Naoki Yoshinaga1, Satoshi Matsuki2, Tomihisa Niitsu3, Yasunori Sato4, Mari Tanaka2, Hanae Ibuki2, Rieko Takanashi2, K. Ohshiro5, Fumiyo Ohshima2, Kenichi Asano5, Osamu Kobori6, Kensuke Yoshimura3, Yoshiyuki Hirano5, Kyoko Sawaguchi4, Masaya Koshizaka4, Hideki Hanaoka4, Akiko Nakagawa5, Michiko Nakazato5, Masaomi Iyo3, Eiji Shimizu2
1Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Departments of
2Cognitive Behavioral Physiology and
3Psychiatry, Graduate School of Medicine, and
4Clinical Research Center, Chiba University Hospital, Chiba, Japan
5Research Center for Child Mental Development, Chiba University, and
6Department of Psychology, Swansea University, Swansea, UK
Tóm tắt
<b><i>Background:</i></b> Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. <b><i>Methods:</i></b> This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. <b><i>Results:</i></b> Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. <b><i>Conclusions:</i></b> Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.
