Baseline Severity as a Moderator of the Waiting List–Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis

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Baseline Severity as a Moderator of the Waiting List–Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder : A Systematic Review and Individual Patient Data Meta-analysis

Scholten, Willemijn (author): GGZ InGeest, Netherlands; Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

Seldenrijk, Adrie (author): GGZ InGeest, Netherlands; Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

Hoogendoorn, Adriaan (author): Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

Bosman, Renske (author): Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

Muntingh, Anna (author): GGZ InGeest, Netherlands; Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

Karyotaki, Eirini (author): Vrije Univ Amsterdam, Netherlands,Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, the Netherlands

Andersson, Gerhard (author): Linköpings universitet,Psykologi,Filosofiska fakulteten,Institutionen för biomedicinska och kliniska vetenskaper,Medicinska fakulteten,Region Östergötland, Öron- näsa- och halskliniken,Karolinska Inst, Sweden,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden;Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden

Berger, Thomas (author): Univ Bern, Switzerland,Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland

Carlbring, Per (author): Stockholms universitet,Klinisk psykologi,Stockholm Univ, Sweden,Department of Psychology, Stockholm University, Stockholm, Sweden

Furmark, Tomas (author): Uppsala universitet,Institutionen för psykologi

Bouchard, Stéphane (author): Univ Quebec Outaouais, Canada; Ctr Integre Sante & Serv Sociaux Outaouais, Canada,Departement de Psychoéducation et Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada;Centre de Recherche, Centre Intégré de Santé et des Services Sociaux de l’Outaouais, Gatineau, Quebec, Canada

Goldin, Philippe (author): Univ Calif Davis, CA USA,Betty Irene Moore School of Nursing, University of California, Davis, Sacramento

Kampmann, Isabel (author): Univ Munster, Germany,Institute of Psychology, University of Münster, Münster, Germany

Morina, Nexhmedin (author): Univ Munster, Germany,Institute of Psychology, University of Münster, Münster, Germany

Kocovski, Nancy (author): Wilfrid Laurier Univ, Canada,Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada

Leibing, Eric (author): Georg August Univ Goettingen, Germany,Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine Goettingen, Georg-August-Universität Goettingen, Goettingen, Germany

Leichsenring, Falk (author): Justus Liebig Univ Giessen, Germany,Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany

Stolz, Timo (author): Univ Bern, Switzerland,Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland

van Balkom, Anton (author): GGZ InGeest, Netherlands; Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

Batelaan, Neeltje (author): GGZ InGeest, Netherlands; Vrije Univ Amsterdam, Netherlands; Amsterdam Publ Hlth, Netherlands,GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands

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American Medical Association (AMA), 2023
2023
English.
In: JAMA psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X. ; 80:8, s. 822-831

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; http://kipublication...; https://urn.kb.se/re...; https://urn.kb.se/re...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD.Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD.Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial.Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD.Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models.Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS.Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list–controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = –20.3; 95% CI, −24.9 to −15.6; P < .001; Cohen d = –0.95; 95% CI, −1.16 to −0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = –0.22; 95% CI, −0.39 to −0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list–controlled symptom reductions after CBT (Cohen d = –1.13 [95% CI, −1.39 to −0.88] for patients with very severe SAD; Cohen d = –0.54 [95% CI, −0.80 to −0.29] for patients with mild SAD).Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.

Subject headings

SAMHÄLLSVETENSKAP -- Psykologi (hsv//swe)
SOCIAL SCIENCES -- Psychology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)

Keyword

social anxiety disorder
SAD
cognitive behavioral therapy
CBT
individual patient data meta-analysis
symptom severity
randomized clinical trials
psykologi
Psychology

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ref (subject category)
art (subject category)

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SOCIAL SCIENCES: SOCIAL SCIENCES; and Psychology

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Psychiatry

Articles in the publication: JAMA psychiatry

By the university: Stockholm University; Karolinska Institutet; Linköping University; Uppsala University

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