open access
메뉴
open access
메뉴
E-ISSN : 2733-4538
This study aimed to identify evidence-based treatments of social anxiety disorder to be used with Korean populations. To achieve this purpose, we first reviewed the clinical features of social anxiety disorder and research on evidence-based treatments (EBTs) conducted abroad. Then, we identified EBTs for use with Korean populations through the systematic review and meta-analysis of social anxiety treatment studies conducted in Korea. Thirty-three domestic social anxiety treatment studies published in academic journals between 2000 and 2017 were systematically reviewed and meta-analyzed. All studies reviewed were characterized by randomized controlled trials or controlled trials at least and included the adequate statistics needed for the calculation of effect sizes (ESs). The ESs of each of the social anxiety treatments on social anxiety outcomes, other-related outcomes, and overall outcomes were calculated for both the adult and adolescent/child groups. The analyses found that all the treatment types reviewed demonstrated large effect sizes on social anxiety and related outcomes. The analyses also found cognitive behavioral treatment (CBT) in adults and CBT and CBT combined with social skills training in adolescents and children to be well-established EBT for social anxiety disorder. The clinical implications of the research findings were discussed, and recommendations for the potential users were made.
Acarturk, C., Cuijpers, P., Van Straten, A., & De Graaf, R. (2009). Psychological treatment of social anxiety disorder: A meta-analysis. Psychological Medicine, 39, 241-254.
Aderka, I. M., Hofmann, S. G., Nickerson, A., Hermesh, H., Gilboa- Schechtman, E., & Marom, S. (2012). Functional impairment in social anxiety disorder. Journal of Anxiety Disorders, 26, 393-400.
Ahn, J. K., Kwon, J. H., & Yoon, H. Y. (2014). Effectiveness of the internet-based self-help program for social anxiety disorder. Korean Journal of Clinical Psychology, 33, 695-721.
Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., … Haro, J. M. (2004). Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109, 21-27.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
An, K. Y., & Park, K. H. (2015). The effect of video feedback and cognitive review on self-evaluated performance for socially anxious individuals. Cognitive Behavior Therapy in Korea, 15, 433-448.
Asher, M., Asnaani, A., & Aderka, I. M. (2017). Gender differences in social anxiety disorder: A review. Clinical Psychology Review, 56, 1-12.
Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Hofler, M., Lieb, R., & Wittchen, H. U. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64, 903-912.
Beesdo‐Baum, K., Knappe, S., Fehm, L., Höfler, M., Lieb, R., Hofmann, S. G., & Wittchen, H. U. (2012). The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatrica Scandinavica, 126, 411-425.
Bentley, K. H., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Fox, K. R., & Nock, M. K. (2016). Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clinical Psychology Review, 43, 30-46.
Blanco, C., Xu, Y., Schneier, F. R., Okuda, M., Liu, S. M., & Heimberg, R. G. (2011). Predictors of persistence of social anxiety disorder:A national study. Journal of Psychiatric Research, 45, 1557-1563.
Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., . . . Keller, M. B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162, 1179-1187.
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., . . . Woody, S. (1998). Update on empirically validated therapies. II. The Clinical Psychologist, 51, 3-16.
Chang, H. A., & Ahn, C. Y. (2003). The effect of cyber group therapy for social phobia. Korean Journal of Clinical Psychology, 22, 93-108.
Cho, M. J., Kim, J. K., Jeon, H. J., Suh, T., Chung, I. W., Hong, J. P., . . . Lee, C. K. (2007). Lifetime and 12-month prevalence of DSMIV psychiatric disorders among Korean adults. The Journal of Nervous and Mental Disease, 195, 203-210.
Cho, Y. R. (2001). The effectiveness of cognitive-behavioral group therapy for speech anxiety. Korean Journal of Clinical Psychology, 20, 399-411.
Cho, Y. R., Won, H. T., & Pyo, K. S. (2000). The effects of group cognitive therapy for social phobia. Korean Journal of Clinical Psychology, 19, 181-206.
Choi, H. B., & Lim, S. M. (2000). The combined effects of handacupunctural and cognitive-behavioral therapy for social anxiety. The Korean Journal of Counseling and Psychotherapy, 12, 33-51.
Choi, Y. Y., & Son, C. N. (2012). The effects of positive psychotherapy on social anxiety, optimism, and subjective well-being of social phobia-prone college students. The Korean Journal of Health Psychology, 17, 573-588.
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., . . . Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568-578.
Cougle, J. R., Keough, M. E., Riccardi, C. J., & Sachs-Ericsson, N. (2009). Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. Journal of Psychiatric Research, 43, 825-829.
Council for the training in the evidence-based behavioral practice. (2017). Evidence-based behavioral practice for social anxiety disorder. Retrieved from http://www.ebbp.org/skillsBasedResources.html
Cristea, I. A., Kok, R. N., & Cuijpers, P. (2015). Efficacy of cognitive bias modification interventions in anxiety and depression:Meta-analysis. The British Journal of Psychiatry, 206, 7-16.
Cuming, S., & Rapee, R. M. (2010). Social anxiety and self-protective communication style in close relationships. Behaviour Research and Therapy, 48, 87-96.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455-463.
Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: Prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43, 257-265.
Hart, T. A., Turk, C. L., Heimberg, R. G., & Liebowitz, M. R. (1999). Relation of marital status to social phobia severity. Depression and Anxiety, 10, 28-32.
Health Insurance Review and Assessment Service. (2017). Health insurance statistics in 2016. Retrieved from http://opendata.hira.or.kr/op/opc/olap4thDsInfo.do
Hedges, H., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.
Hedman, E., El Alaoui, S., Lindefors, N., Andersson, E., Rück, C., Ghaderi, A., … Ljótsson, B. (2014). Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-year follow-up of a randomized trial. Behaviour Research and Therapy, 59, 20-29.
Heimberg, R. G., Hofmann, S. G., Liebowitz, M. R., Schneier, F. R., Smits, J. A., Stein, M. B., . . . Craske, M. G. (2014). Social anxiety disorder in DSM‐5. Depression and Anxiety, 31, 472-479.
Heinrichs, N., Rapee, R. M., Alden, L. A., Bögels, S., Hofmann, S. G., Oh, K. J., & Sakano, Y. (2006). Cultural differences in perceived social norms and social anxiety. Behaviour Research and Therapy, 44, 1187-1197.
Heo, S. M., & Lee, B. K. (2016). The effects of therapy variables in acceptance commitment therapy on social anxiety. Cognitive Behavior Therapy in Korea, 16, 445-467.
Higgins, J. P. T., & Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327, 557-560.
Hofmann, S. G., Asnaani, A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and Anxiety, 27, 1117-1127.
Hoyer, J., Wiltink, J., Hiller, W., Miller, R., Salzer, S., Sarnowsky, S., . . . Leibing, E. (2016). Baseline patient characteristics predicting outcome and attrition in cognitive therapy for social phobia: Results from a large multicentre trial. Clinical Psychology & Psychotherapy, 23, 35-46.
Hwu, H. G., Yeh, E. K., & Chang, L. Y. (1989). Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatrica Scandinavica, 79, 136-147.
Jang, S. S., & Shin, H. K. (2010). The effects of a multi-dimensional group program using video feedbacks for the reduction of public speaking anxiety on the presentation anxiety, self-efficacy and presentation behaviors among the female high school students. Korean Journal of Woman Psychology, 15, 175-187.
Jeong, D. W., & Jeong, J. B. (2015). The effect of cognitive behavior therapy focused on social skills and emotional identification and expression of elementary school students who have social anxiety. Journal of Emotional & Behavioral Disorders, 31, 321-344.
Jeong, J. K., & Son, C. N. (2013). Effects of psychodrama on dysfunctional beliefs, fear of negative evaluation, emotion regulation, and depression in the social phobia group. Korean Journal of Clinical Psychology, 32, 141-159.
Ji, S. J. (2013). The effects of cognitive behavioral group therapy program on self-efficacy and peer relationship of children with social anxiety. Journal of Psychology and Behavior, 5, 65-91.
Jørstad-Stein, E. C., & Heimberg, R. G. (2009). Social phobia: An update on treatment. Psychiatric Clinics of North America, 32, 641-663.
Kampmann, I. L., Emmelkamp, P. M., & Morina, N. (2016). Metaanalysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders, 42, 71-84.
Kang, S. J., & Shin, H. K. (2017). The effects of a mindfulnessbased cognitive therapy with add-on exposure procedure and the changes of process variables among university students with speech anxiety. Korean Journal of Clinical Psychology, 36, 118-130.
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC psychiatry, 14, S1.
Kawakami, N., Takeshima, T., Ono, Y., Uda, H., Hata, Y., Nakane, Y., . . . Kikkawa, T. (2005). Twelve‐month prevalence, severity, and treatment of common mental disorders in communities in Japan: Preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry and Clinical Neurosciences, 59, 441-452.
Keller, M. B. (2003). The lifelong course of social anxiety disorder:A clinical perspective. Acta Psychiatrica Scandinavica, 108, 85-94.
Kessler, R. C. (2003). The impairments caused by social phobia in the general population: Implications for intervention. Acta Psychiatrica Scandinavica, 108, 19-27.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627.
Kim, D. H., & Son C. N. (2016). Effects of acceptance and commitment therapy (ACT) on social anxiety, rejection sensitivity and acceptance of social anxiety disorder-prone college students. Korean Journal of Clinical Psychology, 35, 101-119.
Kim, J. C., & Son, C. N. (2010). The effects of the mindfulnessbased cognitive-behavioral group therapy on reduction of speech anxiety. The Korean Journal of Stress Research, 18, 59-68.
Kim, J. M. (2006). The effects of cognitive-behavioral group counseling program for social anxiety in adolescents. The Korea Journal of Counseling, 7, 541-556.
Kim, J. M. (2008a). A comparison of the effects of cognitive-behavioral group treatment and cognitive-behavioral group treatment with attention training for adolescents with social anxiety disorder. The Korean Journal of Counseling and Psychotherapy, 20, 243-267.
Kim, J. M. (2008b). The effects of a cognitive-behavioral group therapy program for social anxiety in female adolescents. Journal of Korean Home Management Association, 26, 13-24.
Kim, J. M. (2009). A comparison of the effects of cognitive-behavioral group counseling and neuro linguistic programming group counseling for social anxiety in female adolescents. The Korea Journal of Counseling, 10, 849-866.
Kim, J. M., & Son, C. N. (2013). Effects of acceptance and commitment therapy (ACT) on social avoidance and self-focused attention or college student with speech anxiety. The Korean Journal of Health Psychology, 18, 267-283.
Kim, M. O., & Son, C. N. (2013). Effects of acceptance and commitment therapy on interpersonal anxiety, stress, coping style, and social self-efficacy of college students with interpersonal anxiety. Korean Journal of Health Psychology, 18, 301-321.
Kim, S. I., & Baik, J. S. (2013). The effects of acceptance-commitment group therapy on college students’ speech anxiety: Based on cognitive defusion techniques. The Korean Journal of Counseling and Psychotherapy, 25, 19-40.
Ko, Y. J., & Kim, J. M. (2015). The effect of cognitive behavioral therapy and acceptance and commitment therapy on female university students with social anxiety disorder. Journal of Emotional & Behavioral Disorders, 31, 175-197.
Kwon, S. I., & Chung, H. H. (2014). Effects of the acceptance and commitment therapy program on psychological adjustment of university students with a high level of social anxiety. Cognitive Behavior Therapy in Korea, 14, 145-164.
Lee, C. H., Cho, Y. R., & Oh, E. H. (2016). The efficacy of mindfulness-based exposure therapy on speech anxiety and baseline depressive symptom severity as a moderator: Compared with cognitive behavioral group therapy. Korean Journal of Clinical Psychology, 35, 335-363.
Lee, C. K., & Lee, K. H. (1997). A national-wide epidemiological study of mental disorders in Korea (XVIII): Cross national epidemiology of social phobia. Journal of Korean Neuropsychiatric Association, 36, 571-577.
Lee, S. H., Shin, Y. C., & Oh, K. S. (1994). A clinical study of social phobia for 10 years. Journal of Korean Neuropsychiatric Association, 33, 305-312.
Lee, S., Tsang, A., Zhang, M. Y., Huang, Y. Q., He, Y. L., Liu, Z. R., . . . Kessler, R. C. (2007). Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China. Psychological Medicine, 37, 61-71.
Lim, L., Chan, H. N., Chew, P. H., Chua, S. M., Ho, C., Kwek, S. K. D., . . . Wan, Y. M. (2015). Ministry of Health clinical practice guidelines: Anxiety disorders. Singapore Medical Journal, 56, 310-316.
Lipsey, M. W., & Wilson, D. B. (1993). The efficacy of psychological, educational and behavioral treatment. American Psychologist, 48, 1181-1209.
Magee, W. J., Eaton, W. W., Wittchen, H. U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159-168.
McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45, 1027-1035.
Ministry of Health and Welfare. (2017). The survey of mental disorders in Korea. Sejong: Author.
National Institute for Health and Care Excellence. (2013). Social anxiety disorder: Recognition, assessment, and treatment. Retrieved from https://www.nice.org.uk/guidance/cg159/chapter/1-recommendations#interventions-for-adults-with-social-anxietydisorder-2
Oh, J. Y., & Son, C. N. (2009). The effects of cognitive-behavioral group therapy on the reduction of public self-consciousness, interpersonal anxiety and fear of negative evaluation with social phobia-prone students. Social Science Studies, 33, 285-308.
Park, K. H., & Ahn, C. Y. (2001). The importance of homework compliance in cognitive-behavioral group treatment for social phobia. Korean Journal of Clinical Psychology, 20, 595-610.
Powers, M. B., Sigmarsson, S. R., & Emmelkamp, P. M. (2008). A meta-analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy, 1, 94-113.
Rapee, R. M., Kim, J., Wang, J., Liu, X., Hofmann, S. G., Chen, J., . . . Alden, L. E. (2011). Perceived impact of socially anxious behaviors on individuals᾿ lives in Western and East Asian countries. Behavior Therapy, 42, 485-492.
Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA:Results from the National Comorbidity Survey Replication. Psychological Medicine, 38, 15-28.
Schreier, S. S., Heinrichs, N., Alden, L., Rapee, R. M., Hofmann, S. G., Chen, J., . . . Bögels, S. (2010). Social anxiety and social norms in individualistic and collectivistic countries. Depression and Anxiety, 27, 1128-1134.
Seok, J. M., & Son, C. N. (2013). The effects of mindfulness and acceptance-based program on attachment anxiety and social anxiety of college students with preoccupied attachment type. The Korean Journal of Health Psychology, 18, 627-642.
Shen, Y. C., Zhang, M. Y., Huang, Y. Q., He, Y. L., Liu, Z. R., Cheng, H., . . . Kessler, R. C. (2006). Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychological Medicine, 36, 257-267.
Shin, J. E. (2009). The effects of cognitive and behavioral group counseling program to relieve college students of public speaking anxiety. The Korea Journal of Counseling, 10, 285-297.
Silverman, W. K., & Hinshaw, S. P. (2008). The second special issue on evidence- based psychosocial treatments for children and adolescents:A 10-year update. Journal of Clinical Child and Adolescent Psychology, 37, 1-7.
So, H. Y., & Son, C. N. (2008). The effects of cognitive-behavioral therapy on middle school students with social anxiety. The Korean Journal of Stress Research, 16, 181-189.
Society of Clinical Psychology, Division 12 of the American Psychological Association. (2017). Cognitive behavioral therapy for social anxiety disorder. Retrieved from https://www.div12.org/psychological-treatments/disorders/social-phobia-and-publicspeaking-anxiety/cognitive-behavioral-therapy-for-social-anxietydisorder/
Son, J. A., & Kwon, J. H. (2001). The effects of cognitive-behavioral group therapy of adolescents with social phobia. Cognitive Behavior Therapy in Korea, 1, 77-92.
Son, J. K., & Kang, K. S. (2014). A study on the effect of cognitivebehavior music therapy on improving social phobia of women’s university students. Journal of Arts Psychotherapy, 10, 99-121.
Stein, M. B., Fuetsch, M., Müller, N., Höfler, M., Lieb, R., & Wittchen, H. U. (2001). Social anxiety disorder and the risk of depression:A prospective community study of adolescents and young adults. Archives of General Psychiatry, 58, 251-256.
Stein, M. B., & Kean, Y. M. (2000). Disability and quality of life in social phobia: Epidemiologic findings. American Journal of Psychiatry, 157, 1606-1613.
Stein, M. B., Torgrud, L. J., & Walker, J. R. (2000). Social phobia symptoms, subtypes, and severity: Findings from a community survey. Archives of General Psychiatry, 57, 1046-1052.
Turner, S. M., Beidel, D. C., Cooley, M. R., Woody, S. R., & Messer, S. C. (1994). A multicomponent behavioral treatment for social phobia: Social effectiveness therapy. Behaviour Research and Therapy, 32, 381-390.
Weinstock, L. S. (1999). Gender differences in the presentation and management of social anxiety disorder. The Journal of Clinical Psychiatry, 60, 9-13.
Xu, Y., Schneier, F., Heimberg, R. G., Princisvalle, K., Liebowitz, M. R., Wang, S., & Blanco, C. (2012). Gender differences in social anxiety disorder: Results from the national epidemiologic sample on alcohol and related conditions. Journal of Anxiety Disorders, 26, 12-19.
Yoon, H. Y., & Kwon, J. H. (2013). The efficacy of cognitive behavior therapy for social anxiety disorder: Changes in the attentional bias and the implicit self-esteem. Cognitive Behavior Therapy in Korea, 13, 211-234.