Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial

Journal of Anxiety Disorders, vol. 104, pp. 102860

Abstract

BACKGROUND: Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. METHODS: We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). RESULTS: Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. CONCLUSION: GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.

Authors 6

1. Astrid E. Baljé corresponding Aachen Institute of Psychology, Leiden University

   Leiden University · PsyQ

   Affiliation as printed

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands. Electronic address: astrid.balje@psyq.nl

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands

   Institute of Psychology/Leiden University, Leiden, the Netherlands

2. Anja Greeven Aachen Institute of Psychology, Leiden University

   Leiden University · PsyQ

   Affiliation as printed

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands. Electronic address: a.greeven@psyq.nl

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands

   Institute of Psychology/Leiden University, Leiden, the Netherlands

3. Mathijs L. Deen Aachen Institute of Psychology, Leiden University

   Leiden University · Parnassia Groep · Parnassia Groep Academie

   Affiliation as printed

   Institute of Psychology/Leiden University, Leiden, the Netherlands; Parnassia Group Academy/Parnassia Psychiatric Institute, The Hague, the Netherlands. Electronic address: m.deen@parnassiagroep.nl

   Institute of Psychology/Leiden University, Leiden, the Netherlands

   Parnassia Group Academy/Parnassia Psychiatric Institute, The Hague, the Netherlands

4. Anne E. van Giezen Aachen Institute of Psychology, Leiden University

   Leiden University · PsyQ

   Affiliation as printed

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands. Electronic address: giezen@fsw.leidenuniv.nl

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands

   Institute of Psychology/Leiden University, Leiden, the Netherlands

5. Arnoud R. Arntz

   University of Amsterdam

   Affiliation as printed

   Department of Clinical Psychology/University of Amsterdam, Amsterdam, the Netherlands. Electronic address: A.R.Arntz@uva.nl

   Department of Clinical Psychology/University of Amsterdam, Amsterdam, the Netherlands

6. Philip Spinhoven Aachen Institute of Psychology, Leiden University

   Leiden University · PsyQ

   Affiliation as printed

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands; Institute of Psychology/Leiden University, Leiden, the Netherlands. Electronic address: spinhoven@fsw.leidenuniv.nl

   Department of Anxiety Disorders/Psyq, The Hague, the Netherlands

   Institute of Psychology/Leiden University, Leiden, the Netherlands