Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T06:29:02.595Z Has data issue: false hasContentIssue false
  • English
  • Français

Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials

Published online by Cambridge University Press:  20 July 2007

K. Ponniah  and
S. D. Hollon
K. Ponniah*
Affiliation:
New York State Psychiatric Institute, New York and Department of Psychiatry, Columbia University, New York
S. D. Hollon
Affiliation:
Department of Psychology, Vanderbilt University, Nashville, TN, USA
*
*Address for correspondence: Dr Kathryn Ponniah, Redhill Reigate & Horley Primary Care Mental Health Team, Surrey and Borders Partnership NHS Trust, Shaw's Corner, Blackborough Road, Reigate, Surrey, RH2 7DG, UK. (Email: kathrynbetts@hotmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Social phobia is a chronic disorder that results in substantial impairment. We conducted a qualitative review of randomized controlled trials (RCTs) of psychological interventions for social phobia.

Method

Articles were identified through searches of electronic databases and manual searches of reference lists. They were classified by psychological interventions evaluated. Data regarding treatment, participants and results were then extracted and tabulated. We identified which psychological interventions are empirically supported, using the scheme proposed by Chambless & Hollon (Journal of Consulting and Clinical Psychology 1998, 66, 7–18).

Results

Thirty studies evaluating the efficacy of social skills training (SST), exposure therapy and/or cognitive treatments were identified. Cognitive behavior therapy (CBT), involving cognitive restructuring and exposure to feared and avoided social situations or behavioral experiments, was found to be an efficacious and specific treatment for social phobia. Exposure therapy was found to be an efficacious treatment since most of the evidence of its efficacy was from comparisons with no treatment. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure. Some studies reported that the interventions were equivalent, while others found that patients treated with CBT had a better outcome. There was little evidence to support the use of SST.

Conclusions

CBT is the psychological intervention of choice for social phobia. The findings of this review are compared to those of other major reviews and limitations are discussed.

Type
Invited Review
Information
Psychological Medicine , Volume 38 , Issue 1 , January 2008 , pp. 3 - 14
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akillas, E. & Efran, J. S. (1995). Symptom prescription and reframing: should they be combined? Cognitive Therapy and Research 19, 263–279.CrossRefGoogle Scholar
Al-Kubaisy, T., Marks, I. M., Logsdail, S., Marks, M. P., Lovell, K., Sungur, M. & Araya, R. (1992). Role of exposure homework in phobia reduction: A controlled study. Behavior Therapy 23, 599–621.CrossRefGoogle Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
Beck, A. T., Emery, G. & Greenberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. Basic Books: New York.Google Scholar
Blomhoff, S., Haug, T. T., Hellstrom, K., Holme, I., Humble, M., Madsbu, H. P. & Wold, J. E. (2001). Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. British Journal of Psychiatry 179, 23–30.CrossRefGoogle ScholarPubMed
Butler, G. (1985). Exposure as a treatment for social phobia: some instructive difficulties. Behaviour Research and Therapy 23, 651–657.CrossRefGoogle ScholarPubMed
Butler, G., Cullington, A., Munby, M., Amies, P. & Gelder, M. (1984). Exposure and anxiety management in the treatment of social phobia. Journal of Consulting and Clinical Psychology 52, 642–650.CrossRefGoogle ScholarPubMed
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D. A. F., Bennett Johnson, S., McCurry, S., Mueser, K. T., Pope, K. S., Sanderson, W. C., Shoham, V., Stickle, T., Williams, D. A. & Woody, S. R. (1998). Update on empirically validated therapies, II. Clinical Psychologist 51, 3–16.Google Scholar
Chambless, D. L. & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66, 7–18.CrossRefGoogle ScholarPubMed
Chambless, D. L. & Ollendick, T. H. (2001). Empirically supported psychological interventions: controversies and evidence. Annual Review of Psychology 52, 685–716.CrossRefGoogle ScholarPubMed
Clark, D. B. & Agras, W. S. (1991). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry 148, 598–605.Google ScholarPubMed
Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, H., Flower, T., Davenport, C. & Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology 71, 1058–1067.CrossRefGoogle ScholarPubMed
Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In Social Phobia: Diagnosis, Assessment, and Treatment (ed. Heimberg, R. G., Liebowitz, M. R., Hope, D. A. and Schneier, F. R.), pp. 69–93. Guilford Press: New York.Google Scholar
Clark, J. V. & Arkowitz, H. (1975). Social anxiety and self-evaluation of interpersonal performance. Psychological Reports 36, 211–221.CrossRefGoogle ScholarPubMed
Cottraux, J., Note, I., Albuisson, E., Yao, S. N., Note, B., Mollard, E., Bonasse, F., Jalenques, I., Guerin, J. & Coudert, A. J. (2000). Cognitive behavior therapy versus supportive therapy in social phobia: a randomized controlled trial. Psychotherapy and Psychosomatics 69, 137–146.CrossRefGoogle ScholarPubMed
Crits-Christoph, P., Wilson, G. T. & Hollon, S. D. (2005). Empirically supported psychotherapies: comment on Westen, Novotny, and Thompson-Brenner (2004). Psychological Bulletin 131, 412–417.CrossRefGoogle ScholarPubMed
Davidson, J. R. T., Foa, E. B., Huppert, J. D., Keefe, F. J., Franklin, M. E., Compton, J. S., Zhao, N., Connor, K. M., Lynch, T. R. & Gadde, K. M. (2004). Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Archives of General Psychiatry 61, 1005–1013.CrossRefGoogle ScholarPubMed
DeRubeis, R. J. & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology 66, 37–52.CrossRefGoogle ScholarPubMed
Edelmann, R. J. (1985). Dealing with embarrassing events: socially anxious and non-socially anxious groups compared. British Journal of Clinical Psychology 24, 281–288.CrossRefGoogle ScholarPubMed
Emmelkamp, P. M. G., Mersch, P.-P., Vissia, E. & van der Helm, M. (1985). Social phobia: a comparative evaluation of cognitive and behavioral interventions. Behaviour Research and Therapy 23, 365–369.CrossRefGoogle ScholarPubMed
Furmark, T., Tillfors, M., Marteinsdottir, I., Fischer, H., Pissiota, A., Langstrom, B. & Fredrikson, M. (2002). Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Archives of General Psychiatry 59, 425–433.CrossRefGoogle ScholarPubMed
Gelernter, C. S., Uhde, T. W., Cimbolic, P., Arnkoff, D. B., Vittone, B. J., Tancer, M. E. & Bartko, J. J. (1991). Cognitive-behavioral and pharmacological treatments of social phobia. A controlled study. Archives of General Psychiatry 48, 938–945.CrossRefGoogle ScholarPubMed
Gruber, K., Moran, P. J., Roth, W. T. & Taylor, C. B. (2001). Computer-assisted cognitive behavioral group therapy for social phobia. Behavior Therapy 32, 155–165.CrossRefGoogle Scholar
Hackmann, A., Clark, D. M. & McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy 38, 601–610.CrossRefGoogle ScholarPubMed
Hackmann, A., Surawy, C. & Clark, D. M. (1998). Seeing yourself through others' eyes: a study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy 26, 3–12.CrossRefGoogle Scholar
Harvey, A. G., Clark, D. M., Ehlers, A. & Rapee, R. M. (2000). Social anxiety and self-impression: cognitive preparation enhances the beneficial effects of video feedback following a stressful social task. Behaviour Research and Therapy 38, 1183–1192.CrossRefGoogle Scholar
Haug, T. T., Blomhoff, S., Hellstrom, K., Holme, I., Humble, M., Madsbu, H. P. & Wold, J. E. (2003). Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial. British Journal of Psychiatry 182, 312–318.CrossRefGoogle Scholar
Haug, T. T., Hellstrom, K., Blomhoff, S., Humble, M., Madsbu, H.-P. & Wold, J. E. (2000). The treatment of social phobia in general practice. Is exposure therapy feasible? Family Practice 17, 114–118.CrossRefGoogle Scholar
Heimberg, R. G. & Barlow, D. H. (1988). Psychosocial treatments for social phobia. Psychosomatics 29, 27–37.CrossRefGoogle ScholarPubMed
Heimberg, R. G., Liebowitz, M. R., Hope, D. A., Schneier, F. R., Holt, C. S., Welkowitz, L. A., Juster, H. R., Campeas, R., Bruch, M. A., Cloitre, M., Fallon, B. & Klein, D. F. (1998). Cognitive behavioral group therapy vs phenelzine therapy for social phobia. Archives of General Psychiatry 55, 1133–1141.CrossRefGoogle ScholarPubMed
Herbert, J. D., Rheingold, A. A., Gaudiano, B. A. & Myers, V. H. (2004). Standard versus extended cognitive behavior therapy for social anxiety disorder: a randomized-controlled trial. Behavioural and Cognitive Psychotherapy 32, 131–147.CrossRefGoogle Scholar
Hirsch, C. R., Meynen, T. & Clark, D. M. (2004). Negative self-imagery in social anxiety contaminates social interactions. Memory 12, 496–506.CrossRefGoogle ScholarPubMed
Hofmann, S. G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology 72, 392–399.CrossRefGoogle ScholarPubMed
Hofmann, S. G., Moscovitch, D. A., Kim, H.-J. & Taylor, A. N. (2004). Changes in self-perception during treatment of social phobia. Journal of Consulting and Clinical Psychology 72, 588–596.CrossRefGoogle ScholarPubMed
Hope, D. A., Heimberg, R. G. & Bruch, M. A. (1995). Dismantling cognitive-behavioral group therapy for social phobia. Behaviour Research and Therapy 33, 637–650.CrossRefGoogle ScholarPubMed
Kessler, R. C. (2003). The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatrica Scandinavica 108 (Suppl. 417), 19–27.CrossRefGoogle Scholar
Kim, E.-J. (2005). The effect of the decreased safety behaviors on anxiety and negative thoughts in social phobics. Anxiety Disorders 19, 69–86.CrossRefGoogle ScholarPubMed
Liebowitz, M. R., Heimberg, R. G., Schneier, F. R., Hope, D. A., Davies, S., Holt, C. S., Goetz, D., Juster, H. R., Lin, S.-H., Bruch, M. A., Marshall, R. D. & Klein, D. F. (1999). Cognitive-behavioral group therapy versus phenelzine in social phobia: long term outcome. Depression and Anxiety 10, 89–98.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Lucock, M. P. & Salkovskis, P. M. (1988). Cognitive factors in social anxiety and its treatment. Behaviour Research and Therapy 26, 297–302.CrossRefGoogle ScholarPubMed
Mansell, W. & Clark, D. M. (1999). How do I appear to others? Social anxiety and processing of the observable self. Behaviour Research and Therapy 37, 419–434.CrossRefGoogle ScholarPubMed
Mansell, W., Clark, D. M. & Ehlers, A. (2003). Internal versus external attention in social anxiety: an investigation using a novel paradigm. Behaviour Research and Therapy 41, 555–572.CrossRefGoogle ScholarPubMed
Mattick, R. P. & Peters, L. (1988). Treatment of severe social phobia: effects of guided exposure with and without cognitive restructuring. Journal of Consulting and Clinical Psychology 56, 251–260.CrossRefGoogle ScholarPubMed
Mersch, P. P. A. (1995). The treatment of social phobia: the differential effectiveness of exposure in vivo and an integration of exposure in vivo, rational emotive therapy and social skills training. Behavior Research and Therapy 33, 259–269.CrossRefGoogle Scholar
Morgan, H. & Raffle, C. (1999). Does reducing safety behaviours improve treatment response in patients with social phobia? Australian and New Zealand Journal of Psychiatry 33, 503–510.CrossRefGoogle ScholarPubMed
Newman, M. G., Hofmann, S. G., Trabert, W., Roth, W. T. & Taylor, C. B. (1994). Does behavioral treatment of social phobia lead to cognitive changes? Behavior Therapy 25, 503–517.CrossRefGoogle Scholar
Oosterbaan, D. B., van Balkom, A. J. L. M., Spinhoven, P., van Oppen, P. & van Dyck, R. (2001). Cognitive therapy versus moclobemide in social phobia: a controlled study. Clinical Psychology and Psychotherapy 8, 263–273.CrossRefGoogle Scholar
Ost, L.-G., Jerremalm, A. & Johansson, J. (1981). Individual response patterns and the effects of different behavioral methods in the treatment of social phobia. Behavior Research and Therapy 19, 1–16.CrossRefGoogle ScholarPubMed
Otto, M. W., Pollack, M. H., Gould, R. A., Worthington, J. J., McArdle, E. T., Rosenbaum, J. F. & Heimberg, R. G. (2000). A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia. Journal of Anxiety Disorders 14, 345–358.CrossRefGoogle ScholarPubMed
Persons, J. B. & Silberschatz, G. (1998). Are results of randomized controlled trials useful to psychotherapists? Journal of Consulting and Clinical Psychology 66, 126–135.CrossRefGoogle ScholarPubMed
Rapee, R. M. & Hayman, K. (1996). The effects of video feedback on the self-evaluation of performance in socially anxious subjects. Behaviour Research and Therapy 34, 315–322.CrossRefGoogle ScholarPubMed
Rapee, R. M. & Lim, L. (1992). Discrepancy between self- and observer ratings of performance in social phobics. Journal of Abnormal Psychology 101, 728–731.CrossRefGoogle ScholarPubMed
Roth, A. & Fonagy, P. (2005). What Works for Whom? A Critical Review of Psychotherapy research (2nd edn). Guilford Press: New York.Google Scholar
Roth, A. D. & Parry, G. (1997). The implications of psychotherapy research for clinical practice and service development: lessons and limitations. Journal of Mental Health 6, 367–380.Google Scholar
Salaberria, K. & Echeburua, E. (1998). Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia. Behavior Modification 22, 262–284.CrossRefGoogle Scholar
Scholing, A. & Emmelkamp, P. M. G. (1993 a). Cognitive and behavioral treatments of fear of blushing, sweating or trembling. Behaviour Research and Therapy 31, 155–170.CrossRefGoogle ScholarPubMed
Scholing, A. & Emmelkamp, P. M. G. (1993 b). Exposure with and without cognitive therapy for generalized social phobia: effects of individual and group treatment. Behaviour Research and Therapy 31, 667–681.CrossRefGoogle ScholarPubMed
Scholing, A. & Emmelkamp, P. M. G. (1996 a). Treatment of fear of blushing, sweating, or trembling: results at long-term follow-up. Behavior Modification 20, 338–356.CrossRefGoogle ScholarPubMed
Scholing, A. & Emmelkamp, P. M. G. (1996 b). Treatment of generalized social phobia: results at long-term follow-up. Behaviour Research and Therapy 34, 447–452.CrossRefGoogle ScholarPubMed
Spence, S. H. (1994). Interpersonal problems. Treatment. In The Handbook of Clinical Adult Psychology (2nd edn) (ed. Lindsay, S. J. E. and Powell, G. E.), pp. 253–270. Routledge: London.Google Scholar
Stahl, S. M. (1996). Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. Cambridge University Press: Cambridge.Google Scholar
Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W. & Clark, D. M. (2003). Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy 41, 991–1007.CrossRefGoogle ScholarPubMed
Stopa, L. & Clark, D. M. (2000). Social phobia and interpretation of social events. Behaviour Research and Therapy 38, 273–283.CrossRefGoogle ScholarPubMed
Stopa, L. & Clark, D. M. (1993). Cognitive processes in social phobia. Behaviour Research and Therapy 31, 255–267.CrossRefGoogle ScholarPubMed
Stravynski, A., Arbel, N., Bounader, J., Gaudette, G., Lachance, L., Borgeat, F., Fabian, J., Lamontagne, Y., Sidoun, P. & Todorov, C. (2000). Social phobia treated as a problem in social functioning: a controlled comparison of two behavioural group approaches. Acta Psychiatrica Scandinavica 102, 188–198.CrossRefGoogle ScholarPubMed
Stravynski, A., Marks, I. & Yule, W. (1982). Social skills problems in neurotic outpatients. Social skills training with and without cognitive modification. Archives of General Psychiatry 39, 1378–1385.CrossRefGoogle ScholarPubMed
Taylor, S., Woody, S., Koch, W. J., McLean, P., Paterson, R. J. & Anderson, K. W. (1997). Cognitive restructuring in the treatment of social phobia: efficacy and mode of action. Behavior Modification 21, 487–511.CrossRefGoogle ScholarPubMed
Trower, P., Bryant, B. & Argyle, M. (1978). Social Skills and Mental Health. Methuen: London.Google Scholar
Turner, S. M., Beidel, D. C. & Jacob, R. G. (1994). Social phobia: a comparison of behavior therapy and atenolol. Journal of Consulting and Clinical Psychology 62, 350–358.CrossRefGoogle ScholarPubMed
Westen, D., Novotny, C. M. & Thompson-Brenner, H. (2004). The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin 130, 631–663.CrossRefGoogle ScholarPubMed
Wittchen, H.-U. & Fehm, L. (2003). Epidemiology and natural course of social fears and social phobia. Acta Psychiatrica Scandinavica 108 (Suppl. 417), 4–18.CrossRefGoogle Scholar
Wolpe, J. (1973). The Practice of Behavior Therapy (2nd edn). Pergamon: New York.Google Scholar