SOCIAL PHOBIA is a chronic, debilitating, and prevalent anxiety disorder that has received surprisingly little controlled clinical study. Affected individuals can be seriously impaired, both vocationally and interpersonally, and are at high risk for both depression and alcoholism. Current studies suggest substantial efficacy for two diverse approaches to the treatment of social phobia. The MAO inhibitor PHENELZINE appears effective in two thirds of social phobic patients, as demonstrated in an ongoing placebo-controlled clinical trial. Advantages of phenelzine treatment include rapid onset, efficacy in severe cases, and help for associated depressive features. Limitations, however, include medication side effects, risk of hypertensive crises, dietary restrictions, possible relapse on discontinuation, and lack of response in some patients. COGNITIVE-BEHAVIORAL GROUP THERAPY (CBGT) has demonstrated similar efficacy in comparison with a credible psychosocial control group. Advantages of CBGT treatment include absence of medication side effects, suggestions of durability after discontinuation of treatment, and active patient involvement. Moreover, CBGT appears most effective in patients with discrete performance anxiety, whereas phenelzine seems more effective the generalized subtype of social phobia. However, findings for both treatments are based on a small number of studies and require replication, both at the original sites and at new sites. In addition, a comparative trial of phenelzine and CBGT is timely and necessary. An important aspect of this proposal is the collaboration between pharmacologically- and psychosocially-oriented research program. Each center will enter 96 patients, randomized to four treatments (phenelzine, CBGT pill placebo, psychosocial placebo) for a 12- week trial with independent evaluation. Phenelzine and CBGT responders will continue through 6 months of additional treatment and 6 months of treatment-free follow-up to assess durability of response. Long-range goals are to establish guidelines for the treatment of social phobia by comparing the overall efficacy of phenelzine and CBGT and by highlighting the clinical characteristics of patients most likely to benefit from each treatment; to refine the DSM-III- R nosology of social phobia with regard to clinical subtype to better understand the mechanisms by which CBGT and phenelzine ameliorate social phobia; and to contribute to an integration of pharmacological and psychosocial research and treatment in the anxiety disorders.
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