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Articles   |    
Long-Term Outcome of Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder
Falk Leichsenring, D.Sc.; Simone Salzer, D.Sc.; Manfred E. Beutel, M.D.; Stephan Herpertz, M.D.; Wolfgang Hiller, Ph.D.; Juergen Hoyer, Ph.D.; Johannes Huesing, Dr.Rer.Medic.; Peter Joraschky, M.D.; Bjoern Nolting, M.D.; Karin Poehlmann, Ph.D.; Viktoria Ritter, D.Phil.Nat.; Ulrich Stangier, D.Sc.; Bernhard Strauss, Ph.D.; Susan Tefikow, Ph.D.; Tobias Teismann, Ph.D.; Ulrike Willutzki, Ph.D; Joerg Wiltink, M.D.; Eric Leibing, D.Sc.
Am J Psychiatry 2014;171:1074-1082. doi:10.1176/appi.ajp.2014.13111514
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Dr. Beutel has received speaker’s honoraria from Böhringer Ingelheim, Pfizer, and Servier. Dr. Hoyer has received speaker’s honoraria from AstraZeneca. All other authors report no financial relationships with commercial interests.

Supported by grant 01GV0607 from the German Federal Ministry of Education and Research (BMBF).

From the Clinic of Psychosomatics and Psychotherapy, Justus-Liebig University Giessen, Giessen, Germany; the Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Göttingen, Göttingen, Germany; the Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany; the Clinic of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Bochum, Germany; the Ruhr University Bochum, Bochum, Germany; the Clinical Psychology and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany; the Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany; the Coordination Center for Clinical Trials, University of Heidelberg, Heidelberg, Germany; the Clinic for Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany; the Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany; the Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany; the Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany.

Address correspondence to Dr. Leichsenring (Falk.Leichsenring@psycho.med.uni-giessen.de).

Copyright © 2014 by the American Psychiatric Association

Received November 19, 2013; Revised March 12, 2014; Revised April 22, 2014; Accepted April 25, 2014.

Abstract

Objective  Relatively few studies have examined the long-term outcome of psychotherapy in social anxiety disorder. The authors previously reported findings of a clinical trial comparing cognitive-behavioral therapy (CBT), psychodynamic therapy, and a wait-list control. The purpose of the present study was to follow the participants’ status over the ensuing 24 months.

Method  Outpatients with social anxiety disorder who were treated with CBT (N=209) or psychodynamic therapy (N=207) in the previous trial were assessed 6, 12, and 24 months after the end of therapy. Primary outcome measures were rates of remission and response.

Results  For both CBT and psychodynamic therapy, response rates were approximately 70% by the 2-year follow-up. Remission rates were nearly 40% for both treatment conditions. Rates of response and remission were stable or tended to increase for both treatments over the 24-month follow-up period, and no significant differences were found between the treatment conditions after 6 months.

Conclusions  CBT and psychodynamic therapy were efficacious in treating social anxiety disorder, in both the short- and long-term, when patients showed continuous improvement. Although in the short-term, intention-to-treat analyses yielded some statistically significant but small differences in favor of CBT in several outcome measures, no differences in outcome were found in the long-term.

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FIGURE 1. Enrollment and Study Flow of Patients With Social Anxiety Disorder Randomly Assigned to Cognitive-Behavioral Therapy (CBT), Psychodynamic Therapy, or a Waiting Lista

a Some patients who were not available for a scheduled examination may have taken part in a later examination; therefore, the frequencies of (terminal) withdrawals may deviate from the difference between the available patients on two consecutive assessments.

FIGURE 2. Response Rates for Cognitive-Behavioral Therapy (CBT) and Psychodynamic Therapy in Patients With Social Anxiety Disorder

FIGURE 3. Remission Rates for Cognitive-Behavioral Therapy (CBT) and Psychodynamic Therapy in Patients With Social Anxiety Disorder
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TABLE 1.Baseline Characteristics of Patients With Social Anxiety Disorder and Recruitment According to Study Center
Table Footer Note

a Seventy-nine participants were randomly assigned to a waiting list.

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TABLE 2.Outcomes for Patients With Social Anxiety Disorder Randomly Assigned to Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (Intention-to-Treat Sample)a
Table Footer Note

a All analyses were performed with data from the intention-to-treat sample using multiple imputation.

Table Footer Note

b Values represent the proportion of patients who remitted, defined as a score <30 on the Liebowitz Social Anxiety Scale.

Table Footer Note

c Values represent the proportion of patients who had a response to therapy, defined as a reduction in the Liebowitz Social Anxiety Scale score by ≥31%.

Table Footer Note

d Scores on the Liebowitz Social Anxiety Scale range from 0 to 144, with higher scores indicating greater pathology.

Table Footer Note

e Scores on the Social Phobia and Anxiety Inventory range from 0 to 132, with higher scores indicating greater pathology.

Table Footer Note

f Scores on the Beck Depression Inventory range from 0 to 63, with higher scores indicating greater pathology.

Table Footer Note

g Scores on the Inventory of Interpersonal Problems range from 0 to 32, with higher scores indicating greater pathology.

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