Cognitive Behavioral Therapy for Social Anxiety Disorder

Overseen By Lacey Bonner, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Psychotic symptoms, Personality disorder, Substance use, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 14

Duration: 12 weeks

264 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two therapies to determine which better aids veterans with social anxiety disorder and posttraumatic stress. One therapy, Cognitive Behavioral Therapy (CBT), focuses on changing negative thought patterns. The other, Transdiagnostic Behavior Therapy (TBT), addresses multiple issues simultaneously using various exposure techniques. Veterans experiencing social anxiety and posttraumatic stress symptoms and registered at the Ralph H. Johnson Veterans Affairs Health Care System might be suitable candidates. The trial aims to identify which therapy more effectively reduces symptoms and improves daily life. As an unphased trial, it offers veterans the chance to contribute to valuable research that could enhance therapeutic options for these conditions.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, if you have recently started new psychiatric medications within the last 4 weeks, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Transdiagnostic Behavior Therapy (TBT) is generally easy for people to handle. Studies have found that those who use TBT are usually satisfied with the treatment. Many complete the therapy and experience fewer symptoms of depression and anxiety.

Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder (SAD) is also known to be safe. It has been successfully used to help people with SAD feel better and improve their quality of life. Thus, both TBT and CBT for SAD are considered safe options for treating anxiety and related issues.

Both therapies use exposure techniques, which help people face and overcome their fears. Reports of serious side effects are rare, making them safe choices for many individuals. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Transdiagnostic Behavior Therapy (TBT) for social anxiety disorder because it takes a unique approach to treatment by targeting avoidance behaviors across various anxiety-related conditions. Unlike traditional Cognitive Behavioral Therapy (CBT) that focuses solely on social anxiety disorder, TBT uses four specific exposure techniques to address different types of avoidance, including situational and emotional. This method aims to provide a more comprehensive strategy by tailoring exposures to each patient's specific symptoms, potentially offering broader and more effective relief from anxiety.

What evidence suggests that this trial's treatments could be effective for social anxiety disorder?

Research shows that Cognitive Behavioral Therapy (CBT), one of the treatments in this trial, effectively treats Social Anxiety Disorder (SAD). Studies indicate that 47.8% to 73.5% of patients experience significant symptom improvement after CBT, with benefits often lasting a year or more. Transdiagnostic Behavior Therapy (TBT), another treatment option in this trial, has also reduced anxiety and depression across various conditions. TBT employs different methods to address avoidance behaviors related to emotional issues, making it a promising option for treating multiple anxiety and depressive disorders, including SAD. ^{6 7 8 9 10}

Who Is on the Research Team?

Daniel F Gros, PhD MA BS

Principal Investigator

Ralph H. Johnson VA Medical Center, Charleston, SC

Are You a Good Fit for This Trial?

This trial is for Veterans registered at Ralph H. Johnson VA Health Care System who have been diagnosed with social anxiety disorder and also show symptoms of posttraumatic stress. They must be able to give informed consent. Specific details on who can't join are not provided.

Inclusion Criteria

Participants must be Veterans and registered at Ralph H. Johnson Veterans Affairs Health Care System

Participants must meet DSM-5 criteria for social anxiety disorder

I understand and can consent to participate in research.

Exclusion Criteria

Primary diagnosis of a condition associated with psychotic symptoms, personality disorder, substance use disorder, or bipolar disorder.

Acute, severe illness or medical condition that likely will interfere with study procedures as documented in their medical record

I started new psychiatric medication less than 4 weeks ago.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person or virtual)

Treatment

Participants receive either Transdiagnostic Behavior Therapy (TBT) or Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder over 12 weekly sessions

12 weeks

12 visits (in-person or virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 6-month follow-up

6 months

1 visit (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Cognitive Behavioral Therapy for Social Anxiety Disorder
• Transdiagnostic Behavior Therapy

Trial Overview The study compares Transdiagnostic Behavior Therapy (TBT), a versatile treatment for various disorders, with Cognitive Behavioral Therapy (CBT) specifically designed for Social Anxiety Disorder in treating veterans with both conditions.

How Is the Trial Designed?

Group I: Transdiagnostic Behavior Therapy Experimental Treatment 1 Intervention

TBT was developed to address transdiagnostic avoidance via the use of four different types of exposure techniques (situational/in-vivo, physical/interoceptive, thought/imaginal, and \[positive\] emotional/behavioral activation). From the transdiagnostic avoidance perspective, the four exposure practices are matched to the type(s) of avoidance experienced by patients based upon their cluster of symptoms/disorders.

Group II: Cognitive Behavioral Therapy for Social Anxiety Disorder Active Control 1 Intervention

To provide an evidence-based comparison for the TBT condition, the research-supported psychological treatment of CBT for SAD will be used. CBT for SAD demonstrates efficacy in improving SAD symptoms and quality of life for patients with SAD, with durable improvements evidenced at follow-up assessments. CBT for SAD was used as a comparison to TBT in previous preliminary research. CBT for SAD involves several primary components, including: 1) psychoeducation, 2) training in cognitive restructuring, 3) exposures, 4) advanced cognitive restructuring, and 5) termination.

Cognitive Behavioral Therapy for Social Anxiety Disorder is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Cognitive Behavioral Therapy for:

• Social Anxiety Disorder
• Depressive Disorders
• Anxiety Disorders
• Posttraumatic Stress Disorder

Approved in European Union as Cognitive Behavioural Therapy for:

• Social Anxiety Disorder
• Depressive Disorders
• Anxiety Disorders
• Posttraumatic Stress Disorder

Approved in Canada as Cognitive Behavioral Therapy for:

• Social Anxiety Disorder
• Depressive Disorders
• Anxiety Disorders
• Posttraumatic Stress Disorder

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A study involving 233 participants with social anxiety disorder (SAD) found that both disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behavior therapies delivered online resulted in significant reductions in SAD symptoms, with an average reduction of over 30%.

The therapies also effectively reduced symptoms of comorbid conditions like depression and generalized anxiety disorder, with improvements maintained or enhanced at a 24-month follow-up, indicating long-term efficacy of both treatment formats.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for Social Anxiety Disorder and comorbid disorders: A randomized controlled trial. Dear, BF., Staples, LG., Terides, MD., et al.[2022]

A study involving seven patients with social anxiety disorder showed that a brief cognitive behavior therapy (CBT) program of six sessions effectively reduced social anxiety symptoms in all participants.

While brief CBT improved overall social anxiety and self-consciousness, it did not significantly reduce fear of negative evaluation for all patients, indicating that some individuals may require longer treatment for deeper cognitive changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brief cognitive behavior therapy in patients with social anxiety disorder: a preliminary investigation. Pinjarkar, RG., Sudhir, PM., Math, SB.[2020]

Emotion Regulation Therapy (ERT) was effective in treating social anxiety disorder (SAD) in four clients who also had symptoms of generalized anxiety disorder (GAD) and depression, showing significant improvements in symptom severity and quality of life after 16 sessions.

The positive effects of ERT were maintained or even increased during follow-up assessments at 1, 2, and 3 months, suggesting that ERT may address underlying issues of emotion dysregulation and motivation in individuals with co-morbid SAD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Emotion regulation therapy for social anxiety disorder: a single case series study. Abasi, I., Pourshahbaz, A., Mohammadkhani, P., et al.[2021]

Transdiagnostic cognitive-behavioral therapy (CBT) is an adaptable treatment that can effectively address a variety of anxiety and emotional disorders, potentially improving accessibility for patients.

Clinical trials and meta-analyses indicate that transdiagnostic CBT is as effective as traditional CBT, and may be particularly beneficial for individuals with multiple anxiety and emotional disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transdiagnostic Therapy. Norton, PJ., Roberge, P.[2018]

A manualized cognitive-behavioral therapy (CBT) treatment for social anxiety disorder (SAD) was implemented in a case study of a 26-year-old male, resulting in complete remission of his symptoms after 15 sessions.

Follow-up assessments at 2 and 8 months post-treatment showed that the remission of SAD symptoms was maintained, highlighting the long-term efficacy of this CBT approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Manualized Cognitive-Behavioral Treatment of Social Anxiety Disorder: A Case Study. Shorey, RC., Stuart, GL.[2021]

This pilot study will be the first to directly compare the efficacy of cognitive behavioral therapy (CBT) and multi-person systemic therapy (ST) specifically for social anxiety disorders, involving 32 patients diagnosed with the disorder.

The primary outcome will focus on changes in social anxiety symptoms after a maximum of 26 hours of therapy, with secondary outcomes assessing various aspects of psychological and social functioning over a follow-up period of 9 and 12 months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing systemic therapy and cognitive behavioral therapy for social anxiety disorders: study protocol for a randomized controlled pilot trial. Hunger, C., Hilzinger, R., Koch, T., et al.[2023]

In a randomized clinical trial with 86 young adults, both individual Trial-Based Cognitive Therapy (TBCT) and group Cognitive-Behavioral Therapy (Group CBT) significantly reduced symptoms of social anxiety and depression compared to a waitlist control group.

This study is the first to compare TBCT and Group CBT in Brazil, demonstrating that both interventions are effective in addressing social anxiety disorder and related psychiatric symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder. Neufeld, CB., Palma, PC., Caetano, KAS., et al.[2020]

A randomized clinical trial involving 46 participants demonstrated that a 12-week transdiagnostic cognitive-behavioral therapy (CBT) was as effective as traditional diagnosis-specific CBT for treating anxiety disorders like panic disorder, social anxiety disorder, and generalized anxiety disorder.

The study supports the use of transdiagnostic CBT as a viable treatment option, which could improve access to effective anxiety treatments without compromising efficacy, making it easier to disseminate these therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transdiagnostic versus diagnosis-specific cbt for anxiety disorders: a preliminary randomized controlled noninferiority trial. Norton, PJ., Barrera, TL.[2022]

Transdiagnostic cognitive behavioral therapy (CBT) protocols have been developed to streamline treatment for affective disorders by combining overlapping components from various disorder-specific CBT approaches, potentially reducing the number of protocols needed.

These newer transdiagnostic treatments, such as group CBT for anxiety and the unified protocol for emotional disorders, aim to address multiple symptoms and comorbidities simultaneously, making CBT more accessible and cost-effective for both providers and patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Movement towards transdiagnostic psychotherapeutic practices for the affective disorders. Gros, DF., Allan, NP., Szafranski, DD.[2018]

In a pilot study with 36 participants, Internet-delivered psychodynamic psychotherapy (IPDT) was slightly more preferred than Internet-delivered cognitive behavioral therapy (ICBT) for treating social anxiety disorder (SAD), but this preference was not statistically significant.

Both treatments led to small to moderate improvements in SAD symptoms over a 10-week period, and therapeutic alliance was found to be a predictor of treatment response, although no significant differences in outcomes were observed between the two therapies at post-treatment or 6-month follow-up.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based psychodynamic therapy vs cognitive behavioural therapy for social anxiety disorder: A preference study. Lindegaard, T., Hesslow, T., Nilsson, M., et al.[2022]

The study tested a brief, 5-session transdiagnostic treatment for anxiety disorders called F-SET, which significantly reduced anxiety (Cohen's d=2.01) and depression (Cohen's d=2.16) in 28 participants compared to a waitlist control group.

The effectiveness of F-SET was linked to a reduction in avoidance strategies, suggesting that targeting these behaviors can be a key mechanism for improving anxiety symptoms, making it a potentially low-cost and efficient therapy option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

False Safety Behavior Elimination Therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders. Riccardi, CJ., Korte, KJ., Schmidt, NB.[2022]

Citations

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Long-term outcomes of cognitive behavioural therapy for ... Social anxiety outcomes continue to improve 12 months or longer after CBT treatment. •. Moderate gains in general anxiety and depressive symptoms after CBT ...

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Long-term outcomes of cognitive behavioural therapy for ... The within-groups effect sizes revealed that 12 months or more after CBT treatment, symptoms continued to improve for social anxiety (gav =.23) and quality of ...

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The effectiveness of cognitive behavioural therapy for ... Depending on the SAD specific questionnaire applied, 47.8% to 73.5% of the sample showed a reliable positive change, whereas 1.9% to 3.8% showed ...

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Cognitive behaviour therapy for social anxiety disorder Multiple meta-analyses now demonstrate the efficacy of cognitive-behaviour therapy (CBT) for SAD (Carpenter et al., Citation2018; Mayo-Wilson et ...

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Initial Outcomes of Transdiagnostic Internet-Delivered ... Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, ...

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Outcomes of transdiagnostic internet-delivered cognitive ... Transdiagnostic online therapy was tailored to public safety personnel (PSP). PSP showed good treatment satisfaction, course completion, and symptom reduction.

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A systematic review and meta-analysis of transdiagnostic ... TD-CBT showed comparable effects to disorder-specific CBT and was superior to other active treatments for depression but not for anxiety.

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Efficacy of Transdiagnostic Behavior Therapy Across the ... This study supports the efficacy of transdiagnostic behavior therapy across various affective disorders, including depression and PTSD.

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Initial Outcomes of Transdiagnostic Internet-Delivered ... Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; ...