Cognitive Behavioral Group Tx for Social Phobia

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Kate Johnson, Contributing Writer Clinical Psychiatry News

TORONTO -- Cognitive behavioral group therapy is superior to
phenelzine for the long-term management of social phobia, said Dr.
Richard Heimberg, director of the Adult Anxiety Clinic at Temple
University in Philadelphia.

Although phenelzine may be slightly superior to cognitive behavioral
group therapy (CBGT) in the short term, producing a response within 6
weeks, response rates were equal at 12 weeks, he said at the annual
meeting of the Association for Advancement of Behavioral Therapy.

When acute therapy is phased down into a maintenance regime and then
eventually stopped, those patients who had been treated by phenelzine
alone had a high rate of relapse, he noted.

In the first phase of the study, Dr. Heimberg and Dr. Michael R.
Liebowitz of the New York State Psychiatric Institute analyzed 133
patients who had been randomly assigned to receive one of four
treatments for a 12-week period: weekly CBGT, phenelzine, a placebo
pill, or educational support group therapy (ESGT).

The CBGT and phenelzine groups had the best responses, at 58% and
64%; the difference between the two groups was not statistically
significant. Patients who were in the phenelzine group showed an
almost full response by 6 weeks, compared with a much slower response
from the CBGT group.

In the two control groups, patients receiving placebo had a 36%
response rate and the ESGT group had a 27% response rate (Arch. Gen.
Psychiatry 55[12]:1133-41, 1998).

The second phase of the study (Depress. Anxiety 10:89-98, 1999)
eliminated the control groups as well as all nonresponders in the
other groups. This left 28 patients -- 14 receiving CBGT and 14
receiving phenelzine -- who completed a 6-month maintenance phase.

The maintenance phase for the CBGT group consisted of a once-monthly
group meeting. Patients in the phenelzine group saw a psychiatrist
once a month to renew prescriptions.

During this period, there were two (14%) relapses among patients in
the CBGT group and three relapses (21%) in the phenelzine group.

Twelve patients in each group completed the final phase of the study,
which consisted of 6 months with no treatment. The total relapse
rates for the two periods combined were 17% in the CBGT group and 50%
in the phenelzine group.

"We can see that phenelzine definitely works much more quickly at the
beginning of treatment, which is not surprising, because CBGT
involves teaching skills, which take time" to develop, commented Dr.
Heimberg.

But once these skills have been taught, they carry patients through
the maintenance and no-treatment phase, whereas phenelzine patients
have nothing to lean on once their medication is withdrawn, he said.

Dr. Heimberg's CBGT consisted of five or six patients who met with a
couple of counselors on a weekly basis in the acute phase and a
monthly basis in the maintenance phase.

The sessions included cognitive exercises; exposure to simulated
anxiety-provoking events; cognitive restructuring before, during, and
after exposure; and both behavioral and cognitive homework
assignments.