Fracalanza Katie, McCabe Randi E, Taylor Valerie H, Antony Martin M
Department of Psychology, Ryerson University, Toronto, ON, Canada.
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Anxiety Treatment and Research Centre, St. Joseph׳s Healthcare Hamilton, ON, Canada.
J Affect Disord. 2014 Jun;162:61-6. doi: 10.1016/j.jad.2014.03.015. Epub 2014 Mar 24.
Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear.
The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD.
At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD.
Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT.
Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.
重度抑郁症（MDD）和双相情感障碍（BD）在社交焦虑障碍（SAD）患者中常同时出现，但这些共病是否会影响针对SAD的认知行为疗法（CBT）的疗效尚不清楚。
本研究考察了患有SAD并伴有共病MDD（SAD+MDD；n=76）、共病BD（SAD+BD；n=19）、共病焦虑障碍（SAD+ANX；n=27）或无共病诊断（SAD+NCO；n=41）的个体从针对SAD的CBT中获益的程度。使用《精神疾病诊断与统计手册》第四版（DSM-IV）的结构化临床访谈对个体进行筛查，然后在针对SAD的12周团体CBT前后完成社交恐惧症量表和抑郁焦虑压力量表。
在治疗前，SAD+MDD组和SAD+BD组报告的社交焦虑症状高于SAD+ANX组和SAD+NCO组。所有组在接受CBT后社交焦虑均有大幅且显著改善。然而，在治疗后，SAD+MDD组和SAD+BD组的社交焦虑症状仍高于SAD+NCO组，且SAD+ANX组与其他任何组在社交焦虑症状上无差异。样本在针对SAD的CBT后抑郁症状也有小幅度且具有统计学意义的改善。
本研究未收集用药信息，且未评估CBT的长期效果。
我们的结果表明，针对SAD的CBT即使在存在共病情绪障碍的情况下短期内也是一种有效的治疗方法，尽管延长治疗疗程可能对该人群有帮助，未来研究应予以探讨。
