LONG-TERM TREATMENT OF SOCIAL PHOBIA

社交恐惧症是一种非常普遍的、使人丧失能力的慢性焦虑 与大量的职业、社会和学术相关的障碍 减损。它增加了患抑郁症、滥用药物和 经济上的依赖。社交恐惧症的治疗较少 关注比治疗其他焦虑症更重要。但是，具体来说， 心理社会和心理药理学治疗已经证明 功效。认知行为团体疗法(CBGT)，由Heimberg开发， 已被证明优于对照疗法，而MAOI苯乙肼(PZ)， 最早由Liebowitz研究，已被证明在几个方面优于安慰剂 对照试验。在一次新颖而非常成功的合作中，海姆伯格 和Liebowitz一起比较了PZ，CBGT，避孕药安慰剂和可信的 心理社会控制，发现PZ和CBGT的优势和显著 临床益处。在某些情况下，PZ比CBGT起效更快、更有效 虽然CBGT的效果在治疗后似乎更持久 停产。 虽然PZ和CBGT产生了积极的效果，但许多患者没有反应 够了，停用PZ会导致严重的复发。因此，我们 仍然需要比CBGT或PZ更有效和更持久的治疗 就像通常实施的那样。我们最近得到了资助，研究急性 PZ/CBGT联合治疗的疗效，可能比PZ或CBGT更有效 独自一人。然而，程序性的预算削减阻碍了对长期预算的研究 CBGT、PZ或其组合的疗效。CBGT需要进一步研究 确定更长时间的强化治疗是否会带来更大的收益。PZ 需要进一步的研究来确定较长的治疗时间是否会减少复发 PZ停止使用。需要对PZ/CBGT进行长期研究以确定 这种组合融合了每个成分的优点，即PZ和PZ的疗效 CBGT的耐久性。如果是这样的话，PZ/CBGT联合治疗将具有独特的 对许多患者来说都是有利的。 我们现在建议检查CBGT的长期疗效和持久性， PZ，以及社交恐惧症的组合。建议的研究是协调的 与已经资助的PZ、CBGT和 PZ/CBGT.急性研究的应答者和最低应答者进入12- 一周密集持续阶段，以评估进一步的 进步。24周的应答者进入28周的维护阶段。 然后在第52周对应答者进行一次以上的反应耐久性评估 一年的后续行动。结果通过盲目评估人员面谈，自我评估 报告问卷和标准化的行为测试。这项研究应该 大大提高我们对有效的长期治疗的认识 社交恐惧症。

Social Phobia is a highly prevalent, disabling, and chronic anxiety disorder associated with substantial vocational, social, and academic impairment. It increases the risk of depression, substance abuse and financial dependence. Treatment for social phobia has received less attention than treatment for other anxiety disorders. However, specific psychosocial and psychopharmacological treatments have demonstrated efficacy. Cognitive Behavioral Group Therapy (CBGT), developed by Heimberg, has proven superior to control therapies while the MAOI phenelzine (PZ), first studied by Liebowitz, has proven superior to placebo in several controlled trials. In a novel and highly successful collaboration, Heimberg and Liebowitz together compared PZ, CBGT, pill placebo, and a credible psychosocial control, and found PZ and CBGT superior and of distinct clinical benefit. PZ was faster acting and more effective than CBGT on some measures while CBGT effects seemed more durable following treatment discontinuation. While PZ and CBGT produced positive effects, many patients did not respond enough, and PZ discontinuation led to significant relapse. Therefore, we still need treatments that are more effective and durable than CBGT or PZ as typically administered. We have recently been funded to study acute efficacy of combined PZ/CBGT, which may be more effective than PZ or CBGT alone. programmatic budget cuts, however, have prevented study of long-term efficacy of CBGT, Pz, or the combination. CBGT needs further study to determine whether longer, intensive treatment results in greater gains. PZ needs further study to determine if longer treatment reduces relapse after PZ discontinuation. Long-term study of PZ/CBGT is needed to determine if the combination fuses strengths of each component, i.e., efficacy of PZ and durability of CBGT. If so, combined PZ/CBGT treatment would be of distinct advantage to many patients. We now propose to examine the long-term efficacy and durability of CBGT, PZ, and the combination in social phobia. The proposed study is coordinated with the already-funded 12-week acute treatment study of PZ, CBGT, and PZ/CBGT. Responders and minimal responders from the acute study enter a 12- week intensive continuation phase to assess magnitude of further improvement. Responders at Week 24 enter a 28 week maintenance phase. Responders at Week 52 are then assessed for durability of response over one year of follow-up. Outcome is evaluated by blind assessor interviews, self- report questionnaires, and standardized behavioral tests. This study should substantially enhance our knowledge of effective long-term treatment for social phobia.