Social Phobia? Drugs, Therapy Work Equally Well

Combining Therapies Won't Provide Greater Relief

From the WebMD Archives

Oct. 4, 2004 -- For relief from social phobia, antidepressants or talk therapy will work equally well. Combining the therapies, however, does not provide any greater benefit, new research shows.

In the U.S., social phobia is a widespread problem -- one that leads to suicide attempts, numerous health problems, and reduced earning potential, writes lead researcher Jonathan R.T. Davidson, MD, a psychiatrist and behavioral scientist with Duke University Medical Center in Durham, N.C.

His report appears in this month's issue of the Archives of General Psychiatry.

Social phobia, also known as social anxiety disorder, involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others or behaving in a way that might cause embarrassment or lead to ridicule.

Studies have found that antidepressants -- particularly the selective serotonin reuptake inhibitors (SSRIs) like Prozac -- help relieve social phobia. Through cognitive behavioral therapy (a form of psychotherapy) people learn to change negative thoughts and behaviors that feed the phobia, and they learn social skills.

But can medication be sufficient without therapy? Is group therapy enough if you don't like taking medications? Do the therapies combined provide even better benefits? These are the questions that Davidson tackled in his study.

He recruited 295 adults diagnosed with social phobia for the 14-week study and randomly assigned them to one of five groups: Prozac alone, group therapy alone, Prozac plus therapy, placebo plus therapy, or a placebo alone.

After 14 weeks of treatment:

  • 54% of the Prozac-plus-therapy group showed "very much improvement" or "much improvement" in their social phobia.
  • 51% of the Prozac-only group showed similar improvement.
  • 52% of the therapy-only group also showed much improvement.
  • 51% of the therapy plus placebo group improved.
  • 32% taking a placebo showed much improvement.

All of these treatments were better than placebo but did not differ from each other, writes Davidson.

Also, despite the progress these patients made, substantial symptoms remained after the 14 weeks of treatment, he notes. Longer-term use of Prozac might produce greater improvement. Individual therapy -- rather than group therapy -- might also work better with this group of patients, he writes.

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SOURCES: Davidson, J. Archives of General Psychiatry, October 2004; vol 61: pp 1005-1013. WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Anxiety Disorders."
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