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Talk Therapy May Help Treat Social Anxiety

Study Shows Changes in Brain Activity in People With Social Phobia Treated With Psychotherapy

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

Feb. 22, 2011 -- A 12-week course of talk therapy, when used to treat social anxiety disorder, produces changes in the electrical activity of the brain, according to new research. The findings appear in Psychological Science.

Symptoms of social phobia or social anxiety disorder include anxiety and self-consciousness in everyday social situations. This anxiety may also have associated physical symptoms such as sweating, nausea, and difficulty speaking. In some, the anxiety is limited to a specific situation, such as public speaking. In other people, it becomes so overwhelming and debilitating they can no longer leave the house.

The researchers say that there has been a substantial amount of research on how medications used to treat social anxiety disorder affect the brain but far less research on how psychotherapy produces changes in the brain.

The Study

In the new study, 25 people with social anxiety disorder completed a 12-week course of cognitive behavior therapy (CBT), a time-limited type of psychotherapy that aims to alter behavior by changing the way people think about their anxiety and its triggers. Researchers used electroencephalograms (EEGs) to measure brain electrical interactions before treatment, halfway through treatment, and after the final CBT session. These readings took place at rest and during an impromptu videotaped speech they were asked to give before two people -- an anxiety-producing task for many with social phobias.

EEG results were compared with those of two control groups consisting of people who had not been diagnosed with social anxiety disorder -- one group with high social anxiety levels and another group of people with low levels of social anxiety.

Talk therapy produced meaningful changes in the amount of "delta-beta coupling" seen on the EEGs. Delta-beta coupling, a particular pattern of brain waves, increases with rising anxiety. After the 12-week course of therapy, EEG readings of the people who received CBT resembled those of the control group who had low levels of social anxiety. By contrast, the earlier delta-beta coupling patterns seen before the talk therapy more closely resembled those with high anxiety levels, say the researchers, who were led by Vladimir Miskovic, a PhD candidate at McMaster University in Hamilton, Ontario, Canada.

"The main purpose of our study was not to set out to establish whether cognitive behavioral therapy is effective for the treatment of social anxiety, but rather, to determine whether there is some neural correlate that changes alongside symptomatic improvement," the study authors tell WebMD in an email.

Whether these findings are generalizable to other anxiety or psychological disorders is not known but does seem likely based on what is already known about the effects of CBT, the researchers say. "Future studies need to specifically test individuals diagnosed with other mood and anxiety disorders," they say.

Study Limitations

Some people in the study were also taking medication to treat their social anxiety, which could skew the findings, but researchers attempted to control for this by making sure that medication dosages remained constant throughout the study. Still, "it would be ideal to follow up with medication-free patients with CBT alone in a future study. However, it is important to note that such plans also present significant challenges, as most outpatients seeking treatment for social anxiety disorder are already taking medications, and asking them to discontinue these would obviously be unethical," the study authors say.

Talk Therapy Is a Part of Treatment for Social Phobia

Alan Manevitz, MD, a clinical psychiatrist at Lenox Hill Hospital in New York City, says the new study is helping to build an evidence-based case for the positive effects of psychotherapy.

"Social anxiety disorder treatment involves a multi-pronged treatment approach targeting the biology, psychology, and behavioral aspects of the disorder," he says. "Social anxiety can be quite disabling, and we need to approach it on all these levels."

More studies are needed to determine the effects of medication. "We know that psychotherapy and medicine work better together than psychotherapy alone or medication alone," he says.

Srini Pillay, MD, an assistant clinical professor of psychiatry at Harvard Medical School in Boston and the author of Life Unlocked: 7 Revolutionary Lessons to Overcome Fear, is not surprised by the new findings.

"The finding that CBT changed brain function that correlated with improvements in social anxiety is expected," he says in an email. "The fact that patients were medicated does raise the question of whether being on medication helped the treatment response and it might have, so we cannot say that CBT is a convincing first-line treatment yet," he says. "We can say that CBT can alleviate symptoms, so for those people who decline to be on medication, there are other symptomatic treatments and some hope that they will feel better."

SOURCES: Miskovic, V. Psychological Science, 2011. Alan Manevitz, MD, clinical psychiatrist, Lenox Hill Hospital, New York City.Srini Pillay, MD, assistant clinical professor, psychiatry, Harvard Medical School, Boston.National Institute of Mental Health: "Social Phobia (Social Anxiety Disorder)."

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