Innovative Treatment as Effective as Psychiatric Drug for Social Anxiety Disorder: Study

Encouraging your children and building their confidence can help reduce social anxiety. Shutterstock

A new technology-driven treatment was found to be as effective as psychiatric medication for treating social anxiety disorder, according to a recent clinical study.

The study compared gaze-contingent music reward therapy (GC-MRT) with a selective serotonin reuptake inhibitor (SSRI) drug treatment in reducing social anxiety disorder symptoms. GC-MRT is based on eye-tracking technology that allows for treatment of social anxiety disorder (SAD) through changing attentional biases in patients.

The paper was published in the American Journal of Psychiatry.

The study randomly allocated 105 adults with SAD into three groups. One group was treated with escitalopram (which is sold as Cipralex and Lexapro). This is is an SSRI drug used as first-line treatment; a second group was treated with GC-MRT; and the third was a control group (which included patients who were told they would receive GC-MRT sessions following a 12-week waiting period).

All the participants underwent a complete clinical assessment before and after the treatments, and they were asked to report on their symptoms and their severity.

Mean changes in clinician-rated and self-reported social anxiety symptoms from baseline to mid- and post-treatment assessments were compared between the groups. The researchers also examined changes in attentional dwell time on threat.

Depression was assessed at the pre- and post-treatment assessments also, “given the high comorbidity between social anxiety disorder and depression” according to the study. Based on previous studies, the researchers expected to see improvement in depressive symptoms only in the SSRI group.

After 10 sessions that lasted for 20 minutes over a 12-week period, about 50 percent of the participants in the GC-MRT treatment group showed significant improvement in their symptoms—similar to the results found in patients who received Cipralex.

Individuals in the GC-MRT and SSRI treatment cohorts showed lower SAD scores at the mid- and post-treatment assessments than the control group. There was no difference in the efficacy of the treatments.

The GC-MRT group also showed a reduction in the amount of time they dwelled on threats.

SAD

Social anxiety disorder is characterized by the constant fear of social or performance situations in which the individual is exposed to unfamiliar people or to the possibility to be scrutinized by others, according to the NIH website. About 12 percent of U.S. adults experience this disorder at some point in their lives.

Yair Bar Haim, who led the study, is the director of the Adler Center for Child Development and Psychopathology and of the Center for Traumatic Stress and Resilience at Tel Aviv University.

He told The Epoch Times that the most common example of SAD is standing in front of an audience, but it doesn’t have to be a large crowd. These individuals might experience anxiety even when eating with company, and they may experience all the classic anxiety symptoms such as sweating, palpitations, and shortness of breath.

Quite often, people with this disorder avoid social situations—at a heavy interpersonal, professional, and economic price.

“It is a serious disorder that usually does not go away without treatment,” Bar Haim said.

One of the main things known about people who suffer from anxiety disorders in general and SAD in particular is that they have an attentional preference to threatening stimuli in their environment, he said.

For example, in an audience, most of the people will have neutral or positive faces, but there might be one or two who look a little more negative. People with SAD tend to direct their attention to those negative faces, and they find it difficult to disconnect from there.

“GC-MRT reduces this tendency through feedback,” the study states.

Bar Haim said that the treatment normalizes this bias, thus alleviating symptoms.

Participants were shown a display of faces in a matrix on a computer screen. The display included both negative and neutral faces. The computer tracked where the users’ gaze fell throughout the session.

“We slowly rewire their attention patterns and normalize them,” Bar Haim said.

When the patient fixated on neutral faces, a music track they had selected beforehand would play. When they fixated on threatening faces, the music stopped.

“This lowers the feeling of anxiety. It significantly lowers the symptoms,” he said.

The efficacy of this treatment was proven in a preliminary controlled study, and other labs around the world replicated the results, Bar Haim said.

Currently, a large-scale study replicating the research is being done at Columbia University in New York, led by Franklin Schneier, associate professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University and assistant director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute. Intermediate results have shown the treatment to be effective.

The current study found that SSRI treatment was associated with lower depression than in the control group. This difference was not observed for the GC-MRT cohort. These results, similar to findings in other reports, “may suggest an advantage of SSRI treatment over GC-MRT in patients with comorbid depression,” the researchers wrote in the paper.

The study also included MRI scans before and after both treatments, Bar Haim said. The scans showed that there are areas in the brain that react in a similar way to the drug and to the GC-MRT. Yet one specific area responded uniquely to the GC-MRT, which is an area in the anterior cingulate cortex that is responsible for directing and regulating attention.

The additional findings will be published in a following paper currently under review, Bar Haim said.

The authors noted that the main limitations were that the current study didn’t include a follow-up on the treatment outcomes, as SSRI treatment continuation is recommended for at least a year.

In addition, both treatments “were limited in their overall clinical effectiveness,” the researchers wrote. Mean clinician-rated total severity scores remained above the suggested clinical cutoff at the post-treatment assessment. Less than 50 percent of the participants showed reliable change.

New Effective Alternative

Currently, there are two main types of treatment for SAD, Bar Haim said.

One is SSRI drugs such as Cipralex. The second is cognitive behavioral therapy (CBT). However, there is quite a relapse with these two treatments, and the success rates are between 50 and 60 percent, he said. That means that there are a lot of people for whom the existing treatment doesn’t work, so “it is good to have another tool” to offer.

For several reasons, not every patient can get drug treatment. Some individuals don’t want to take psychiatric drugs, and some have medical conditions that don’t allow them to take the drugs. This new treatment could be a good alternative for these people.

Although the CBT treatment is effective and non-invasive—it doesn’t involve taking drugs—it does require patients to face their fears, usually through direct exposure, Bar Haim said. Many patients are unable to withstand this, so the dropout rate is relatively high (16–37 percent).

CBT requires 12 to 20 sessions with very skilled therapists who have at least 10 years of training, and there is a serious shortage of these trained professionals.

The new treatment is “an effective treatment with several advantages,” according to Bar Haim. It’s more technical, easier to use, and simpler, and the dropout rate is lower (6 percent according to the current study). Efficiency is similar to that of CBT treatment.

In addition, the costs are lower. Instead of needing a psychologist or psychiatrist with 10 years of training, a technician can administer it.

Currently, several research teams around the world, including Bar Haim’s team, are testing the effectiveness of GC-MRT for treating other psychiatric disorders.

Bar Haim said that there is a strong interest in examining the effectiveness of the new tool to treat depression. His team also conducted research examining this question, which hasn’t yielded very good results so far. Yet several groups of scientists are also examining it, and Bar Haim’s team intends to research this topic again “with new insights.”

Bar Haim’s team is also in the midst of a study evaluating the effectiveness of GC-MRT for treating post-traumatic stress disorder, addictions, and eating disorders.

Currently, the new treatment is available only in a research setting.

When the researchers enrolled patients for the study, they faced “about 10 times more demand” than they could handle, Bar Haim said.

It will take some time to allow the treatment to be available to the general public, but Bar Haim said that he assumes that it will be available to some degree in the near future.

The researchers said they hope to open a dedicated clinic to allow this treatment with the required technical equipment at Tel Aviv University within a year to allow treatment for those who are interested in receiving it.

In the meantime, the scientists share their experience, the software, and the needed means with other institutes in the United States, Canada, and Europe to assist them in implementing the new treatment for their patients.