NEW YORK (Reuters Health) – Both cognitive therapy and interpersonal psychotherapy (IPT) lead to considerable and lasting improvements in symptoms of social anxiety disorder (SAD) compared with no treatment, results of a randomized controlled trial indicate.
However, the trial also finds that CT works better than IPT for reducing social anxiety. Therefore, CT “should be the preferred psychological treatment for SAD,” Ulrich Stangier from University of Frankfurt in Germany and colleagues conclude in the July issue of Archives of General Psychiatry.
SAD is a common mental health disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations, which often leads to avoidance behaviors. Biological, cognitive and interpersonal factors have been implicated in the causes of SAD, each leading to the development of distinctive treatments.
CT aims to modify biased information processing and dysfunctional beliefs that people with SAD often have, while IPT aims to change problematic interpersonal behavior patterns.
Stangier and colleagues say their study is the first to directly compare these two treatments for SAD in an outpatient setting. They conducted their study at two research centers in Germany – one specializing in CT, the other in IPT.
A total of 117 patients with a primary diagnosis of SAD were randomly assigned to 16 individual sessions over 20 weeks of either CT (n = 38) or IPT (n = 38) plus 1 booster session or to a wait-list control group (n = 41). A total of 106 participants completed the treatment or wait-list phase with no marked between-group differences in completers.
According to the investigators, both CT and IPT were associated with significantly greater easing of SAD symptoms compared with no treatment (wait list) and CT was considerably more effective than IPT.
Sixty-six percent of patients who received CT showed marked improvement in social-phobic symptoms at the 20 week posttreatment assessment, compared with 42% of patients who received IPT and 7% of those in the wait-list control group.
At the 1 year follow up, the superiority of CT over IPT persisted, with the group that received CT showing significantly higher response rates (68% vs 32%). Patients who received IPT were also much more apt to have had additional nonprotocol treatment during follow up, the researchers note.
They say fact that CT was superior to IPT was not what they expected. They acknowledge that it’s not clear which ingredients of CT might have led to the larger effects on SAD compared with IPT.
“Because the two treatments differ with respect to the explicit targets for psychotherapeutic change, CT might tackle aspects that are of greater relevance to the etiology of SAD.”
It’s also possible that interpersonal problems may be more likely to resolve when the underlying dysfunctional cognitions and safety avoidance behaviors are effectively modified.
Arch Gen Psych 2011;68:692-700.
