Exposure has often been combined with an anxiety management strategy such as cognitive therapy, relaxation, or pharmacotherapy. If the social phobic exhibits significant deficiencies in social skill, social skills training may also be combined with exposure. However, as will be seen below, it is not clear that these combined treatments are more beneficial than exposure alone. As with the other anxiety disorders, exposure appears to be an effective intervention and probably forms an important foundation for many of the combined treatment packages. Improvement was also seen on more general measures of anxiety and depression.
Gains seem to generally be maintained following treatment termination.
However, it should be noted that the follow-up periods tended to be only a few months. Although it is difficult to draw conclusions given the limited number of studies and methodological difficulties within the studies that have been conducted, exposure appears to be at least as effective as the other treatments listed above and was the most effective treatment in some studies. Several studies have examined whether combining exposure with cognitive therapy leads to greater improvement than exposure alone. In fact, the Feske and Chambless meta-analysis described above addressed this question and found that exposure alone and combined exposure plus cognitive therapy yielded similar improvements on various measures of social phobia. Surprisingly, both treatments yielded similar reductions in cognitive symptoms as well, suggesting that specific cognitive interventions may not be needed to achieve reductions in negative thinking.