Treatment of Social Anxiety Disorder and Avoidant Personality Disorder in Routine Care: A Naturalistic Study of Combined Individual and Group Therapy

Abstract

Background: Cognitive behavioral therapy (CBT) in a group or individual format has proven effective for treating social anxiety in numerous randomized controlled trials. Studies in routine care are rare and focus exclusively on social anxiety disorder (SAD). Findings for avoidant personality disorder (AVPD) are missing. The current effectiveness study evaluates a combination of group and individual CBT for patients with SAD with or without AVPD. Methods: One hundred and five patients diagnosed with SAD with or without comorbid AVPD completed a combination of group and individual CBT. We administered outcome measures prior to individual therapy, prior to group therapy, after group therapy, and ­after individual therapy. Results: Patients experienced a strong decline in social anxiety symptoms (d = 1.1), depression (d = 1.0), and general mental distress (d = 1.1). They also showed a large increase in self-efficacy (d = 1.1). Descriptively, the largest decreases in social anxiety occurred during the group treatment. Controlling for pretreatment severity and depression, a comorbid diagnosis of AVPD was not associated with symptom improvement during treatment. Discussion: The results of the combined treatment were comparable to those of other effectiveness studies. Group treatment seemed to accelerate change in social fears. Patients with AVPD showed the same average improvements as patients without comorbid AVPD.