A preliminary study of individual cognitive behavior therapy for social anxiety disorder in Japanese clinical settings: a single-arm, uncontrolled trial

Naoki Yoshinaga,Osamu Kobori,Satoshi Matsuki,Tetsuya Shiraishi,Masaomi Iyo,Michiko Nakazato,Emi Ito,Mari Tanaka,Fumiyo Ohshima,Eiji Shimizu,Tomomi Kobayashi,Hanae Ibuki,Kenichi Asano,Akiko Nakagawa

doi:10.1186/1756-0500-6-74

Abstract

BackgroundCognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. Individual CBT might be acceptable and effective for patients with SAD even in non-Western cultures; therefore, we conducted a feasibility study of individual CBT for SAD in Japanese clinical settings. We also examined the baseline predictors of outcomes associated with receiving CBT.MethodsThis single-arm trial employed a 14-week individual CBT intervention. The primary outcome was the self-rated Liebowitz Social Anxiety Scale, with secondary measurements of other social anxiety and depressive severity. Assessments were conducted at baseline, after a waiting period before CBT, during CBT, and after CBT.ResultsOf the 19 subjects screened, 15 were eligible for the study and completed the outcome measures at all assessment points. Receiving CBT led to significant improvements in primary and secondary SAD severity (ps < .001). The mean total score on the Liebowitz Social Anxiety Scale improved from 91.8 to 51.7 (before CBT to after CBT), and the within-group effect size at the end-point assessment was large (Cohen’s d = 1.71). After CBT, 73% of participants were judged to be treatment responders, and 40% met the criteria for remission. We found no significant baseline predictors of those outcomes.ConclusionDespite several limitations, our treatment—which comprises a 14-week, individual CBT program—seems feasible and may achieve favorable treatment outcomes for SAD in Japanese clinical settings. Further controlled trials are required in order to address the limitations of this study.Trial registrationUMIN-CTR UMIN000005897

Highlights

Cognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America
While no clear evidence has shown that the combination of Selective serotonin reuptake inhibitor (SSRI) and CBT is more effective than single-modality treatment [10,11], CBT has a number of potential advantages over pharmacotherapy in the treatment of anxiety disorder: longer effects, fewer adverse effects, smaller relapse rates, and greater acceptability [12,13,14]
Treatment acceptability by the therapists All of the participating therapists participated in the CBT training program (Chiba Improving Access for Psychological Therapies project) for 2 years and were able to adhere to the treatment protocol under weekly supervision

Summary

Introduction

Cognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. While no clear evidence has shown that the combination of SSRIs and CBT is more effective than single-modality treatment [10,11], CBT has a number of potential advantages over pharmacotherapy in the treatment of anxiety disorder: longer effects, fewer adverse effects, smaller relapse rates, and greater acceptability [12,13,14]. Pharmacotherapy has disadvantages such as more side effects and higher rates of relapse with the discontinuation of medication [15,16]

Methods

Results

Conclusion