Cognitive behavioral therapy (CBT) by itself is a more effective long-term treatment for social anxiety disorder than medication alone or a combination of the two, according to a new study by researchers at the Norwegian University of Science and Technology (NTNU) and the University of Manchester in England.
Until now, a combination of cognitive therapy and medication was thought to be the most effective treatment for patients with social anxiety disorder. However, nearly 85 percent of the study participants significantly improved or became completely healthy using cognitive therapy alone.
“We’ve set a new world record in effectively treating social anxiety disorders,” says Hans M. Nordahl, a professor of behavioral medicine at NTNU. “This is one of the best studies on social anxiety disorders ever. It’s taken ten years to carry out and has been challenging both academically and in terms of logistics, but the result is really encouraging.”
Social anxiety disorder — or social phobia — is much more serious than social anxiety, which many people deal with to some extent, especially when put in the spotlight. Social anxiety disorder is a diagnosis for individuals who find it hard to function in social situations at all.
Many patients with social anxiety disorder are treated with a combination of talk therapy and medication, such as selective serotonin reuptake inhibitors (SSRIs), said Nordahl. However, these drugs may do more harm than good for these particular patients. He says that while SSRIs often work well in patients with depressive disorders, they actually have the opposite effect in people with social anxiety disorders.
SSRIs often have strong physical side effects as well. When patients have been on medications for some time and want to reduce them, the bodily feelings associated with social phobia, like shivering, flushing, and dizziness in social situations tend to return. Patients often end up in a state of severe social anxiety again.
“Patients often rely more on the medication and don’t place as much importance on therapy. They think it’s the drugs that will make them healthier, and they become dependent on something external rather than learning to regulate themselves. So the medication camouflages a very important patient discovery: that by learning effective techniques, they have the ability to handle their anxiety themselves,” says Nordahl.
For the study, the researchers set out to analyze and compare the most recognized methods for treating social anxiety disorders. Well over 100 patients participated in the study and were divided into four groups.
The first group received only medication, the second group received only therapy, the third group received a combination of the two, and the fourth received a placebo pill. The four groups were compared along the way, and researchers conducted a follow-up assessment with them a year after treatment ended.
During treatment and right afterwards, the patients in groups two and three were managing equally well. But after a year, it was clear that the patients in group two — those who had only received cognitive therapy — were faring the best.
With cognitive therapy alone, the researchers managed to increase the recovery rate in patients with social anxiety disorders by 20 to 25 percent, as compared with the norm for this group.
“This is the most effective treatment ever for this patient group. Treatment of mental illness often isn’t as effective as treating a bone fracture, but here we’ve shown that treatment of psychiatric disorders can be equally effective,” says Nordahl.
Nordahl and the rest of the research team have also worked to improve standard cognitive therapy. They have added new processing elements, which have shown greater effectiveness.
“We’re using what’s called metacognitive therapy, meaning that we work with patients’ thoughts and their reactions and beliefs about those thoughts. We address their rumination and worry about how they function in social situations. Learning to regulate their attention processes and training with mental tasks are new therapeutic elements with enormous potential for this group of patients,” says Nordahl.
The findings are published in the journal Psychotherapy and Psychosomatics.