Manualized versus treatment-as-usual cognitive behavioral therapy for social anxiety disorder: A comparative study

This study aims to compare treatment outcomes of manualized cognitive behavioral therapy (MAN-CBT) with CBT treatment-as-usual (TAU-CBT) in patients with social anxiety disorder across two separate investigations. It was examined whether treatment effects differ between conditions after the total number of sessions, and whether manualized therapies would show better outcomes with equivalent dose of sessions.

All patients underwent CBT at the same outpatient treatment center. This secondary analysis utilizes data from two randomized controlled trials for the manualized CBT groups, while the TAU-CBT groups comprised existing routine-care data not derived from a prior study. Propensity score matching was applied, resulting in subsamples (n = 148; n = 64) with equal proportions of MAN-CBT and TAU-CBT. Social anxiety symptoms and general psychopathology were assessed as outcomes and analyzed using multilevel modeling.

After the total number of sessions, patients in both investigations showed significant reduction in all outcomes (MAN-CBT: d = 0.93-1.99; TAU-CBT d = 0.89-1.44), with no differences between conditions (except for the SPAI in Investigation 2 in favor of MAN-CBT). Overall, TAU-CBT groups had a higher overall therapy dose. With an equivalent therapy dose the MAN-CBT conditions yielded significantly better outcomes than the TAU-CBT groups across all but two outcomes.

Findings indicate manualized CBT treatments require a lower therapy dose than TAU-CBT for comparable effects. Therapy manuals for social anxiety could therefore offer an opportunity to help patients improve faster and may help increase available treatment capacity in the public healthcare system.