One-on-one Cognitive Behavioral Therapy is better than psychiatric medications or other common psychotherapeutic interventions for severe anxiety disorders in adults, according to a large meta-analysis of the scientific literature published in The Lancet Psychiatry. Various types of placebo treatments were also found to be effective.
The study was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, and examined data from 13,164 participants with severe, longstanding social anxiety in 101 clinical trials.
“Individual CBT (which other studies have shown to have a lower risk of side-effects than pharmacotherapy) is associated with large effect sizes,” wrote the researchers. “Thus, it should be regarded as the best intervention for the initial treatment of social anxiety disorder. For individuals who decline psychological intervention, SSRIs show the most consistent evidence of benefit.” The researchers also noted that few trials had looked at combining medication with talk therapy, and “there was no evidence” that combining the two improved outcomes.
“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs,” the lead researcher said in a Johns Hopkins press release.
Placebo interventions also performed relatively well in most trials, the researchers found. “Psychological and pill placebo had greater effects than waitlist; investigation of these effects suggests that non-specific factors might account for about half the total effects of individual CBT and SSRIs.”
Talk therapy — not medication — best for social anxiety disorder, large study finds (Johns Hopkins Bloomberg School of Public Health Press Release on ScienceDaily, September 25, 2014)