Somayeh Sarafpoor, June 2023
CBT (Classical Approaches)
Classical approaches to CBT consist of in vivo exposure, social situations, and cognitive therapy.
CBT (Newly Developed Approaches) The newly developed approaches of CBT consist of third-wave approaches, Internet-delivered therapy, cognitive bias modification, and exposure therapy as far as the treatment of SAD is concerned. (Mohatt et al., 2014; What is exposure therapy
Pharmacotherapy
Two main classes of antidepressant drugs, SSRIs and SNRIs, have been shown to be effective in treating SAD (Mohatt et al., 2014; “What is exposure therapy?” 2017).
Appropriateness of CBT
CBT treatment depends on the person and the variability of one’s symptoms, which can impact how long they participate in CBT treatment. (Osborne et al., 2019) The standard treatment model of CBT is 10 to 12 weekly sessions, each session lasting about an hour. CBT effectiveness can take time, depending on other mental health issues the individual is dealing with or other traumatic histories which may be at play.
Effectiveness of CBT for Social Anxiety Disorder Adolescents & Children In a study done to evaluate the efficacy of CBT to compare and rank the different types of psychotherapies for anxiety disorders in children and adolescents (Zhou et al., 2019), 101 trials with 6625 participants who received 11 different psychotherapies to compare with another or control conditions were selected. The result of this study indicated that group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents. Group CBT efficacy may be attributed to the additional exposure to social stimuli and interaction in the group format, thus increasing the efficacy of psychotherapy.
Combination of CBT and pharmacotherapy in Children & Adolescents with SAD
A study conducted by Walkup et al. (2008) in which children participants were randomized to three groups of CBT for 14 sessions, Pharmacotherapy by taking Up to 200 mg (Sertraline) per day and combination therapy to evaluate the effectiveness of combination therapy in children with SAD. It is important to mention that sertraline is in the class of SSRIs.
The result of this study showed that both cognitive behavioural therapy and sertraline reduced the severity of social phobia in children, but a combination of the two therapies had a superior response rate. The highest effect size was reported in terms of combination therapy (Walkup et al.,2008).
Effectiveness of CBT for Social Anxiety Disorder in Adult
A study done by Mayo-Wilson et al. (2014) showed internet-based CBT (ICBT) as the best intervention for the initial treatment of social anxiety disorder (Mayo-Wilson et al., 2014). For individuals who decline psychological intervention, pharmacological interventions such as SSRIs showed the most consistent evidence of benefit.
Another study investigated the efficacy of the combination of CBT and medication for treating SAD in adults (Canton et al., 2012). The result of this systematic review showed that CBT or some variant of it appears to be the most effective psychological treatment. CBT also appears to offer better protection from relapse at the termination of treatment relative to drug treatments. Finally, the result indicated evidence that the combination of certain classes of medication and CBT may be more effective than either strategy used alone.
Combination of CBT and pharmacotherapy in Adults with SAD
Samantray et al. (2019) examined if combination therapy would be superior to pharmacotherapy alone in treating SAD. Subsequently, 67 participants were divided into a combined therapy group, including CBT + paroxetine (PX) and a pharmacotherapy group with PX alone for 24 weeks. It is important to mention that Paroxetine which was used in this study, is from the SSRIs class. The result showed no significant differences (at post-treatment and booster phases), and both treatment groups have large effect sizes in the post-treatment and end-of-booster phases. However, a significant difference at the two-month follow-up stage was reported that combined treatment of CBT + PX provided no advantage over PX in acute stages of treatment, but the former has significantly better maintenance of treatment gains in 2-month follow-ups than the latter.
Conclusion
1. Group CBT would be the more appropriate choice for addressing children and adolescents with SAD.
2. Combination therapy in children can be superior to CBT and pharmacotherapy in reducing the severity of SAD symptoms.
3. Any format of CBT can be the best intervention for the initial treatment in adults with SAD.
4. Combination therapy seems to be better at maintaining the treatment in adults at the follow-up stage than CBT alone.