Shear M K, Beidel D C
Anxiety Disorders Program, University of Pittsburgh, PA, USA.
J Clin Psychiatry. 1998;59 Suppl 17:39-46.
Cognitive-behavioral therapies (CBTs) are effective treatments for social anxiety disorder/social phobia. Although a variety of procedures are included under the term cognitive-behavioral treatment, it is, however, clear that the key factor influencing treatment outcome for social anxiety disorder is exposure to feared situations. Two formalized CBT programs are cognitive-behavioral group therapy (CBGT) and social effectiveness training (SET). They both involve exposure, but differ in that CBGT focuses on correction of cognitive errors, whereas SET uses social skills training in addition to exposure to feared social situations. CBGT is more efficacious than a psychological placebo and has shown efficacy comparable to that of phenelzine in a double-blind, placebo-controlled study. The onset of effect of phenelzine was more rapid, whereas the effect of CBGT was more sustained. The major component of SET, imaginal and/or in vivo exposure, has been demonstrated to be more effective than pill placebo or the beta-blocker atenolol. Many questions remain regarding CBT strategies and their place in the overall management of patients with social anxiety disorder. Depending upon the particular patient profile, various combinations of drug and/or CBT may prove to be the optimal treatment strategy.
认知行为疗法（CBTs）是治疗社交焦虑障碍/社交恐惧症的有效方法。尽管认知行为治疗这一术语涵盖了多种程序，但很明显，影响社交焦虑障碍治疗效果的关键因素是暴露于恐惧情境。两种形式化的CBT项目是认知行为团体治疗（CBGT）和社交效能训练（SET）。它们都包含暴露环节，但不同之处在于，CBGT侧重于纠正认知错误，而SET除了让患者暴露于恐惧的社交情境外，还采用社交技能训练。在一项双盲、安慰剂对照研究中，CBGT比心理安慰剂更有效，并且已显示出与苯乙肼相当的疗效。苯乙肼起效更快，而CBGT的效果更持久。SET的主要组成部分，即想象和/或现场暴露，已被证明比口服安慰剂或β受体阻滞剂阿替洛尔更有效。关于CBT策略及其在社交焦虑障碍患者整体管理中的地位，仍有许多问题。根据特定患者的情况，药物和/或CBT的各种组合可能被证明是最佳治疗策略。
