LONG-TERM TREATMENT OF SOCIAL PHOBIA

社交恐惧症是一种高度流行的，致残的，慢性焦虑症 与大量职业、社会和学术相关的疾病 损伤它会增加抑郁症、药物滥用和 金融依赖。社交恐惧症的治疗 比治疗其他焦虑症更重要。但具体 心理社会和精神药理学治疗已经证明 功效认知行为团体疗法（CBGT），由Heimberg开发， 已经证明上级对照治疗，而MAOI苯乙肼（PZ）， Liebowitz首次研究，已证明在几个方面优于安慰剂上级 对照试验。在一次新颖而非常成功的合作中，Heimberg 和Liebowitz一起比较了PZ，CBGT，药丸安慰剂和可信的 心理社会控制，并发现PZ和CBGT上级和不同的 临床获益。PZ在某些方面比CBGT起效更快， 虽然CBGT的效果在治疗后似乎更持久， 中止 虽然PZ和CBGT产生了积极的影响，但许多患者没有反应 足够，PZ停药导致显著复发。所以我们 仍然需要比CBGT或PZ更有效和持久的治疗方法 如通常施用的。我们最近得到了一项研究急性 联合PZ/CBGT的疗效，可能比PZ或CBGT更有效 一个人然而，方案预算的削减阻碍了长期的研究， CBGT、Pz或其组合的功效。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 需要进一步研究，以确定更长的治疗时间是否会减少复发后， PZ停药。需要对PZ/CBGT进行长期研究，以确定 该组合融合了每个分量的强度，即，PZ的功效和 CBGT的耐久性。如果是这样，PZ/CBGT联合治疗将具有明显的 这对很多患者都有好处。 我们现在建议研究CBGT的长期功效和耐久性， PZ，以及社交恐惧症的组合。拟议的研究是协调 与已经资助的为期12周的PZ，CBGT和 PZ/CBGT。急性研究的应答者和最小应答者进入12- 为期一周的密集持续阶段，以评估进一步的 改进.第24周的应答者进入28周维持期。 然后评估第52周时的应答者在1周内的应答持久性。 年的后续行动。结果通过盲评估员访谈、自我评估来评估 报告问卷和标准化行为测试。这项研究应 大大提高我们对有效长期治疗的认识， 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.