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Cognitive Behavioral Group Therapy vs Phenelzine Therapy for Social Phobia
12-Week Outcome
Richard G. Heimberg, PhD;
Michael R. Liebowitz, MD;
Debra A. Hope, PhD;
Franklin R. Schneier, MD;
Craig S. Holt, PhD;
Lawrence A. Welkowitz, PhD;
Harlan R. Juster, PhD;
Raphael Campeas, MD;
Monroe A. Bruch, PhD;
Marylene Cloitre, PhD;
Brian Fallon, MD;
Donald F. Klein, MD
Arch Gen Psychiatry. 1998;55:1133-1141.
Background This article presents results of the acute treatment phase of a 2-site study comparing cognitive behavioral group therapy (CBGT) and treatment with the monoamine oxidase inhibitor phenelzine sulfate for social phobia.
Methods One hundred thirty-three patients from 2 sites received 12 weeks of CBGT, phenelzine therapy, pill placebo administration, or educational-supportive group therapy (an attention-placebo treatment of equal credibility to CBGT). The "allegiance effect," ie, the tendency for treatments to seem most efficacious in settings of similar theoretical orientation and less efficacious in theoretically divergent settings, was also examined by comparing responses to the treatment conditions at both sites: 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment.
Results After 12 weeks, phenelzine therapy and CBGT led to superior response rates and greater change on dimensional measures than did either control condition. However, response to phenelzine therapy was more evident after 6 weeks, and phenelzine therapy was also superior to CBGT after 12 weeks on some measures. There were few differences between sites, suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances.
Conclusions After 12 weeks, both phenelzine therapy and CBGT were associated with marked positive response. Although phenelzine therapy was superior to CBGT on some measures, both were more efficacious than the control conditions. More extended cognitive behavioral treatment and the combination of modalities may enhance treatment effect.
From the Center for Stress and Anxiety Disorders, State University of New York at Albany (Drs Heimberg, Hope, Holt, Juster, and Bruch); and the Anxiety Disorders Clinic, New York State Psychiatric Institute, and Columbia University College of Physicians and Surgeons, New York (Drs Liebowitz, Schneier, Welkowitz, Campeas, Cloitre, Fallon, and Klein). Dr Heimberg is now with the Department of Psychology, Temple University, Philadelphia, Pa; Dr Hope, the Department of Psychology, University of Nebraska, Lincoln; Dr Holt, the Department of Psychiatry, University of Iowa, Iowa City; Dr Welkowitz, the Department of Psychology, Keene State College, Keene, NH; and Dr Cloitre, the Payne Whitney Clinic, New York, NY.
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