Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial

Abstract

Exposure therapy alone yielded a further improvement during follow-up, whereas exposure therapy combined with sertraline and sertraline alone showed a tendency towards deterioration after the completion of treatment.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…Exposure patients only reached the degree of improvement that the sertraline patients already had during the acute study. Improvement was also shown in the placebo group, so that the effects were probably due to spontaneous remission (Bandelow 2004; Bandelow and Haug 2004;Haug et al 2003).…”

Rational Use of Antidepressant Drugs

“…What was not discussed is the obvious inappropriateness of sertraline as first-line treatment due to its very low response and remission rates that are very unlikely to be better than those of placebo. Further, once sertraline is introduced, one is left with an iatrogenic comorbidity that is likely to have a negative effect on cognitive behavioral therapy, as was found to be the case in a placebo-controlled study [77]. Why not treating those patients with clonazepam only from the beginning?…”

Issues and controversies surrounding the diagnosis and treatment of social anxiety disorder

“…Unfortunately, very little research has been conducted on the long-term efficacy of combination treatment. However, one study by Haug et al [103], a 1-year follow-up study from the trial by Blomhoff et al [100], found that exposure alone continued to improve during the follow-up period but sertraline and sertraline plus exposure showed deterioration during the follow-up period. The authors concluded that perhaps one reason for this finding is that: 'exposure techniques applied in situations with low levels of anxiety achieved by medication may have less impact than exposure therapy applied in situations with a higher level of anxiety and may lead to a higher degree of relapse after end of treatment'.…”

“…One naturalistic treatment study showed that pre-existing antidepressant use neither enhanced nor detracted from the effectiveness of group CBT for SAD [126]. By contrast, a 1-year follow-up study of a randomized controlled trial showed that patients who had received combination treatment of sertraline and exposure deteriorated during the follow-up period, while those who had received exposure therapy alone experienced further improvement during the follow-up period [103]. Additional research needs to be conducted in this area to determine what long-term impact medication in general may have on exposure therapy for SAD.…”