, 1998, 1134). Altogether, the study was conducted for a period of twelve weeks. After completing six, more patients responded positively to the phenelzine therapy as opposed to CBGT and the other two included in the study (Heimberg et al., 1998, p. 1137). After completing the twelve weeks assessment, CBGT and phenelzine received the same result (Heimberg et al., 1998, p. 1137). Moreover, post treatment indicated that patients who had undergone the two therapies experienced less fear and anxiety in pattern thinking and real life situations. Although response was later in regards to CBGT effectiveness, phenelzine treatment, like in many situations when medication is administered, may be less indicated as it determines the patient to become dependent. Moreover, while CBGT promotes a proactive attitude in controlling anxiety, medication may determine the patient to rely exclusively on such therapeutic interventions. Furthermore, on the long run, the outcome is more favorable for cognitive treatment than phenelzine. Liebowitz et al. (1999) acknowledged that upon interrupted treatment period, ?PZ patients continued to relapse, whereas CBGT patients did not, ? (p. 96) which further highlights that medication treatment is effective insofar as no interruption is considered. With CBGT therapy, it is understood that patients learn more about their situation in order to control it. Nevertheless, physicians and therapists are unlikely to dismiss medication in favor of cognitive therapy as the technique is more time consuming (Blomhoff et al., 2001, p. 23) It is possible that medication is often preferred to cognitive therapies because, be it or not a group therapy, the approach is based on a relationship between the therapist and the patient, at least. This in itself is a social interaction to which both the patient and the therapist need to contribute. It is important to understand that social anxiety is addressed in relation to various situations which patients confront. To some of these situations, CBT may represent decreases in negativity while it produces no effect on other levels. For example, relapse for patients treated with CBGT was infrequent while non-relapsed PZ patients who were assessed acknowledged more positive results overall. Liebowitz et al. (1999) considered that the two may be more beneficial to patients when combined (p. 96).
Social anxiety is very unlikely to be short termed which is why, when medication is not an option for patients, neither cognitive therapies seem to prevail in gaining some sort of control over social situations, individuals are encouraged either by physicians or personal documentation to take on alternative therapies. Acupuncture has often been scientifically assessed as to observe its relation to stress and anxiety reduction. However, its effectiveness has been considered in relevance to insomnia. That is to say that some studies have sought to picture the benefits of acupuncture in light of anxiety causing insomnia and vice versa, the latter being a consequence of the former. Indeed, because anxiety, subsequently, generalized social phobia, is stress inducing, the connection appears viable since stress is further known to cause insomnia. One study, focused on 18 individuals who followed acupuncture treatment for a period of five weeks did indeed show improvements in sleep patterns (Spence et al., 2004, Discussion). However, because the study did not introduce psychopathological patterns, we can assume that, in relation to the study, acupuncture might solve sleep issues, but it would fail in addressing the overall condition of the patient. Indeed, subsequent studies affirmed that ?positive findings are reported for acupuncture in the treatment of generalized anxiety disorder or anxiety neurosis. (Pilkington et al., 2007, p. 9) Nevertheless, Pilkington et al. also acknowledged that ?there is insufficient research evidence for firm conclusions to be drawn. Our concern is that acupuncture is applied in rather safe environments where exposure is less. That is to say that, although some social contact is required, we are inclined to believe that the treatment does not address the patient's real condition, rather it alleviates the distress upon previous social interactions. In other words, patients are not exposed to environments where fear inducing situations arise. Thus, simply because a patient does not experience anxiety in that particular moment, it does not mean that anxiety is not there anymore. Acupuncture is not mind driven, which is to say that no challenges are required from the individual. Since social phobia is experienced precisely because pattern thinking, other mind engaging therapies may provide more relevant results. However, somewhere at the beginning of our paper, we stated that some chronic social phobics may experience an escalation of their condition leading to panic attacks. In experiencing generalized anxiety disorder, for example, muscle tension is often encountered, which is a physiological symptom specific to social phobia, as well. For our purpose, we will consider social phobia as correlated with generalized anxiety disorder (GAD) since the latter yields that patients experiencing the disorder often incorporate more than one specific anxiety disorder. In a study by Peter Sainsbury and J.G. Gibson it was discovered that ?anxious patients showed more muscle tension than the healthy subjects. (1954, p. 219) It is important to understand that muscle tension may imply either a physic or an emotional state of feeling. However, in Sainsbury's and Gibson's study, the majority of the subjects who were assessed explicitly experienced physical tension which is relevant to our purpose for indicating acupuncture's benefits. Thus, it is evidenced that individuals experiencing GAD are more likely to develop muscle tension. Acupuncture aims, among others, at relieving muscle pains and eliminating the discomfort. However, it remains largely a holistic technique and, while it is recommended by some physicians, it is less likely to ease anxiety per se.
After addressing three very distinctive techniques of intervention in treating social phobia, subsequently anxiety disorders, we feel compelled to acknowledge that neither one therapy by itself appears to be one hundred percent effective. When considering medication, side effects are to be taken into account. This is specifically important when patients treated of social phobia are also subject to depression. Indeed, medication is to be considered thoroughly when prescribed, especially when certain patients have been diagnosed with physical illnesses as well. This is because of the effects that combined medication may have over the patient's physical health. For example, depression is sometimes treated with electroconvulsive therapy which, in combination with phenelzine, may lead to unwanted negative effects on patients with diagnosed physical illnesses. Subsequently, medication in treating social phobia offers temporary relief. The patient may feel he or she is much more able to control social interactions when medicated and thus may rely on this technique permanently. Because medication does not address the core of social anxiety, once treatment is stopped, symptoms are likely to return, leaving the individual more anxious and disappointed of not having been able to manage treatment free periods. However, in severe forms of anxieties, medication can indeed represent the primarily solution. Nevertheless, we believe cognitive therapy in addition to exposure therapy to be more relevant in terms of long run outcomes and manageable control over social situations. This is because cognitive behavioral therapies address the underlying cause for social anxiety. Furthermore, it works to bring the patient into a state of acknowledgement and can actually absorb the patient's victimization roles. Nevertheless, as opposed to medication, CBT is proactive and perhaps more challenging, asking the patient to confront fearful situations. This is why we believe stress and cognitive behavioral therapies work side by side. However, we also believe that alternative therapies, such as acupuncture, may work in synergy to gain more positive results. While being exposed to social interactions, it is expected that the patient will experience stress, especially when he is at the beginning of the treatment. While not recommended for singularly addressing social anxiety, acupuncture is known to provide relief of specific anxiety disorder effects, such as muscle tension, mind tension, etc. Indeed, a study focusing on 240 individuals concluded the existence of more positive effects when there was a combination of acupuncture treatment and desensitization (Jorm et al., 2004, Physical Treatments: Acupuncture). Desensitization is one technique which conveys cognitive behavioral therapy more relevance as it focuses on diminishing the negative emotional response of patients exposed to certain situations.
In addressing social phobia, it needs to be considered that individuals respond differently to treatments. This is also relevant to the multitude of treatment methods which exist. As such, specific medication may prove effective for treating one patient while it fails to produce any positive outcome for another. The same, CBT requires the patient to engage more in his own recovery which not many individuals may feel up to.
Blomhoff, S., Haug, T.T., Hellstrom, K., Holme, I., Humble, M., Madsbu, H.P., Wold, J.E. (2001). Randomised controlled general practice trial of sertraline, exposure therapy, and combined treatment in generalized social phobia. The British Journal of Psychiatry, 179, 23-30. doi: 10.1192/bjp.179.1.23
Clark, M.D. (2001). A cognitive perspective on social phobia. In W.R. Crozier & L.E. Alden…