The effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder

J Affect Disord. 2014 Jun;162:61-6. doi: 10.1016/j.jad.2014.03.015. Epub 2014 Mar 24.


Background: Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear.

Methods: The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD.

Results: At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD.

Limitations: Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT.

Conclusion: Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.

Keywords: Bipolar disorder; Cognitive behavioral therapy; Comorbidity; Major depressive disorder; Social anxiety disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety Disorders / complications
  • Anxiety Disorders / therapy*
  • Bipolar Disorder / complications*
  • Cognitive Behavioral Therapy / methods*
  • Depressive Disorder, Major / complications*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Middle Aged
  • Social Behavior
  • Social Behavior Disorders / complications
  • Social Behavior Disorders / therapy*