Social anxiety can be a crippling fear of everyday social situations. People with this disorder may develop intense and chronic fears of any situation where other people are around or specific situations like public speaking, meeting new people, or eating/drinking in public. The symptoms can range from physical signs like blushing, sweating, nausea, and shaky voice to levels of anxiety that prevent daily routine. There are varieties of psychotherapy options that may help manage the anxiety. Two common types have two very different approaches. One called cognitive behavioral therapy (CBT) focuses on how your inner dialogue/thoughts contribute to anxiety. A second approach called interpersonal psychotherapy (IPT) focuses on developing skills to better relate to other people, improving their relationships.
Researchers from Germany examined the two different methods of psychological therapy to determine if one had better outcomes for patients with social anxiety. The study, published in Archives of General Psychiatry, found that more patients improved with CBT than with IPT.
The randomized trials included 117 patients with social anxiety disorder. Patients were divided into one of three groups. The first group received 16 sessions of CBT over 20 weeks with one booster session. A second group received 16 sessions of IPT over 20 weeks with one booster session. The third group was placed on a waitlist and followed as a control group. Evaluators rated anxiety scores at the beginning of treatment, at end of treatment and at one-year follow-up.
Improvement in symptoms at 20 weeks were found in
- 66% with CBT
- 42% with IPT
- 7% on wait list
Improvement in symptoms at one year were found in
Also, additional therapy or medication was required in 38% with IPT but only 12% of patients with CBT.
The skills and experience of the counselors will affect the success rates of any therapeutic approach. In this trial different counselors were used for each approach. An imbalance in skills of the counselors may have over- or underestimated the benefits of either approach.
However, this was a high quality randomized trial, which makes the results more reliable. These results need to be confirmed with other trials but it appears CBT may have an advantage for some people with social anxiety disorder.
Social anxiety, like most psychological disorders, is caused by a combination of genetics and environmental factors that are different for each person. As a result, successful treatment plans can vary from person to person. This study indicates that CBT was the most effective overall but some people also found benefits with IPT. If you are seeking therapy for a psychological disorder talk to your doctor about treatment options. Understanding the difference in approaches may help you decide which will be best for you. In addition, if past therapy was not beneficial a different approach may be the key to managing your disorder.
Stangier U, Schramm E, Heidenreich T, et al.
Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial.
Arch Gen Psychiatry. 2011 Jul;68(7):692-700.
Last reviewed December 2011 by Brian P. Randall, MD
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