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 .
Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia.
BACKGROUND  Generalized social phobia is common , persistent , and disabling and is often treated with selective serotonin reuptake inhibitor drugs or cognitive behavioral therapy . OBJECTIVE We compared fluoxetine ( FLU ) , comprehensive cognitive behavioral group therapy ( CCBT ) , placebo ( PBO ) , and the combinations of CCBT/FLU and CCBT/PBO . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Two academic outpatient psychiatric centers . PATIENTS Subjects meeting a primary diagnosis of generalized social phobia were recruited via advertisement . Seven hundred twenty-two were screened , and 295 were r and omized and available for inclusion in an intention-to-treat efficacy analysis ; 156 ( 52.9 % ) were male , 226 ( 76.3 % ) were white , and mean age was 37.1 years . INTERVENTIONS Treatment lasted for 14 weeks . Fluoxetine and PBO were administered at doses from 10 mg/d to 60 mg/d ( or equivalent ) . Group comprehensive cognitive behavioral therapy was administered weekly for 14 sessions . MAIN OUTCOME MEASURES An independent blinded evaluator assessed response with the Brief Social Phobia Scale and Clinical Global Impressions scales as primary outcomes . A videotaped behavioral assessment served as a secondary outcome , using the Subjective Units of Distress Scale . Adverse effects were measured by self-rating . Each treatment was compared by means of chi2 tests and piecewise linear mixed-effects models . RESULTS Clinical Global Impressions scales response rates in the intention-to-treat sample were 29 ( 50.9 % ) ( FLU ) , 31 ( 51.7 % ) ( CCBT ) , 32 ( 54.2 % ) ( CCBT/FLU ) , 30 ( 50.8 % ) ( CCBT/PBO ) , and 19 ( 31.7 % ) ( PBO ) , with all treatments being significantly better than PBO . On the Brief Social Phobia Scale , all active treatments were superior to PBO . In the linear mixed-effects models analysis , FLU was more effective than CCBT/FLU , CCBT/PBO , and PBO at week 4 ; CCBT was also more effective than CCBT/FLU and CCBT/PBO . By the final visit , all active treatments were superior to PBO but did not differ from each other . Site effects were found for the Subjective Units of Distress Scale assessment , with FLU and CCBT/FLU superior to PBO at Duke University Medical Center , Durham , NC . Treatments were well tolerated . CONCLUSIONS All active treatments were superior to PBO on primary outcomes . Combined treatment did not yield any further advantage . Notwithst and ing the benefits of treatment , many patients remained symptomatic after 14 weeks
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 .