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J Affect Disord. 2014 Jun;162:61-6. doi: 10.1016/j.jad.2014.03.015. Epub 2014 Mar 24.

The effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder.

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Department of Psychology, Ryerson University, Toronto, ON, Canada.
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Anxiety Treatment and Research Centre, St. Joseph׳s Healthcare Hamilton, ON, Canada. Electronic address:
Department of Psychiatry, Women׳s College Hospital, Toronto, ON, Canada.



Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear.


The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD.


At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD.


Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT.


Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.


Bipolar disorder; Cognitive behavioral therapy; Comorbidity; Major depressive disorder; Social anxiety disorder

[Indexed for MEDLINE]

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