Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .
A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and their combination for social anxiety disorder.
CONTEXT Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder , yet many individuals remain symptomatic after treatment . OBJECTIVE To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Research clinics at Columbia University and Temple University . PARTICIPANTS One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder . INTERVENTIONS Cognitive behavioral group therapy ( CBGT ) , phenelzine sulfate , pill placebo , and combined CBGT plus phenelzine . MAIN OUTCOME MEASURES Liebowitz Social Anxiety Scale and Clinical Global Impression ( CGI ) scale scores at weeks 12 and 24 . RESULTS Linear mixed-effects models showed a specific order of effects , with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group , followed by the monotherapies , and the least reduction in the placebo group ( Williams test = 4.97 , P < .01 ) . The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 ( 33.3 % ) ( placebo ) , 16 of 34 ( 47.1 % ) ( CBGT ) , 19 of 35 ( 54.3 % ) ( phenelzine ) , and 23 of 32 ( 71.9 % ) ( combined treatment ) ( chi(2)(1 ) = 8.76 , P < .01 ) . Corresponding remission rates ( CGI = 1 ) were 2 of 27 ( 7.4 % ) , 3 of 34 ( 8.8 % ) , 8 of 35 ( 22.9 % ) , and 15 of 32 ( 46.9 % ) ( chi(2)(1 ) = 15.92 , P < .01 ) . At week 24 , response rates were 9 of 27 ( 33.3 % ) , 18 of 34 ( 52.9 % ) , 17 of 35 ( 48.6 % ) , and 25 of 32 ( 78.1 % ) ( chi(2)(1 ) = 12.02 , P = .001 ) . Remission rates were 4 of 27 ( 14.8 % ) , 8 of 34 ( 23.5 % ) , 9 of 35 ( 25.7 % ) , and 17 of 32 ( 53.1 % ) ( chi(2)(1 ) = 10.72 , P = .001 ) . CONCLUSION Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission
Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .