COMBINING ESCITALOPRAM AND

COGNITIVE BEHAVIOURAL THERAPY

FOR SOCIAL ANXIETY DISORDER:
RANDOMISED CONTROLLED fMRI TRIAL

Presentator: Roslinda Damanik

Supervisor: Dr.dr.Elmeida Effendy,Psychiatrist Consultant
Moderator: dr. Vita Camellia,Psychiatrist
 BACKGROUND
• Selective serotonin reuptake
inhibitors (SSRIs) and Cognitive
Behaviour therapy (CBT) are often
used concomitanly to treat social
anxiety disorder (SAD)

• Still few study have examined

the effect of the combination
 AIM

To evaluate whether adding

escitalopram to ICBT
improves clinical outcome
and alters brain reactivity and
connectivity in SAD
 HYPOTHESE

Escitalopram would enhance the anxiolytic

effect of ICBT and that succesfull
treatment would be associated with
greater reduction in amygdala reactivity
METHOD
 Study Procedure
First session of fMRI with an emotional face masking task, followed by behavioural test

Start treatment

Measuring baseline using LSAS

Second session of fMRI

Treatment responders or
Measuring LSAS, CGI-I non responders
 ICBT
NINE WEEKLY MODULS
• Module 1 :reading section of CBT and SAD
• Module 2-4 :The cognitive model of SAD and
cognitive restructuring
• Modules 5-7: exposure exercise
• Modules 8-9: social skills training and relapse
prevention
 STATISTICAL ANALYSIS
• Demographic pretreatment clinical data were
compared between groups by t-test,Mann-
Whitney U test or chi square test using IBM
SPSS.
• Treatment effects were evaluated using
repeated measurement ANOVAs
• Neural reactivity and connectivity changes in
treatment and respons group were analysed
within SPM8.
 Summary of Findings

Adding escitalopram to ICBT for SAD

increases the number of responders,
reduce anticipatory speech anxiety,
and attenuates amygdala reactivity
to an emotional face-matching task
 LIMITATIONS
• Could not compare combined treatment with
monotherapies
• Relatively modest sample size especially when
comparing responders with non-responders
within treatment
• Failure to show a significant effect of LSAS at
post-treatment
THANKYOU........