Metaanalyses

To date, there have been four peer-reviewed meta-analyses that have examined the relative importance of components of cognitive-behavioural treatments and compared cognitive-behavioural treatments to other interventions (Federoff & Taylor, 2001; Feske & Chambless, 1995; Gould et al., 1997; Taylor, 1996). In general, effect sizes tended to be moderate, with no differences in attrition across CBT variants. In Feske & Chambless' (1995) meta-analysis, treatments that integrated cognitive restructuring and exposure yielded effect sizes similar to exposure alone on both post-treatment and follow-up measures of social anxiety, cognitive symptoms, depression and general anxiety. Taylor (1996) compared the effect sizes of cognitive restructuring alone, exposure treatments, cognitive restructuring combined with exposure, and SST. Effect sizes for all interventions on measures of social anxiety were similar, and all surpassed those of waiting-list controls. However, only the combination of cognitive restructuring and exposure showed greater effect sizes than placebo controls. Furthermore, within-in group effect sizes for all active treatments tended to increase from post-treatment to follow-up assessment.

Two more meta-analyses examined the relative effectiveness of cognitive-behavioural treatments and pharmacotherapy for social anxiety disorder. After examining 24 studies, Gould et al. (1997) reported that both CBT (including cognitive restructuring, exposure, SST, systematic desensitization, flooding, and anxiety management) and pharmacotherapy were superior to control conditions and were associated with similar effect sizes on measures of social anxiety, cognitive change and depression. Treatments that included an exposure component also yielded significantly larger effect sizes than either cognitive restructuring alone or SST. For those studies reporting follow-up information (seven on CBT, one on pharmacotherapy), within-groups effects sizes revealed modest improvement after treatment. Although no differences were found for group versus individual treatment, CBGT was the most cost-effective intervention for social anxiety disorder, echoing the earlier finding of Lucas & Telch (1993).

Federoff & Taylor (2001) also provide evidence that pharmacotherapies and cognitive-behavioural therapies achieve similar effect sizes. In this meta-analysis of 108 outcome trials for social anxiety, benzodiazepines, but not the monoamine oxidase inhibitors or SSRIs, produced larger effects than CBT (including cognitive restructuring, exposure, combined cognitive restructuring and exposure, applied relaxation and SST) on self-report but not observer-rated, measures of social anxiety.

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