title: Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial.
abstract: 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.
authors.affiliation: Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshinaga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsuki
authors.forename: Tomihisa
authors.initials: T
authors.lastname: Niitsu
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.forename: Mari
authors.initials: M
authors.lastname: Tanaka
authors.forename: Hanae
authors.initials: H
authors.lastname: Ibuki
authors.forename: Rieko
authors.initials: R
authors.lastname: Takanashi
authors.forename: Keiko
authors.initials: K
authors.lastname: Ohshiro
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Ohshima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Asano
authors.forename: Osamu
authors.initials: O
authors.lastname: Kobori
authors.forename: Kensuke
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hirano
authors.forename: Kyoko
authors.initials: K
authors.lastname: Sawaguchi
authors.forename: Masaya
authors.initials: M
authors.lastname: Koshizaka
authors.forename: Hideki
authors.initials: H
authors.lastname: Hanaoka
authors.forename: Akiko
authors.initials: A
authors.lastname: Nakagawa
authors.forename: Michiko
authors.initials: M
authors.lastname: Nakazato
authors.forename: Masaomi
authors.initials: M
authors.lastname: Iyo
authors.forename: Eiji
authors.initials: E
authors.lastname: Shimizu
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D000072861:Phobia, Social / Q000628:therapy*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents