PHARMACOTHERAPY OF SOCIAL PHOBIA

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Social Phobia is a highly prevalent, disabling, and chronic anxiety disorder associated with substantial vocational, social, and academic impairment in adults as well as children. It increases the risk of depression, substance abuse and financial dependence. Nevertheless, social phobia has received less attention than other anxiety disorders, and there are no universally accepted treatments for this condition. 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, first studies by Liebowitz, has proven superior to placebo in several controlled trials. In a novel and highly successful collaboration that has become a model in the field, Heimberg and Liebowitz together compared phenelzine, CBGT, pill placebo, and a credible psychosocial control treatment, and found phenelzine and CBGT superior on a variety of measures and of distinct clinical benefits. Phenelzine was faster acting and more effective with CBGT on some measures, while CBGT tended to be more durable following treatment discontinuation. While phenelzine and CBGT produced positive effects, a number of patients, especially among generalized social phobics, did not respond sufficiently. There was also significant relapse following phenelzine discontinuation. Therefore, there is still a need for treatments for social phobia that are more effective and more durable that those two treatments as typically administered. Specifically the combination of an MAOI and CBGT has never been evaluated. For a variety of reasons, the combination treatment may be more effective that either individual therapy, more durable than medication alone, and especially effective for patients with generalized social phobia. If so, combined phenelzine/CBGT treatment would be of distinct benefit for many patients whose clinical needs are currently not well met. To address these needs, Liebowitz and Heimberg will now compare CBGT, phenelzine, the combination of these two treatments, and pill placebo in a acute study the treatment of social phobia. Outcome is evaluated by blind independent assessor interviews, self-report questionnaires, and standardized behavioral tests. The contributions of subtype and treatment site to outcome will also be examined. This study should substantially enhance our knowledge of effective treatments for social phobia.