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A Placebo-Controlled Trial of Phenelzine, Cognitive Behavioral Group Therapy, and Their Combination for Social Anxiety Disorder
Open accessAbstract
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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“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
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“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
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“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
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“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
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“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]).”
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“Not only does PT cause side effects, but also between 20 and 50% of patients have either a contra-indication or don’t respond to PT (Lydiard et al., 1996; Davidson et al., 2004; Blanco et al., 2010; Hyman, 2010).”
From The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial (2019) · cites this paper as Blanco et al., 2010
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Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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