title: Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial.
abstract: BACKGROUND
  The most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and cognitive therapy (CT). Combined treatment is advocated for SAD but has not been evaluated in randomized trials using CT and SSRI. Our aim was to evaluate whether one treatment is more effective than the other and whether combined treatment is more effective than the single treatments.
  
  
  METHODS
  A total of 102 patients were randomly assigned to paroxetine, CT, the combination of CT and paroxetine, or pill placebo. The medication treatment lasted 26 weeks. Of the 102 patients, 54% fulfilled the criteria for an additional diagnosis of avoidant personality disorder. Outcomes were measured at posttreatment and 12-month follow-up assessments.
  
  
  RESULTS
  CT was superior to paroxetine alone and to pill placebo at the end of treatment, but it was not superior to the combination treatment. At the 12-month follow-up, the CT group maintained benefits and was significantly better than placebo and paroxetine alone, whereas there were no significant differences among combination treatment, paroxetine alone, and placebo. Recovery rates at 12 months were much higher in the CT group (68%) compared to 40% in the combination group, 24% in the paroxetine group, and 4% in the pill placebo group.
  
  
  CONCLUSIONS
  CT was the most effective treatment for SAD at both posttreatment and follow-up compared to paroxetine and better than combined treatment at the 12-month follow-up on the Liebowitz Social Anxiety Scale. Combined treatment provided no advantage over single treatments; rather there was less effect of the combined treatment compared to CT alone.
authors.affiliation: Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Hans M
authors.initials: HM
authors.lastname: Nordahl
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Vogel
authors.forename: Gunnar
authors.initials: G
authors.lastname: Morken
authors.forename: Tore C
authors.initials: TC
authors.lastname: Stiles
authors.forename: Pål
authors.initials: P
authors.lastname: Sandvik
authors.forename: Adrian
authors.initials: A
authors.lastname: Wells
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000627:therapeutic use*; D010554:Personality Disorders / Q000628:therapy*; D000072861:Phobia, Social / Q000150:complications* / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors