Samantray Narendranath, Kar Nilamadhab, Singh Preeti, Swain Sarada Prasanna, Singh Amool Ranjan, Chaudhury Suprakash, Mahapatra Jashobanta
Department of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College and Hospital, Cuttack, Odisha, India.
Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Wolverhampton, England, UK.
Ind Psychiatry J. 2019 Jul-Dec;28(2):211-217. doi: 10.4103/ipj.ipj_13_19. Epub 2020 Aug 14.
Individually, cognitive behavior therapy (CBT) and paroxetine (PX) are considered as frontline treatments for social anxiety disorder (SAD). However, the possibility of combined interventions of these might be more helpful than either intervention alone has met with mixed reviews. Hence, the goal of the current study was to examine whether combining CBT + PX would be superior to PX alone in the treatment of SAD in various stages of treatment.
The present study is a single-center, rater-blind, behavioral placebo (Bh. PBO)-controlled study. Sixty-seven participants were prospectively observed in two groups, one receiving CBT + PX and PX + Bh. PBO for 24 weeks. The Social Interaction Anxiety Scale (SIAS) was measured at pre, post (12 weeks), end of booster (24 weeks), and 2-month follow-up (32 weeks) stage. The SIAS was measured at pre, post (12 weeks), end of booster (24 weeks), and 2-month follow-up (32 weeks) stage.
Both treatment groups have significant difference in the mean scores of SIAS in posttreatment, booster, and follow-up stages from their respective mean scores at prestage. Mann-Whitney U-test found no significant differences in the mean scores of SIAS between CBT + PX and PX + Bh. PBO at posttreatment and booster phase, whereas a statistically significance difference ( = 0.03) was found in 2-month follow-up stages. Both treatment groups have large effect size in posttreatment and end of booster phase. At 2-month follow-up stage, a large effect size of 1.11 was found in CBT + PX group as compared to medium size of 0.6 in PX + Bh. PBO group.
Combined treatment of CBT + PX provided no advantage over PX + Bh. PBO in acute stages of treatment, but the former have significantly better maintenance of treatment gains in 2-month follow-ups than the latter.
认知行为疗法（CBT）和帕罗西汀（PX）分别被视为社交焦虑障碍（SAD）的一线治疗方法。然而，这两种方法联合干预可能比单独使用任何一种干预更有帮助，对此的评价不一。因此，本研究的目的是检验在SAD治疗的各个阶段，CBT + PX联合治疗是否优于单独使用PX治疗。
本研究是一项单中心、评估者盲法、行为安慰剂（Bh. PBO）对照研究。前瞻性观察67名参与者，分为两组，一组接受CBT + PX治疗，另一组接受PX + Bh. PBO治疗，为期24周。在治疗前、治疗后（12周）、强化治疗结束时（24周）和2个月随访（32周）阶段测量社交互动焦虑量表（SIAS）。
两个治疗组在治疗后、强化治疗和随访阶段的SIAS平均得分与各自治疗前的平均得分相比均有显著差异。曼-惠特尼U检验发现，在治疗后和强化治疗阶段，CBT + PX组和PX + Bh. PBO组的SIAS平均得分无显著差异，而在2个月随访阶段发现有统计学显著差异（= 0.03）。两个治疗组在治疗后和强化治疗结束阶段均有较大的效应量。在2个月随访阶段，CBT + PX组的效应量为1.11，而PX + Bh. PBO组为0.6，为中等效应量。
在治疗急性期CBT + PX联合治疗并不比PX + Bh. PBO有优势，但在2个月随访中，前者在维持治疗效果方面明显优于后者。
