Generalized social phobia (GSP) is a chronic and debilitating anxiety disorder, affecting over 2% of the population, and resulting in significant morbidity and suicide attempts. Recent studies have indicated a number of promising treatments, including fluoxetine (FLU), cognitive therapy (CT), exposure therapy (EX) and social skills training (SST). No studies have compared FLU (or any other serotonergic drug) with cognitive behavior therapy in GSP, or examined the effectiveness of a combined treatment group. Moreover, no study has yet evaluated the extent to which different treatments for GSP (e.g., medications, CBT) can be transported/replicated across sites. The major goals of the proposed study are: (a) to evaluate the effectiveness of FLU, a comprehensive cognitive behavioral program (CCBT) that includes CT, EX and SST, and a combination of FLU and CCBT in GSP; (b) to compare relapse rates associated with the different groups after discontinuation of treatment; (c) to examine the transportability of the two treatment approaches; and (d) to examine possible predictors of treatment response. Four-hundred subjects (200 per site) meeting DSM-III-R criteria for GSP will be randomly assigned to one of five conditions: FLU, CCBT, FLU+CCBT, CCBT+pill placebo, and placebo alone. Treatment will be administered for 14 weeks, followed by a 24 week treatment free follow-up. Outcome will be assessed by independent evaluator ratings, self-report scales, and behavioral measures of social skills. Assessments will be conducted before, during, and after treatment as well as during the follow-up phase. Important to this proposal is the collaboration between pharmacologically and cognitive-behaviorally oriented research programs. Long range goals are to establish guidelines for the pharmacological and cognitive behavioral treatment of GSP, to understand the separate and combined effects of pharmacotherapy and cognitive behavioral therapy in this condition, and to integrate pharmacological and psychosocial approaches to the anxiety disorders.
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