Cognitive Behavioral Group Therapy vs Phenelzine Therapy for Social Phobia

Background: This article presents results of the acute treat- ment phase of a 2-site study comparing cognitive behav- ioral group therapy (CBGT) and treatment with the mono- amine oxidase inhibitor phenelzine sulfate for social phobia. Methods: One hundred thirty-three patients from 2 sites received 12 weeks of CBGT, phenelzine therapy, pill pla- cebo administration, or educational-supportive group therapy (an attention-placebo treatment of equal credibil- ity to CBGT). The "allegiance effect," ie, the tendency for treatments to seem most efficacious in settings of similar theoretical orientation and less efficacious in theoreti- cally divergent settings, was also examined by comparing responses to the treatment conditions at both sites: 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment. Results: After 12 weeks, phenelzine therapy and CBGT led to superior response rates and greater change on di- mensional measures than did either control condition. However, response to phenelzine therapy was more evi- dent after 6 weeks, and phenelzine therapy was also su- perior to CBGT after 12 weeks on some measures. There were few differences between sites, suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances. Conclusions: After 12 weeks, both phenelzine therapy and CBGT were associated with marked positive re- sponse. Although phenelzine therapy was superior to CBGT on some measures, both were more efficacious than the control conditions. More extended cognitive behav- ioral treatment and the combination of modalities may enhance treatment effect. Arch Gen Psychiatry. 1998;55:1133-1141