Do depressive symptoms affect the outcome of treatments for SAD? A meta analysis of randomized controlled trials

Naama Rozen, Idan M. Aderka

Research output: Contribution to journalReview articlepeer-review


Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms. In the present meta-analysis, we reviewed the treatment outcome literature in SAD and examined whether depressive symptoms predict treatment outcome. We focused on randomized controlled trials of cognitive behavior therapy (individual face-to-face, group format, and internet-delivered format) and randomized controlled trials of pharmacotherapy. After implementing exclusion criteria, 108 studies with 133 treatment conditions (n = 12,913 participants) were included in the meta-analysis. Our findings indicated that treatments for SAD were efficacious and significantly reduced social anxiety symptoms across all treatment modalities. Exclusion of individuals with MDD or high levels of depression did not affect outcome at post-treatment or at follow-up. However, we found that elevated depressive symptoms were associated with greater reductions in social anxiety symptoms from pre-treatment to post-treatment. Importantly, this effect was above and beyond pre-treatment levels of social anxiety. Finally, analyzing treatment modalities separately, we found that depressive symptoms were associated with better post-treatment outcomes in individual face-to-face CBT but not in other modalities. Clinical and research implications of these findings are discussed.

Original languageEnglish
Article number101874
JournalClinical Psychology Review
StatePublished - Aug 2020

Bibliographical note

Funding Information:
Naama Rozen was supported by the President's Scholarship from the University of Haifa .

Publisher Copyright:
© 2020 Elsevier Ltd


  • Cognitive behavior therapy
  • Depression
  • Meta-analysis
  • Pharmacotherapy
  • Social anxiety disorder

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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