School of Psychological Sciences, University of Haifa, Israel.
School of Psychological Sciences, University of Haifa, Israel.
Clin Psychol Rev. 2020 Aug;80:101874. doi: 10.1016/j.cpr.2020.101874. Epub 2020 Jun 5.
Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms. In the present meta-analysis, we reviewed the treatment outcome literature in SAD and examined whether depressive symptoms predict treatment outcome. We focused on randomized controlled trials of cognitive behavior therapy (individual face-to-face, group format, and internet-delivered format) and randomized controlled trials of pharmacotherapy. After implementing exclusion criteria, 108 studies with 133 treatment conditions (n = 12,913 participants) were included in the meta-analysis. Our findings indicated that treatments for SAD were efficacious and significantly reduced social anxiety symptoms across all treatment modalities. Exclusion of individuals with MDD or high levels of depression did not affect outcome at post-treatment or at follow-up. However, we found that elevated depressive symptoms were associated with greater reductions in social anxiety symptoms from pre-treatment to post-treatment. Importantly, this effect was above and beyond pre-treatment levels of social anxiety. Finally, analyzing treatment modalities separately, we found that depressive symptoms were associated with better post-treatment outcomes in individual face-to-face CBT but not in other modalities. Clinical and research implications of these findings are discussed.
患有社交焦虑障碍（SAD）的个体通常伴有升高的抑郁症状。在本项荟萃分析中，我们对 SAD 的治疗结果文献进行了回顾，并检验了抑郁症状是否能预测治疗结果。我们关注的是认知行为疗法（个体面对面、小组和网络格式）的随机对照试验，以及药物治疗的随机对照试验。在实施排除标准后，108 项研究（共 133 个治疗条件）包含了 12913 名参与者被纳入荟萃分析。我们的研究结果表明，SAD 的治疗方法是有效的，能够显著降低所有治疗方式下的社交焦虑症状。在治疗后或随访时，排除 MDD 或高抑郁水平的个体并不影响结果。然而，我们发现，升高的抑郁症状与从治疗前到治疗后的社交焦虑症状的更大减轻相关。重要的是，这种效果超出了治疗前的社交焦虑水平。最后，我们分别分析治疗方式，发现抑郁症状与个体面对面 CBT 的治疗后更好的结果相关，但与其他方式无关。这些发现的临床和研究意义将在文中讨论。
