Cognitive behavioural therapy is preferable to other psychological therapies and pharmacological treatments for the initial treatment of social anxiety disorder, according to a study in the Lancet.
The systematic review and meta-analysis looked at evidence from published and unpublished studies between 1988 and 2013, including a total of 13,164 patients, aged 36 years on average.
It covered 41 first-line interventions, including both pharmacological and non-pharmacological treatments, and looked at patients’ outcomes on validated measures of social anxiety.
Both individual cognitive behavioural therapy (CBT) and group CBT were effective, when treated patients were compared with waitlist control groups, with standardised mean differences (SMDs) of -1.19 and -0.92 – but only individual CBT, and SSRIs and SNRIs, were more effective than placebo, with SMDs of -0.56 and -0.44, respectively.
Individual CBT was also associated with greater effect sizes than psychodynamic psychotherapy and interpersonal psychotherapy, mindfulness, and supportive therapy.
The researchers wrote: ‘Individual CBT (which other studies have shown to have a lower risk of side-effects than pharmacotherapy) is associated with large effect sizes. Thus, it should be regarded as the best intervention for the initial treatment of social anxiety disorder.’
They added that the research backs up recent NICE advice that individual CBT should be offered as the treatment of choice for social anxiety disorder, followed by an SSRI or CBT-based supported self-help, and then psychodynamic psychotherapy, while other drugs should only be used if patients do not respond to other treatments.
The team concluded that this suggests ‘increased access to treatment would reduce disability and improve quality of life for people with social anxiety disorder’.
Lancet 2014; available online 26 September
