Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany
American Journal of Psychiatry (Impact Factor: 12.3). 05/2013; 170(7). DOI: 10.1176/appi.ajp.2013.12081125
Source: PubMed


OBJECTIVE Various approaches to cognitive-behavioral therapy (CBT) have been shown to be effective for social anxiety disorder. For psychodynamic therapy, evidence for efficacy in this disorder is scant. The authors tested the efficacy of psychodynamic therapy and CBT in social anxiety disorder in a multicenter randomized controlled trial. METHOD In an outpatient setting, 495 patients with social anxiety disorder were randomly assigned to manual-guided CBT (N=209), manual-guided psychodynamic therapy (N=207), or a waiting list condition (N=79). Assessments were made at baseline and at end of treatment. Primary outcome measures were rates of remission and response, based on the Liebowitz Social Anxiety Scale applied by raters blind to group assignment. Several secondary measures were assessed as well. RESULTS Remission rates in the CBT, psychodynamic therapy, and waiting list groups were 36%, 26%, and 9%, respectively. Response rates were 60%, 52%, and 15%, respectively. CBT and psychodynamic therapy were significantly superior to waiting list for both remission and response. CBT was significantly superior to psychodynamic therapy for remission but not for response. Between-group effect sizes for remission and response were small. Secondary outcome measures showed significant differences in favor of CBT for measures of social phobia and interpersonal problems, but not for depression. CONCLUSIONS CBT and psychodynamic therapy were both efficacious in treating social anxiety disorder, but there were significant differences in favor of CBT. For CBT, the response rate was comparable to rates reported in Swedish and German studies in recent years. For psychodynamic therapy, the response rate was comparable to rates reported for pharmacotherapy and cognitive-behavioral group therapy.

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Available from: Viktoria Ritter, Mar 28, 2014
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    • "quality of object relations and interpersonal problems, reflecting quality and extent of characteristic behavior patterns (Vinnars et al., 2009), and defense mechanisms (Bond and Perry, 2004; Perry and Bond, 2012). Instead, comparisons between various short-term therapies have mostly found no significant differences across different outcome domains for patients with depressive and anxiety disorder (Abbass et al., 2011; Cuijpers et al., 2010; Driessen et al., 2013; Salzer et al., 2011; Slavin-Mulford and Hilsenroth, 2011), albeit some studies have shown lesser (Leichsenring et al., 2013b; Watzke et al., 2012) and some greater (Kallestad et al., 2010) effects in different aspects of personality functioning after short-term psychodynamic therapy in comparison to other therapies. As far as the authors know, there are only two randomized controlled trials that have compared the effectiveness of shortand long-term psychotherapy in patients with anxiety or depressive disorders on personality functioning, the Helsinki Psychotherapy Study (HPS, Knekt and Lindfors, 2004; Lindfors et al., 2012), and the Norwegian group therapy trial by Lorentzen et al. (2013). "
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    ABSTRACT: Background: Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in personality functioning are available. In this study we compared the effects of two short-term therapies and long-term psychodynamic psychotherapy on patients’ personality functioning during a 5-year follow-up. Methods: Altogether 326 patients of the Helsinki Psychotherapy Study, with anxiety or mood disorder, were randomly assigned to either short-term psychotherapy of about six months (solution-focused therapy (SFT, n=97) or short-term psychodynamic psychotherapy (SPP, n=101)), or to long-term psychodynamic psychotherapy (LPP, n=128), lasting on average three years. Outcomes in personality functioning (i.e., self-concept, defense style, interpersonal problems, and level of personality organization) were assessed five to seven times using, respectively, questionnaires (SASB, DSQ, IIP) and interview (LPO) during the 5-year follow-up from randomization. Results: Personality functioning improved in all therapy groups. Both short-term therapies fared better than LPP during the first year of follow-up, by faster improvement in self-concept and decrease in immature defense style. SFT also showed more early reduction of interpersonal problems. However, LPP thereafter showed larger and more sustained benefits than SFT and SPP, through greater changes in selfconcept. Additionally, LPP outperformed SFT at the end of the follow-up in IIP and LPO, after adjustment for auxiliary treatment. No differences were noted between the short-term therapies at any measurement point. Limitations: Auxiliary treatment was used relatively widely which limits generalization to exclusive use of short- or long-term therapy. Conclusions: LPP seems to be somewhat more effective than short-term therapies in facilitating long-term changes in personality functioning.
    Full-text · Article · Mar 2015 · Journal of Affective Disorders
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    • "The main study of the SOPHO-NET was a large multi-centre randomized controlled trial evaluating the efficacy of manualized cognitivebehavioural psychotherapy and psychodynamic psychotherapy compared to waiting list. The results of the efficacy trial have been published elsewhere (Leichsenring et al., 2013). For this analysis we used baseline data collected prior to the intervention. "
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    ABSTRACT: Background Social anxiety disorder (SAD) is associated with low direct costs compared to other anxiety disorders while indirect costs tend to be high. Mental comorbidities have been identified to increase costs, but the role of symptom severity is still vague. The objective of this study was to determine the costs of SAD, and to explore the impact of symptoms and comorbidities on direct and indirect costs. Methods Baseline data, collected within the SOPHO-NET multi-centre treatment study (N=495), were used. Costs were calculated based on health care utilization and lost productivity. Symptom severity was measured with the Liebowitz-Social-Anxiety-Scale; comorbidities were included as covariates. Results Total 6-month costs were accrued to €4802; 23% being direct costs. While there was no significant association with SAD symptom severity for direct costs, costs of absenteeism increased with symptom severity in those with costs >0; comorbid affective disorders and eating disorders had an additional effect. Self-rated productivity was lower with more pronounced symptoms even after controlling for comorbidities. Limitations As the study was based on a clinical sample total costs were considered, rather than net costs of SAD and no population costs could be calculated. Discussion The burden associated with lost productivity was considerable while costs of healthcare utilization were rather low as most patients had not sought for treatment before. Efforts to identify patients with SAD earlier and to provide adequate treatment should be further increased. Mental comorbidities should be addressed as well, since they account for a large part of indirect costs associated with SAD.
    Full-text · Article · Aug 2014 · Journal of Affective Disorders
    • "The trial is part of the Social Phobia Psychotherapy Research Network (SOPHO-NET) [15]. Design and results of the trial have been reported elsewhere [16]. "
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    ABSTRACT: The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia. We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients' responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients' responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/ EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve. Compared to the general population, patients with social phobia reported more problems in the dimensions "usual activities", "pain/ discomfort", and "anxiety/ depression" and less problems in "mobility" and "self-care". The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5 < effect size < 0.8) in the British EQ-5D index and only significant in patients with improved health status. The ROC analysis revealed no significant results. The EQ-5D was moderately reliable and responsive in patients with improved health status. Construct validity was limited.Trial registration: Current Controlled Trials ISRCTN53517394.
    No preview · Article · Dec 2013 · Health and Quality of Life Outcomes
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