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JAMA and Archives Journals

Antidepressants, cognitive behavioral therapy appear equally effective in treating social phobia

CHICAGO – The use of fluoxetine (an antidepressant) or comprehensive cognitive behavioral therapy (CCBT) were similarly effective for treating social phobia, while combining these treatments did not provide further benefit, according to an article in the October issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.
According to the article, as many as 14 percent of people in the United States experience social phobia, also known as social anxiety disorder. Previous studies have shown that selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral treatments (CBTs) have been effective in treating social phobia.

Jonathan R.T. Davidson, M.D., from Duke University Medical Center at Durham, N.C., and colleagues compared the efficacy of fluoxetine, CCBT, placebo, CCBT plus fluoxetine, and CCBT plus placebo in 295 patients with generalized social phobia. Of the study participants, 156 were male and 226 (76.3 percent) were white, with an average age of 37.1 years. Treatment lasted for 14 weeks, with fluoxetine and placebo administered in 10 mg/day to 60 mg/day doses. Those receiving group CCBT attended sessions one day a week for the 14 weeks. The sessions included specific social skills training (for example, how to begin a conversation with a stranger), role playing, and cognitive restructuring.

By the end of the study period, 54.2 percent of those receiving both fluoxetine and CCBT reported "very much improvement" or "much improvement" in their social phobia. Of participants taking only fluoxetine, 50.9 percent reported such progress, while 51.7 percent of participants receiving only CCBT also reported very much or much improvement. A comparable proportion (50.8 percent) of those receiving the combination of CCBT and placebo reported similar results, whereas only 31.7 percent of those who received placebo reported such improvement.

"All active treatments were superior to placebo on primary outcomes. Combined treatment did not yield any further advantage. Notwithstanding the benefits of treatment, many patients remained symptomatic after 14 weeks," the authors write.

"…this [trial] has demonstrated that widely used treatments (i.e., CBT and fluoxetine) are effective for individuals with generalized social phobia, many of whom are significantly impaired. Although fluoxetine and CCBT were more successful than placebo, substantial symptoms still remained after 14 weeks' treatment.…Finally, combining fluoxetine with CCBT did not provide any greater therapeutic benefit."

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(Arch Gen Psychiatry. 2004; 61: 1005-1013. Available post-embargo at www.archgenpsychiatry.com)

Editor's note: This study was supported by a grant from the National Institute of Mental Health, Bethesda, Md. (Drs. Davidson and Foa).

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org.