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CBT is better than interpersonal psychotherapy for social anxiety disorder

Last month's posts "What shall we do about the fact that there are supershrinks and pseudoshrinks" and "Discussion on the Dodo assertion - all good depession treatments are equally effective" argued for the primacy of non-specific effects in psychotherapy.  However in "Rolls Royce therapy and Anke Ehlers on PTSD" I also laid out a counter-argument saying "Maybe we can do better by carefully looking at who is reporting the very best results in the best high quality research studies and only altering our interventions to take on board these more Rolls Royce developments".  Such developments certainly include Anke's work, and too a CBT approach to panic disorder & agoraphobia - see "Dissemination of cognitive therapy for panic disorder in primary care" with its finding that a relatively brief training led to therapists improving the outcomes they were achieving from only 17% of their clients being panic-free at the end of therapy to 54% doing this well.  We can also add CBT for social anxiety disorder to this mix of problems where the specific therapeutic approach can add considerably to the results that are achievable.   

Last month Stangier & colleagues reported on "Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: A randomized controlled trial".  The abstract of their paper read - "Context: Cognitive therapy (CT) focuses on the modification of biased information processing and dysfunctional beliefs of social anxiety disorder (SAD). Interpersonal psychotherapy (IPT) aims to change problematic interpersonal behavior patterns that may have an important role in the maintenance of SAD. No direct comparisons of the treatments for SAD in an outpatient setting exist. Objective: To compare the efficacy of CT, IPT, and a waiting-list control (WLC) condition. Design: Randomized controlled trial. Setting: Two academic outpatient treatment sites. Patients: Of 254 potential participants screened, 117 had a primary diagnosis of SAD and were eligible for randomization; 106 participants completed the treatment or waiting phase. Interventions: Treatment comprised 16 individual sessions of either CT or IPT and 1 booster session. Twenty weeks after randomization, posttreatment assessment was conducted and participants in the WLC received 1 of the treatments. Main Outcome Measures: The primary outcome was treatment response on the Clinical Global Impression Improvement Scale as assessed by independent masked evaluators. The secondary outcome measures were independent assessor ratings using the Liebowitz Social Anxiety Scale, the Hamilton Rating Scale for Depression, and patient self-ratings of SAD symptoms. Results: At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC. Regarding response rates and Liebowitz Social Anxiety Scale scores, CT performed significantly better than did IPT, and both treatments were superior to WLC. At 1-year follow-up, the differences between CT and IPT were largely maintained, with significantly higher response rates in the CT vs the IPT group (68.4% vs 31.6%) and better outcomes on the Liebowitz Social Anxiety Scale. No significant treatment x site interactions were noted. Conclusions: Cognitive therapy and IPT led to considerable improvements that were maintained 1 year after treatment; CT was more efficacious than was IPT in reducing social phobia symptoms."

Impressive stuff ... and certainly an important study to note, both when trying to help people with social anxiety disorder and when arguing that psychotherapy is not all about "non-specific" effects.  The particular form of therapy we practice and how well we apply it is also important.  As usual, in a debate, both sides have something useful to add.  

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