Social phobia is a prevalent yet poorly understood anxiety disorder characterized by the experience of intense anxiety in, and often avoidance of social situations involving scrutiny by others. Social phobia not only leads to a high degree of subjective distress, but also can result in loneliness, reduced academic and vocational performance, restricted career and personal development, alcohol abuse and depression. As in other anxiety disorders, the anxiety experienced by social phobics is characterized by somatic (bodily sensations), cognitive (thoughts), and overt behavior (avoidance) features. Information on the treatment of social phobia lags far behind that of other phobic conditions. Two very different treatments, drug treatment with beta-adrenergic blocking agents and behavior therapy with desensitization both have shown considerable promise. However, there has been no published attempt to compare these two treatments, or to examine their combined effectiveness in treating social phobia. The proposed study is a treatment comparison of desensitization plus placebo, the beta-blocking drug atenolol, combined desensitization and atenolol, and placebo. One hundred and eighty subjects will participate in a 3 month treatment phase and a 6 month follow-up phase. The results will allow an assessment of the effectiveness of atenolol, desensitization, and the potentially synergistic combination of atenolol plus desensitization. Furthermore, the durability of these treatments will be determined. This study will provide important information on the clinical management of social phobia and the impact of these treatments on social and global functioning.
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