Background: The efficacy of cognitive behaviour therapy (CBT) in social phobia has been demonstrated in several controlled trials and meta-analyses, but no comparison of CBT with supportive therapy (ST) can be found in the literature. Method: The aim of the trial was to study the effectiveness of CBT versus ST carried out ‘as usual’. Sixty-seven DSM-4 social phobic patients (89% generalized subtype, most with avoidant personality) were randomly allocated into two groups. Group 1 (CBT) received 8 1-hour sessions of individual cognitive therapy (CT) for 6 weeks, followed by 6 2-hour sessions of social skills training (SST) in group weekly. Group 2 received ST for 12 weeks (6 half-hour sessions), then the patients were switched to CBT. All patients agreed not to take any medication during the whole trial. In group 1, 29 patients reached week 6, 27 reached week 12, and 24 weeks 36 and 60 (endpoint). In group 2, 29 patients reached week 6, 28 reached weeks 12 and 18, 26 week 24, and 23 reached weeks 48 and 72 (endpoint). Results: At week 6, after CT, group 1 was better than group 2 on the main social phobia measure. At week 12, after SST, group 1 was better than group 2 on most of the measures and demonstrated a significantly higher rate of responders. This finding was replicated after switching group 2 to CBT. Sustained improvement was observed in both groups at follow-up. Compliance with abstinence from medication increased over time. Conclusions: CBT was more effective than ST and demonstrated long-lasting effects. This may suggest that social phobia management requires more than a simple and inexpensive psychological intervention.

Marzillier J, Lambert C, Kellett J: A controlled evaluation of systematic desensitization and social skills training for socially inadequate psychiatric patients. Behav Res Ther 1976;14:225–238.
Butler G, Cullington A, Munby M, Amies P, Gelder M: Exposure and anxiety management in the treatment of social phobias. J Consult Clin Psychol 1984;52:642–650.
Shaw PA: Comparison of three behaviour therapies in the treatment of social phobia. Br J Psychiatry 1979;134:620–623.
Liebowitz MR, Gorman JM, Fyer AJ, Klein DF: Social phobia. Review of a neglected anxiety disorder. Arch Gen Psychiatry 1985;42:729–736.
Kanter NJ, Goldfried MR: Relative effectiveness of rational restructuring and self-control desensitization in the reduction of interpersonal anxiety. Behav Ther 1979;10:472–490.
Emmelkamp PMG, Mersch PP, Vissia E, Van der Helm M: Social phobia: A comparative evaluation of cognitive and behavioural interventions. Behav Res Ther 1985;23:365–369.
Jerremalm A, Jansson L, Öst LG: Cognitive and physiological reactivity and the effects of different behavioural methods in the treatment of social phobias. Behav Res Ther 1986;24:171–180.
Heimberg RG, Dodge C, Hope DA, Kennedy CR, Zollo L, Becker RE: Cognitive behavioral group treatment for social phobia: Comparison with a credible placebo control. Cogn Ther Res 1990;14:1–23.
Heimberg RG, Salzman D, Holt C, Blendell K: Cognitive behavioral group treatment for social phobia: Effectiveness of a five year follow-up. Cognitive Ther Res 1993;17:325–339.
Heimberg R, Juster HR: Cognitive behavioral treatments: Literature review; in Heimberg RG, Liebowitz MR, Hope DA, Schneier FR (eds): Social Phobia. Diagnosis, Assessment and Treatment. New York, Guilford Press, 1995, pp 261–309.
Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, Holt CS, Welkowitz LA, Juster HR Campeas R, Bruch MA, Cloitre M, Fallon B, Klein DF: Cognitive behavioral group therapy vs phenelzine therapy for social phobia. 12 week outcome. Arch Gen Psychiatry 1998;55:1133–1141.
Hope DA, Heimberg RG, Bruch MA: Dismantling cognitive-behavioral group therapy for social phobia. Behav Res Ther 1995;33:637–650.
Stravinsky A, Marks IM, Yule W: Social skills problems in neurotic out-patients. Arch Gen Psychiatry 1982;39:1378–1385.
Mattick RM, Peters L, Clarke JC: Exposure and cognitive restructuring for social phobia: A controlled study. Behav Ther 1989;20:3–23.
Feske U, Chambless DL: Cognitive behavioral versus exposure only treatment for social phobia. Behav Ther 1995;26:695–720.
Taylor S: Meta-analysis of cognitive-behavioral treatments for social phobia. J Behav Ther Exp Psychiatry 1996;27:1–9.
Gould RA, Buckminster S, Pollack MH, Otto MW, Yap L: Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clin Psychol Sci Pract 1997;4:291–306.
American Psychiatric Association: Diagnostic and Statistical Manual of mental disorders, ed 4. Washington, American Psychiatric Association, 1991.
Marks IM, Hallam RS, Connolly J, Philpott R: Nursing in behavioural therapy: An advanced clinical role for nurses. London, Whitefriars Press, 1977, pp 70–71.
Bouvard M, Cottraux J: Protocoles et échelles d’évaluation en psychiatrie et en psychologie. Paris, Masson, 1996.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
Beck AT, Emery G, Greenberg R: Anxiety Disorders and Phobias. A Cognitive Perspective. New York, Basic Books, 1985.
Liberman RP: Personal effectiveness. Guiding people to assert themselves and improve their social skills. Champaign, Research Press, 1975.
Fava G: Sequential treatment: A new way of integrating pharmacotherapy and psychotherapy. Psychother Psychosom 1999;66:227–229.
Marks IM, Mathews AM: Brief standard rating for phobic patients. Behav Res Ther 1979;17:263–267.
Cottraux J, Bouvard M, Messy P: Validation et analyse factorielle d’une échelle de phobies: La version française du questionnaire des peurs de Marks et Mathews. Encéphale 1987;13:23–29.
Liebowitz MR, Gorman JM, Fyer AJ, Campeas R, Levin AP, Sandberg D, Hollander E, Papp L, Goetz D: Pharmacotherapy of social phobia: A placebo controlled comparison of phenelzine and atenolol. J Clin Psychiatry 1988;49:252–257.
Liebowitz MR, Schneier FR, Campeas R, Hollander E, Hatterer J, Fyer AJ, Gorman JM, Davies S, Gully R, Klein DF: Phenelzine vs atenolol in social phobia. Arch Gen Psychiatry 1992;49:290–300.
Yao SN, Note I, Fanget F, Albuisson E, Bouvard M, Jalenques I, Cottraux J: L’Anxiété sociale chez les Phobiques sociaux: Validation de l’échelle d’anxiété sociale de Liebowitz – Version Française. Encéphale 1999;25:429–435.
Glass CR, Merluzzi T, Biever JL, Larsen K: Cognitive assessment of social anxiety: Development and validation of a self-statement questionnaire. Cogn Ther Res 1982;6:37–55.
Yao SN, Cottraux J, Mollard E, Albuisson E, Note I, Jalencques I, Fanget F, Robbe-Grillet P, De Chassey M, Ektmedjian N, Bouvard M, Coudert AJ: The French version of the Social Interaction Self-Statement Test (SISST): A validation and sensitivity study in social phobics. Behav Cognitive Psychother 1998;26:237–249.
Beck AT, Real WY, Rickels K: Short form of depression inventory: Cross validation. Psychol Rep 1974;34:1184–1186.
Beck AT, Epstein N, Harrison RP, Emery G: Development of the sociotropy autonomy scale: A measure of personality factors in psychopathology. Philadelphia, University of Pennsylvania, 1983.
Cottraux J, Note I, Cungi C, Légeron P, Heim F, Chneiweiss L, Bernard G, Bouvard M: A controlled study of cognitive-behavior therapy with buspirone or placebo in panic disorder with agoraphobia. A one year follow-up. Br J Psychiatry 1995;167:635–641.
Bouvard M, Mollard E, Guérin J, Cottraux J: Study and course of the psychological profile in 77 patients experiencing panic disorder with agoraphobia after cognitive behaviour therapy with or without buspirone. Psychother Psychosom 1997;66:27–32.
Cohen D: Statistical power analysis for behavioral sciences, ed 2. Hillsdale, Erlbaum, 1988.
Scholing A, Emmelkamp PMG: Exposure with and without cognitive therapy for generalized social phobia: Effects of individual and group treatment. Behav Res Ther 1993;31:667–681.
Emmelkamp PMG, Scholing A: Cognitive and Behavioural treatments of fear of blushing, sweating or trembling. Behav Res Ther 1993;31:155–170.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.