvement of their health-related quality of life. (PsycINFO Database Record (c) 2008 APA, all rights
reserved) (journal abstract).
Journal of Clinical Psychopharmacology, 25(6) : 580-
583
- Year: 2005
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Tricyclic antidepressants
Wagner, Karen Dineen, Berard, Ray, Stein, Murray B., Wetherhold, Erica, Carpenter, David J., Perera,
Phillip, Gee, Michelle, Davy, Katherine, Machin, Andrea
BACKGROUND: Social anxiety disorder is a debilitating, highly prevalent disorder in children and adolescents. If left
untreated, it can interfere with emotional, social, and school functioning. OBJECTIVE: To evaluate the efficacy and tolerability of paroxetine in
children and adolescents with social anxiety disorder. DESIGN AND SETTING: Multicenter, 16-week, randomized, double-blind, placebo-controlled,
flexible-dose, parallel-group, outpatient study.Patients A total of 322 children (8-11 years of age) and adolescents (12-17 years of age) with social
anxiety disorder as their predominant psychiatric illness.Intervention Eligible patients were randomized (1:1) to receive paroxetine (10-50 mg/d) or
placebo. RESULTS: Four hundred twenty-five patients were screened, and 322 were randomized to treatment. Of these, 319 were included in the
intention-to-treat population (paroxetine, n = 163; placebo, n = 156). At the week 16 last observation carried forward end point, the odds of
responding (Clinical Global Impression-Improvement score of 1 or 2) were statistically significantly greater for paroxetine (77.6% response
[125/161]) than for placebo (38.3% response [59/154]) (adjusted odds ratio, 7.02; 95% confidence interval, 4.07 to 12.11; P<.001). The proportion of
patients who were \"very much\" improved (Clinical Global Impression-Improvement score of 1) was 47.8% (77/161) for paroxetine compared with 14.9%
(23/154) for placebo. Adverse events occurring at an incidence of 5% or greater for paroxetine and twice that for placebo were insomnia (14.1% vs
5.8%), decreased appetite (8.0% vs 3.2%), and vomiting (6.7% vs 1.9%). Withdrawals due to adverse events were infrequent (5.5% [9/163] for paroxetine
and 1.3% [2/156] for placebo). CONCLUSION: Paroxetine is an effective, generally well-tolerated treatment for pediatric social anxiety disorder.
Archives of
General Psychiatry, 61(11) : 1153-62
- Year: 2004
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)
Garcia-Lopez, Luis-Joaquin, Olivares, Jose, Turner, Samuel M., Beidel, Deborah C., Albano, Anne M., Sanchez-Meca, Julio
Examined the clinical significance and effect size of 3 multi-component treatments for social phobia in an adolescent population. 59
adolescents (aged 15-17 yrs) who met DSM-IV criteria for generalized social phobia were assigned to 3 experimental treatments (N=44; Social
Effectiveness Therapy for Adolescents-Spanish version, Cognitive-Behavioral Group Therapy for Adolescents, or Therapy for Adolescents with
Generalized Social Phobia) or a control condition (N=15). Assessments were conducted at pretest, posttest and after a 12-mo follow-up. Assessment
measures included a broad range of scales to evaluate maladaptation, social skills, public speech, and self-esteem as well as cognitive and avoidance
symptoms of social anxiety. Short-term and long-term results support the effectiveness of the treatments in contrast with the control condition
according to high and very high effect sizes obtained. Further, outcomes based on clinical significance also show significant changes in contrast to
control condition. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Psicologia Conductual Revista Internacional de Psicologia Clinica de las
Salud, 10(2) : 371-385
- Year: 2002
- Problem: Social phobia (social anxiety disorder)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
The Research Unit on Pediatric Psychopharmacology Anxiety Study
Group,
Drugs that selectively inhibit serotonin reuptake are effective treatments for adults with mood and anxiety
disorders, but limited data are available on the safety and efficacy of serotonin-reuptake inhibitors in children with anxiety disorders. 128
children (aged 6-17 yrs) who met the criteria for social phobia, separation anxiety disorder, or generalized anxiety disorder, and who had received
psychological treatment for 3 wks without improvement were studied. The children were randomly assigned to receive fluvoxamine or placebo for 8 wks
and were evaluated with rating scales designed to assess the degree of anxiety and impairment. Children in the fluvoxamine group had a mean decrease
of 9.7 points in symptoms of anxiety on the Pediatric Anxiety Rating Scale, as compared with a decrease of 3.1 points among children in the placebo
group. On the Clinical Global Impressions-Improvement scale, 48 of 63 children in the fluvoxamine group had a response to the treatment, as compared
with 19 of 65 children in the placebo group. It is concluded that fluvoxamine is an effective treatment for children and adolescents with social
phobia, separation anxiety disorder, or generalized anxiety disorder. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
New England Journal of Medicine, 344(17) : 1279-
1285
- Year: 2001
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Gormally J, Varvil-Weld D. Raphael R. Sipps G.
The major purpose of this study was to compare the effects of
three treatments of social anxiety: cognitive counseling, skills training, and a treatment that combined these two approaches. The results showed
that compared with a wait-list control, the three treatments produced significantly greater improvement on three of the five outcome measures. All
three procedures appeared equally effective, since no significant differences were obtained on any of the five general outcome measures. Changes in
the targets of counseling (i.e., maladaptive cognitions and conversational skill) were also assessed. Whereas all treatments produced more change on
maladaptive cognitions compared with the waiting list control group, the treatments providing cognitive counseling produced the most change. No
differences between treatments or between the waiting list and the treatments were obtained on measures of conversational skill. These results are
discussed in terms of Bandura's self-efficacy theory and the influence of both specific and nonspecific sources of improvement in counseling. The
study also raises several potential hypotheses for future research, including the relation between type of deficit and treatment outcome and the
pervasive versus situation-specific nature of anxiety problems for minimal daters.
Journal
of Counseling Psychology, 28(2) : 147-57
- Year: 1981
- Problem: Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training, Other Psychological Interventions