Öppna denna publikation i ny flik eller fönster >>GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands.
Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro- and Developmental Psychology, VU Amsterdam, Amsterdam, the Netherlands.
Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden;Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Psychology, Stockholm University, Stockholm, Sweden.
Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
Departement de Psychoéducation et Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada;Centre de Recherche, Centre Intégré de Santé et des Services Sociaux de l’Outaouais, Gatineau, Quebec, Canada.
Betty Irene Moore School of Nursing, University of California, Davis, Sacramento.
Institute of Psychology, University of Münster, Münster, Germany.
Institute of Psychology, University of Münster, Münster, Germany.
Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada.
Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine Goettingen, Georg-August-Universität Goettingen, Goettingen, Germany.
Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany.
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands.
GGZ inGeest, Amsterdam, the Netherlands;Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands.
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2023 (Engelska)Ingår i: JAMA Psychiatry, ISSN 2168-622X, Vol. 80, nr 8, s. 822-831Artikel i tidskrift (Refereegranskat) Published
Abstract [en]
Importance Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD.
Objective To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD.
Data Sources For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial.
Study Selection Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD.
Data Extraction and Synthesis Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models.
Main Outcomes and Measures The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS.
Results A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list–controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = –20.3; 95% CI, −24.9 to −15.6; P < .001; Cohen d = –0.95; 95% CI, −1.16 to −0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = –0.22; 95% CI, −0.39 to −0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list–controlled symptom reductions after CBT (Cohen d = –1.13 [95% CI, −1.39 to −0.88] for patients with very severe SAD; Cohen d = –0.54 [95% CI, −0.80 to −0.29] for patients with mild SAD).
Conclusions and Relevance In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.
Ort, förlag, år, upplaga, sidor
American Medical Association (AMA), 2023
Nationell ämneskategori
Psykiatri Psykologi
Identifikatorer
urn:nbn:se:uu:diva-503128 (URN)10.1001/jamapsychiatry.2023.1291 (DOI)001000481100003 ()37256597 (PubMedID)
2023-06-012023-06-012024-01-26Bibliografiskt granskad