Cognitive behavioral therapy (CBT) is the most efficacious psychotherapy for social anxiety disorder, according to a meta-analysis in the Journal of Affective Disorders.
Linghan Sun, of Southwest University in Chongqing, China, and colleagues analyzed data from 92 studies covering 90 randomized control trials and involving 6,971 participants. The selected studies examined multiple CBT protocols as well as cognitive restructuring, exposure therapy, psychodynamic therapy, interpersonal therapy, and/or mindfulness-based interventions to control conditions such as treatment as usual, placebo, and a waitlist. The researchers also explored the efficacy of different delivery formats (e.g., face-to-face versus online).
Overall, CBT modalities were the most efficacious, particularly the Clark and Wells protocols, which aim to help individuals with social anxiety disorder (SAD) shift their attention away from internal negative thoughts and toward external cues in social situations. The Hope, Heimberg, and Turk CBT protocols, which focus on verbal cognitive restructuring and exposure to feared situations, were also effective. Among the CBT models developed specifically for the online treatment of SAD, the Andersson and Carlbring protocols, which center on behavioral activation, had the highest efficacy. In terms of treatment delivery, clinician-guided, individual face-to-face CBT yielded the best efficacy, whereas self-help book–based CBT was the least effective. Psychodynamic therapy was the most effective non-CBT treatment.
“[B]y ranking treatments based on their relative effectiveness in reducing severity of SAD symptoms, clinicians could make more informed decisions about which psychotherapy might be most suitable for their patients,” the researchers wrote. “Furthermore, clinicians will be able to flexibly choose the suitable delivery formats of CBT based on the specific situation.”
For related information, see the Focus article “Cognitive-Behavioral Treatments for Anxiety and Stress-Related Disorders.”
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