Treating antidepressant-resistant social anxiety disorder with cognitive behavioral therapy: a randomized clinical trial
Treating antidepressant-resistant social anxiety disorder with cognitive behavioral therapy: a randomized clinical trial
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用认知行为疗法治疗抗抑郁药耐药性社交焦虑症：一项随机临床试验
DOI：
10.1159/000444221
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发表时间：
2016
影响因子：
22.8
通讯作者：
Shimizu E
中科院分区：
文献类型：
--
作者：
43.Yoshinaga N;Matsuki S;Niitsu T;Sato Y;Tanaka M;Ibuki H;Takanashi R;Ohshiro K;Ohshima F;Asano K;Kobori O;Yoshimura K;Hirano Y;Sawaguchi K;Koshizaka M;Hanaoka H;Nakagawa A;Nakazato M;Iyo M;Shimizu E
背景：尽管抗抑郁药仍然是社交焦虑症（SAD）的常用治疗方法，但很大一部分患者在服用抗抑郁药后病情未能缓解。然而，尚未建立管理此类患者的标准方法。本研究旨在检验认知行为疗法 (CBT) 作为常规护理 (UC) 辅助疗法与单独 UC 治疗在抗抑郁治疗后仍有症状的 SAD 患者中的有效性。方法：这是一项前瞻性随机开放盲终点研究，有两个平行组（CBT + UC 和单独 UC，均持续 16 周），于 2012 年 6 月至 2014 年 3 月进行。招募了 42 名患者，并根据试点结果设置了 42 名总样本量。 结果：患者被随机分配至 CBT + UC (n = 21) 或单独 UC (n = 21)。 16周后，CBT+UC和单独UC的利博维茨社交焦虑量表相对于基线的调整平均降低分别为-40.87和0.68；组间差异为−41.55（−53.68 至−29.42，p < 0.0001）。 CBT + UC 和单独 UC 的缓解率分别为 85.7% 和 10.0% (p < 0.0001)。相应的缓解率分别为 47.6 和 0.0% (p = 0.0005)。在社交焦虑症状、抑郁症状和功能障碍方面，CBT + UC 也存在显着差异。结论：我们的结果表明，对于抗抑郁药物治疗无效的 SAD 患者，CBT 是 UC 的有效辅助治疗方法，持续 16 周，可减少社交焦虑和相关症状。
Background:Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment.Methods:This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results.Results:Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment.Conclusions:Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.