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Chapter 30. Social Anxiety Disorder and Specific Phobias

Franklin R. Schneier, M.D.; Brigette A. Erwin, Ph.D.; Richard G. Heimberg, Ph.D.; Randall D. Marshall, M.D.; Lisa A. Mellman, M.D.
DOI: 10.1176/appi.books.9781585622986.258250

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Excerpt

Social anxiety disorder and specific phobias are two of the most common mental disorders, and knowledge about their treatments has grown rapidly in recent years. A stimulus to research into specific treatments has been the recognition that phobias are a heterogeneous entity, as reflected in the Diagnostic and Statistical Manual of Psychiatric Disorders, Third Edition (DSM-III; American Psychiatric Association 1980) and subsequent editions. Distinctions between social anxiety disorder, specific phobias, and agoraphobia have been validated by differential course of illness; familial, environmental, and genetic factors; and psychological and biological characteristics. There has been a corresponding recognition that particular types of phobias may respond best to specific psychotherapeutic and pharmacological treatments. In this chapter, we review the treatment of social anxiety disorder and specific phobias.

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References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, DC, American Psychiatric Association, 1980
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Ballenger JC, Davidson J, Lecrubier Y, et al: Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry 59 (suppl 17):54–60, 1998
 
Barber J, Morse J, Krakauer I, et al: Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy 34:133–143, 1997
 
Blanco C, Schneier FR, Schmidt A, et al: Pharmacological treatment of social anxiety disorder: a meta-analysis. Depression Anxiety 18:29–40, 2003
[PubMed]
 
Blomhoff S, Haug TT, Hellström K, et al: Randomized controlled general practice trial of sertraline, exposure therapy, and combined treatment in generalised social phobia. Br J Psychiatry 179:23–30, 2001
[PubMed]
 
Bohn P, Sternbach H: Topical aluminum chloride for social phobia-related hyperhidrosis. Am J Psychiatry 153:1368, 1996
[PubMed]
 
Bonnet U: Moclobemide: therapeutic use and clinical studies. CNS Drug Rev 9:97–140, 2003
[PubMed]
 
Bouton ME: Context, ambiguity, and unlearning: sources of relapse after behavioral extinction. Biol Psychiatry 52:976–986, 2002
[PubMed]
 
Campos PE, Solyom L, Koelink A: The effects of timolol maleate on subjective and physiological components of air travel phobia. Can J Psychiatry 29:570–574, 1984
[PubMed]
 
Chambless DL: Spacing of exposure sessions in treatment of agoraphobia and simple phobia. Behav Ther 21:217–229, 1990
 
Clark DB, Agras WS: The assessment and treatment of performance anxiety in musicians. Am J Psychiatry 148:598–605, 1991
[PubMed]
 
Clark DM, Wells A: A cognitive model of social phobia, in Social Phobia: Diagnosis, Assessment, and Treatment. Edited by Heimberg RG, Liebowitz MR, Hope DA, et al. New York, Guilford, 1995, pp 69–93
 
Clark DM, Ehlers A, McManus F, et al: Cognitive therapy vs fluoxetine in generalized social phobia: a randomized placebo controlled trial. J Consult Clin Psychol 71:1058–1067, 2003
[PubMed]
 
Connor KM, Davidson JRT, Potts NLS, et al: Discontinuation of clonazepam in the treatment of social phobia. J Clin Psychopharmacol 18:373–378, 1998
[PubMed]
 
Davidson JR, Potts N, Richichi E, et al: Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol 13:423–428, 1993
[PubMed]
 
Davidson JR, Foa EB, Huppert JD, et al: Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Arch Gen Psychiatry 61:1005–1013, 2004
[PubMed]
 
De Jongh A, ten Broeke E, Renssen MR: Treatment of specific phobias with eye movement desensitization and reprocessing (EMDR): protocol, empirical status, and conceptual issues. J Anxiety Disord 13:69–85, 1999
 
Erwin BA, Heimberg RG, Juster HR, et al: Comorbid anxiety and mood disorders among persons with social anxiety disorder. Behav Res Ther 40:19–35, 2002
[PubMed]
 
Fedoroff IC, Taylor ST: Psychological and pharmacological treatments of social phobia: a meta-analysis. J Clin Psychopharmacol 21:311–324, 2001
[PubMed]
 
Feske U, Chambless DL: Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behav Ther 26:695–720, 1995
 
Gabbard G: Anxiety disorders, in Psychodynamic Psychiatry in Clinical Practice, 4th Edition. Washington, DC, American Psychiatric Publishing, 2005, pp 249–282
 
Gelernter CS, Uhde TW, Cimbolic P, et al: Cognitive-behavioral and pharmacological treatments of social phobia. A controlled study. Arch Gen Psychiatry 48:938–945, 1991
[PubMed]
 
Gotestam KG, Berntzen D: Use of the modeling effect in one-session exposure. Scand J Behav Ther 26:97–101, 1997
 
Gould RA, Buckminster S, Pollack MH, et al: Cognitive-behavioral and pharmacological treatment for social phobia: a meta-analysis. Clin Psychol: Science and Practice 4:291–306, 1997
 
Haug TT, Blomhoff S, Hellström K, et al: Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomized controlled trial. Br J Psychiatry 182:312–318, 2003
[PubMed]
 
Heimberg RG: Cognitive-behavioral therapy for social anxiety disorder: current status and future directions. Biol Psychiatry 51:101–108, 2002
[PubMed]
 
Heimberg RG, Becker RE: Cognitive-Behavioral Group Therapy for Social Phobia: Basic Mechanisms and Clinical Applications. New York, Guilford, 2002
 
Heimberg RG, Dodge CS, Hope DA, et al: Cognitive behavioral group treatment for social phobia: comparison with a credible placebo control. Cog Ther Res 14:1–23, 1990
 
Heimberg RG, Salzman DG, Holt CS, et al: Cognitive behavioral group treatment for social phobia: effectiveness at five-year follow-up. Cog Ther Res 17:325–339, 1993
 
Heimberg RG, Liebowitz MR, Hope DA, et al: Cognitive-behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Arch Gen Psychiatry 55:1133–1141, 1998
[PubMed]
 
Hellström K, Fellenius J, Öst LG: One versus five sessions of applied tension in the treatment of blood phobia. Behav Res Ther 34:101–112, 1996
[PubMed]
 
Hope DA, Heimberg RG, Juster HR, et al: Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach. New York, Oxford University Press, 2000
 
Klein DF, Zitrin CM, Woerner MG: Treatment of phobias, 2: behavior therapy and supportive psychotherapy: are there any specific ingredients? Arch Gen Psychiatry 40:139–145, 1983
[PubMed]
 
Kobak KA, Greist JH, Jefferson JW, et al: Fluoxetine in social phobia: a double-blind, placebo-controlled pilot study. J Clin Psychopharmacol 22:257–262, 2002
[PubMed]
 
Lieb R, Wittchen HU, Hofler M, et al: Parental psychopathology, parenting styles, and the risk of social phobia in offspring: a prospective-longitudinal community study. Arch Gen Psychiatry 57:859–866, 2000
[PubMed]
 
Liebowitz MR, Schneier F, Campeas R, et al: Phenelzine vs. atenolol in social phobia: a placebo controlled comparison. Arch Gen Psychiatry 49:290–300, 1992
[PubMed]
 
Liebowitz MR, Heimberg RG, Schneier FR, et al: Cognitive-behavioral group therapy versus phenelzine in social phobia: long-term outcome. Depression Anxiety 10:89–98, 1999
[PubMed]
 
Lipsitz JD, Markowitz JC, Cherry S, et al: An open trial of interpersonal psychotherapy for the treatment of social phobia. Am J Psychiatry 156:1814–1816, 1999
[PubMed]
 
Maltby N, Kirsch I, Mayers M, et al: Virtual reality exposure therapy for the treatment of fear of flying: a controlled investigation. J Consult Clin Psychol 70:1112–1118, 2002
[PubMed]
 
Marks IM, Viswanathan R, Lipsedge MS, et al: Enhanced relief of phobias by flooding during waning diazepam effect. Br J Psychiatry 121:493–506, 1972
[PubMed]
 
Mennin DS, Fresco DM, Heimberg RG, et al: Screening for social anxiety disorder in the clinical setting: using the Liebowitz Social Anxiety Scale. J Anxiety Disord 16:661–673, 2002
[PubMed]
 
Öst LG: Rapid treatment of specific phobias, in Phobias: A Handbook of Theory, Research and Treatment. Edited by Davey GCL. London, Wiley, 1997, pp 227–247
 
Öst LG, Jerremalm A, Johansson J: Individual response patterns and the effects of different behavioral methods in the treatment of social phobia. Behav Res Ther 19:1–16, 1981
 
Öst LG, Johansson J, Jerremalm A: Individual response patterns and the effects of different behavioral methods in the treatment of claustrophobia. Behav Res Ther 20:445–460, 1982
 
Öst LG, Sterner U, Fellenius J: Applied tension, applied relaxation, and the combination in the treatment of blood phobia. Behav Res Ther 27:109–121, 1989
 
Öst LG, Salkovskis PM, Hellström K: One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia. Behav Ther 22:407–422, 1991
 
Otto MW, Pollack MH, Gould RA, et al: A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia. J Anxiety Disord 14:345–358, 2000
[PubMed]
 
Pande AC, Davidson JRT, Jefferson JW, et al: Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol 19:341–348, 1999
[PubMed]
 
Rapee RM, Heimberg RG: A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther 35:741–756, 1997
[PubMed]
 
Ressler KJ, Rothbaum BO, Tannenbaum L, et al: Cognitive enhancers as adjuncts to psychotherapy: use of d-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 61:1136–1144, 2004
[PubMed]
 
Rodebaugh TL, Holaway RM, Heimberg RG: The treatment of social anxiety disorder. Clin Psychol Rev 24:883–908, 2004a
 
Rodebaugh TL, Woods CM, Thissen DM, et al: More information from fewer questions: the factor structure and item properties of the original and Brief Fear of Negative Evaluation Scale. Psychol Assess 16:169–181, 2004b
 
Rosenbaum JF, Biederman J, Boduc EA, et al: Comorbidity of parental anxiety disorders as risk for childhood-onset anxiety in inhibited children. Am J Psychiatry 149:475–481, 1992
[PubMed]
 
Rothbaum BO, Hodges LF, Kooper R, et al: Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiatry 152:626–628, 1995
[PubMed]
 
Rothbaum BO, Hodges L, Smith S, et al: A controlled study of virtual reality exposure therapy for fear of flying. J Consult Clin Psychol 68:1020–1026, 2000
[PubMed]
 
Rothbaum BO, Hodges L, Anderson PL, et al: Twelve-month follow-up of virtual reality and standard exposure therapies for the fear of flying. J Consult Clin Psychol 70:428–432, 2002
[PubMed]
 
Schneier FR, Saoud J, Campeas R, et al: Buspirone in social phobia. J Clin Psychopharmacol 13:251–256, 1993
[PubMed]
 
Schneier FR, Blanco C, Campeas R, et al: Citalopram treatment of social anxiety disorder and comorbid major depression. Depression Anxiety 17:191–196, 2003
[PubMed]
 
Seedat S, Stein MB: Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder. J Clin Psychiatry 65:244–248, 2004
[PubMed]
 
Simpson HB, Schneier FR, Campeas R, et al: Imipramine in the treatment of social phobia. J Clin Psychopharmacol 18:132–135, 1998a
 
Simpson HB, Schneier FS, Marshall RD, et al: Low-dose selegiline (l-deprenyl) in social phobia. Depression Anxiety 7:126–129, 1998b
 
Stangier U, Heidenreich T, Peitz M, et al: Cognitive therapy for social phobia: individual versus group treatment. Behav Res Ther 41:991–1007, 2003
[PubMed]
 
Stanley RO, Burrows GD, Judd FK: Hypnosis in the management of anxiety disorders, in Handbook of Anxiety, Vol 4: The Treatment of Anxiety. Edited by Noyes R Jr, Roth M, Burrows GD. Amsterdam, Netherlands, Elsevier, 1990, pp 537–548
 
Stein MB, Liebowitz MR, Lydiard B, et al: Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. JAMA 280:708–713, 1998
[PubMed]
 
Stein DJ, Stein MB, Pitts CD, et al: Predictors of response to pharmacotherapy in social anxiety disorder: an analysis of 3 placebo-controlled paroxetine trials. J Clin Psychiatry 63:152–155, 2002
[PubMed]
 
Stein DJ, Westenberg HG, Yang H, et al: Fluvoxamine CR in the long-term treatment of social anxiety disorder: the 12- to 24-week extension phase of a multicentre, randomized, placebo-controlled trial. Int J Neuropsychopharmacol 6:317–323, 2003
[PubMed]
 
Stein DJ, Ipser JC, van Balkom AJ: Pharmacotherapy for social anxiety disorder. Cochrane Database Syst Rev (4):CD001206, 2000; DOI: 10.1002/14651858.CD001206. pub2, 2005
 
Taylor S: Meta-analysis of cognitive-behavioral treatment for social phobia. J Behav Ther Exp Psychiatry 27:1–9, 1996
[PubMed]
 
Telaranta T: Treatment of social phobia by endoscopic thoracic sympathicotomy. Eur J Surg 580:27–32, 1998
[PubMed]
 
Thorpe SJ, Salkovskis PM: Phobia beliefs: do cognitive factors play a role in specific phobias? Behav Res Ther 33:805–816, 1995
[PubMed]
 
Turk CL, Coles M, Heimberg RG: Psychotherapy for social phobia, in Textbook of Anxiety Disorders. Edited by Stein DJ, Hollander E. Washington, DC, American Psychiatric Press, 2002, pp 323–339
 
Turner SM, Beidel DC, Cooley MR, et al: A multicomponent behavioral treatment for social phobia: social effectiveness therapy. Behav Res Ther 32:381–390, 1994
[PubMed]
 
Turner SM, Beidel DC, Cooley-Quille MR: Two-year follow-up of social phobics treated with social effectiveness therapy. Behav Res Ther 33:553–555, 1995
[PubMed]
 
Van Vliet IM, den Boer JA, Westenberg HGM, et al: Clinical effects of buspirone in social phobia: a double-blind, placebo-controlled study. J Clin Psychiatry 58:164–168, 1997
 
Versiani M, Mundim FD, Nardi AE, et al: Tranylcypromine in social phobia. J Clin Psychopharmacol 8:279–283, 1988
[PubMed]
 
Zitrin CM, Klein DF, Woerner MG, et al: Treatment of phobias, I: comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry 40:125–138, 1983
[PubMed]
 
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