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Cited by 206Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and their combination for social anxiety disorder

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Blanco, Carlos, Heimberg, Richard G., Schneier, Franklin R., Fresco, David M., Chen, Henian, Turk, Cynthia L., Vermes, Donna, Erwin, Brigette A. +4 more·2010·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2010.11PMC PMC2856667
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Abstract

CONTEXT: Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder, yet many individuals remain symptomatic after treatment. OBJECTIVE: To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Research clinics at Columbia University and Temple University. PARTICIPANTS: One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder. INTERVENTIONS: Cognitive behavioral group therapy (CBGT), phenelzine sulfate, pill placebo, and combined CBGT plus phenelzine. MAIN OUTCOME MEASURES: Liebowitz Social Anxiety Scale and Clinical Global Impression (CGI) scale scores at weeks 12 and 24. RESULTS: Linear mixed-effects models showed a specific order of effects, with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group, followed by the monotherapies, and the least reduction in the placebo group (Williams test = 4.97, P < .01). The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 (33.3%) (placebo), 16 of 34 (47.1%) (CBGT), 19 of 35 (54.3%) (phenelzine), and 23 of 32 (71.9%) (combined treatment) (chi(2)(1) = 8.76, P < .01). Corresponding remission rates (CGI = 1) were 2 of 27 (7.4%), 3 of 34 (8.8%), 8 of 35 (22.9%), and 15 of 32 (46.9%) (chi(2)(1) = 15.92, P < .01). At week 24, response rates were 9 of 27 (33.3%), 18 of 34 (52.9%), 17 of 35 (48.6%), and 25 of 32 (78.1%) (chi(2)(1) = 12.02, P = .001). Remission rates were 4 of 27 (14.8%), 8 of 34 (23.5%), 9 of 35 (25.7%), and 17 of 32 (53.1%) (chi(2)(1) = 10.72, P = .001). CONCLUSION: Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission.

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Crossref · 10.1001/archgenpsychiatry.2010.11

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  • The reliable change percentages (51.8% to 80.4%) are consistent with other reliable change numbers for CBGT (Blanco et al., 2010; Heimberg et al., 1990; Kocovski et al., 2013).

    “These numbers are consistent with other reliable change numbers for CBGT (Blanco et al., 2010; Heimberg et al., 1990; Kocovski et al., 2013).”

    From Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder (2018) · cites this paper as Blanco et al., 2010

    The Results (Continuation Phase; page not available) report a 52.9% response rate for CBGT, which falls within the cited 51.8%–80.4% range. But the Methods (Statistical Analyses; page not available) define response using the CGI-I, not a reliable-change measure; this paper therefore does not establish the claimed comparison of reliable-change percentages. (LLM, conf=0.81)

    Experimental — accuracy not yet measured

  • In vivo exposure for social phobia, imaginal exposure for PTSD, and interoceptive exposure for panic disorder have demonstrated extensive efficacy.

    “In vivo exposures for conditions such as social phobia (Blanco et al., 2010), imaginal exposures for conditions such as posttraumatic stress disorder (Cloitre et al., 2002; Foa, 2011), and interoceptive exposures for conditions such as panic disorder (Craske & Barlow, 2008) have demonstrated extensive efficacy.”

    From United we stand: emphasizing commonalities across cognitive-behavioral therapies. (2013) · cites this paper as Blanco et al., 2010

    The Methods (Treatments; page unavailable) describe real-life exposure as part of cognitive behavioral group therapy for social anxiety disorder. The Discussion (page unavailable) says reviews support CBT’s efficacy, but also says this trial’s CBT group was generally not superior to placebo in pairwise comparisons. Because exposure was delivered alongside cognitive techniques, the paper does not establish extensive efficacy for in vivo exposure itself. The PTSD and panic-disorder clauses cite other sources and are not attributed to Blanco et al. (LLM, conf=0.86)

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  • For social anxiety disorder, combined treatment shows greater effects than pharmacotherapy alone (d = 1.05 vs. 0.60 on the LSAS).

    “and studies for SAD show greater effects of combined treatment relative to pharmacotherapy alone (e.g., d = 1.05 vs. 0.60 on the LSAS, respectively; Blanco et al., 2010).”

    From An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results (2014) · cites this paper as Blanco et al., 2010

    The Results (Outcome Evaluation; page unavailable) report larger LSAS improvements and generally larger effect sizes for combined treatment than for phenelzine alone. Our copy does not give the claimed LSAS effect sizes of d = 1.05 and 0.60 in the retrieved text; its stated week-24 values are 0.91 and 0.35 for combined treatment and phenelzine, respectively. The direction of the comparison is supported, but the specific numbers cannot be verified. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Cognitive-behavioral therapy typically has limited impact on functional domains, including occupational functioning.

    “however, research also demonstrates that CBT typically has limited impact on functional domains, including occupational functioning (Blanco et al., 2010).”

    From Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial (2024) · cites this paper as Blanco et al., 2010

    Methods > Assessments describes the Sheehan Disability Scale as measuring impairment in work and other functional domains. Results > Outcome Evaluation reports no significant difference between cognitive-behavioral group therapy and placebo on any outcome measure in this social-anxiety trial. That supports a limited effect on the study’s disability measure, but not the broader claim that CBT typically has limited impact on functioning or a separate finding about occupational functioning. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Both treatments are well documented and have been implemented in scientific research before in treatment studies for GCBT and individual and group ST.

    “Both treatments are well documented [17, 24, 75] and have been implemented in scientific research before in treatment studies for GCBT (e.g. [76–79]) and individual and group ST (e.g. [19, 43, 80, 81]).”

    From Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial. (2016) · cites this paper as [76]

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Research works printed but not linked: 2

  1. [26]DiNardo P Brown T Barlow D Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L) New York Oxford University Press 1994
  2. [38]Silvapulle M Sen P Constrained Statistical Inference New York John Wiley and Sons 2004

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Authors
Blanco, C., Heimberg, R. G., Schneier, F. R., Fresco, D. M., Chen, H., Turk, C. L., Vermes, D., Erwin, B. A., Schmidt, A. B., Juster, H. R., Campeas, R., & Liebowitz, M. R.
Affiliations
  • New York State Psychiatric Institute (US)
  • Temple University (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2010-03-01
Volume
67
Issue
3
Pages
286
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2010.11
PMC
PMC2856667
OpenAlex
W1990056753
Cited by
206
References
54
Citations by year
2026: 4 · 2025: 7 · 2024: 9 · 2023: 5 · 2022: 7 · 2021: 12 · 2020: 7 · 2019: 29 · 2018: 10 · 2017: 9 · 2016: 12 · 2015: 8 · 2014: 22 · 2013: 22 · 2012: 15
FWCI
26.63
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R10MH057148, MH44119, MH57148, R01MH044119)
  • National Institute on Drug Abuse (DA023200, K02DA023200)
  • National Center for Research Resources (M01RR000349, RR-00349)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
social anxiety disorder, phenelzine, group cognitive behavioral therapy, combined psychotherapy and pharmacotherapy, trazodone, selective serotonin reuptake inhibitors, antidepressant augmentation, treatment response and remission, placebo response, Liebowitz Social Anxiety Scale, Clinical Global Impression Scale, treatment tolerability, treatment acceptability
MeSH terms
Adolescent, Adult, Aged, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Monoamine Oxidase Inhibitors, Phenelzine, Phobic Disorders, Placebos, Psychiatric Status Rating Scales, Psychometrics, Psychotherapy, Group, Surveys and Questionnaires, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders

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