Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Germany.
Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Germany.
Behav Res Ther. 2017 Aug;95:87-98. doi: 10.1016/j.brat.2017.05.012. Epub 2017 May 26.
This study examined the effectiveness of manualized cognitive therapy (mCT) following the Clark-Wells approach versus non-manualized cognitive-behavioral treatment-as-usual (CBTAU) for social anxiety disorder (SAD) in routine practice.
Forty-eight private practitioners were recruited within a multi-center trial and either received training in manualized CT for SAD or no such training. Practitioners treated 162 patients with SAD in routine practice (N = 107 completers, n = 57 for mCT, n = 50 for CBTAU). Social anxiety symptoms (Liebowitz Social Anxiety Scale; LSAS) and secondary measures were assessed before treatment, at treatment-hour 8, 15, and 25, at end of treatment, as well as 6 and 12 months after treatment.
Patients in both groups showed significant reductions of SAD severity after treatment (d = 1.91 [mCT] and d = 1.80 [CBTAU], within-group effect sizes, intent-to-treat analyses, LSAS observer ratings), which remained stable at follow-up. There were no differences between groups in terms of symptom reduction and treatment duration.
The present trial confirms the high effectiveness of CBTAU and mCT for SAD when practitioners conduct the treatments in routine practice. Additional training in the CT manual did not result in significant between-group effects on therapy outcome. Explanations for this unexpected result are discussed.
本研究考察了基于 Clark-Wells 方法的定式认知疗法（mCT）与非定式认知行为治疗常规疗法（CBTAU）治疗社交焦虑障碍（SAD）的有效性。
在一项多中心试验中，招募了 48 名私人从业者，他们接受了定式认知治疗 SAD 的培训或未接受此类培训。从业者在常规实践中治疗了 162 名 SAD 患者（N=107 例完成者，mCT 组 57 例，CBTAU 组 50 例）。在治疗前、治疗第 8、15、25 小时、治疗结束时以及治疗结束后 6 个月和 12 个月，评估了社交焦虑症状（Liebowitz 社交焦虑量表；LSAS）和次要指标。
两组患者在治疗后社交焦虑严重程度均显著降低（mCT 组 d=1.91，CBTAU 组 d=1.80，意向治疗分析，LSAS 观察者评分），随访时仍保持稳定。两组在症状缓解和治疗持续时间方面无差异。
本试验证实了 CBTAU 和 mCT 在从业者常规实践中治疗 SAD 的高度有效性。在 CT 手册方面的额外培训并未导致治疗结果出现显著的组间差异。对这一意外结果的解释进行了讨论。
