***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . : American Psychiatric Association , 1994 ) criteria for generalized social phobia were assigned to cognitive therapy ( CT ) , fluoxetine plus self-exposure ( FLU + SE ) , or placebo plus self-exposure ( PLA + SE ) . At posttreatment ( 16 weeks ) , the medication blind was broken . CT and FLU + SE patients then entered a 3-month booster phase . Assessment s were at pretreatment , midtreatment , posttreatment , end of booster phase , and 12-month follow-up . Significant improvements were observed on most measures in all 3 treatments . On measures of social phobia , CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment . FLU + SE and PLA + SE  did not differ . CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up . On general mood measures , there were few differences between the OBJECTIVE To address the lack of a simple and st and ardized instrument to assess overall panic disorder severity , the authors developed a scale for the measurement of panic disorder severity . METHOD Ten independent evaluators used the seven-item Panic Disorder Severity Scale to assess 186 patients with principal DSM-III-R diagnoses of panic disorder ( with no or mild agoraphobia ) who were participating in the Multicenter Collaborative Treatment Study of Panic Disorder . In addition , 89 of these patients were reevaluated with the same scale after short-term treatment . A subset of 24 patients underwent two independent assessment s to establish interrater reliability . Internal consistency , convergent and discriminant validity , and sensitivity to change were also determined . RESULTS The Panic Disorder Severity Scale was associated with excellent interrater reliability , moderate internal consistency , and favorable levels of validity and sensitivity to change . Individual items showed good convergent and discriminant validity . Analysis suggested a two-factor model fit the data best . CONCLUSIONS The Panic Disorder Severity Scale is a simple , efficient way for clinicians to rate severity in patients with established diagnoses of panic disorder . However , further research with more diverse groups of panic disorder patients and with a broader range of convergent and discriminant validity measures is needed BACKGROUND Traditional pharmacological approaches to treating psychiatric disorders focus on correcting presumed biochemical abnormalities . However , some disorders , particularly the anxiety-related disorders exemplified by specific phobia , have an emotional learning component to them that can be facilitated with psychotherapy . OBJECTIVE To determine whether D-cycloserine ( DCS ) , a partial agonist at the N-methyl-d-aspartate receptor that has previously been shown to improve extinction of fear in rodents , will also improve extinction of fear in human phobic patients undergoing behavioral exposure therapy . DESIGN R and omized , double-blind , placebo-controlled trial examining DCS vs placebo treatment in combination with a precisely controlled exposure paradigm . SETTING Participants were recruited from the general community to a research clinic . PARTICIPANTS Twenty-eight subjects with acrophobia diagnosed by the Structured Clinical Interview for DSM-IV were enrolled . INTERVENTIONS After we obtained pretreatment measures of fear , subjects were treated with 2 sessions of behavioral exposure therapy using virtual reality exposure to heights within a virtual glass elevator . Single doses of placebo or DCS were taken prior to each of the 2 sessions of virtual reality exposure therapy . Subjects , therapists , and assessors were blind to the treatment condition . Subjects returned at 1 week and 3 months posttreatment for measures to determine the presence and severity of acrophobia symptoms . MAIN OUTCOME MEASURES Included were measures of acrophobia within the virtual environment , measures of acrophobia in the real world , and general measures of overall improvement . An objective measure of fear , electrodermal skin fluctuation , was also included during the virtual exposure to heights . Symptoms were assessed by self-report and by independent assessors at approximately 1 week and 3 months posttreatment . RESULTS Exposure therapy combined with DCS result ed in significantly larger reductions of acrophobia symptoms on all main outcome measures . Subjects receiving DCS had significantly more improvement compared with subjects receiving placebo within the virtual environment ( 1 week after treatment , P</=.001 ; 3 months later , P</=.05 ) . Subjects receiving DCS also showed significantly greater decreases in posttreatment skin conductance fluctuations during the virtual exposure ( P</=.05 ) . Additionally , subjects receiving DCS had significantly greater improvement compared with subjects receiving placebo on general measures of real-world acrophobia symptoms ( acrophobia avoidance [ P</=.02 ] , acrophobia anxiety [ P</=.01 ] , attitudes toward heights [ P</=.04 ] , clinical global improvement [ P</=.01 ] , and number of self-exposures to real-world heights [ P</=.01 ] ) ; the improvement was evident early in treatment and was maintained at 3 months . CONCLUSION These pilot data provide initial support for the use of acute dosing of DCS as an adjunct to exposure-based psychotherapy to accelerate the associative learning processes that contribute to correcting psychopathology Nondirective ( ND ) , applied relaxation ( AR ) , and cognitive behavioral ( CBT ) therapies for generalized anxiety disorder ( GAD ) were compared . The latter 2 conditions were generally equivalent in outcome but superior to ND at post assessment . The 3 conditions did not differ on several process measures , and ND created the greatest depth of emotional processing . Follow-up results indicated losses in gains in ND , maintained gains in the other 2 conditions , especially CBT , and highest endstate functioning for CBT . AR and CBT thus contain active ingredients in the treatment of GAD ; support exists for further development of imagery exposure methods or cognitive therapy because of their likely role in promoting maintenance of change with this disorder . Expectancy for improvement was also associated with outcome , suggesting the need for further research on this construct for underst and ing the nature of GAD and its amelioration Acute stress disorder ( ASD ) is a precursor of chronic posttraumatic stress disorder ( PTSD ) . Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy ( CBT ) or supportive counseling ( SC ) within 2 weeks of their trauma . Fewer participants in CBT ( 8 % ) than in SC ( 83 % ) met criteria for PTSD at posttreatment . There were also fewer cases of PTSD in the CBT condition ( 17 % ) than in the SC condition ( 67 % ) 6 months posttrauma . There were greater statistically and clinical ly significant reductions in intrusive , avoidance , and depressive symptomatology among the CBT participants than among the SC participants . This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD BACKGROUND  Generalized social phobia is common , persistent , and disabling and is often treated with selective serotonin reuptake inhibitor drugs or cognitive behavioral therapy . OBJECTIVE We compared fluoxetine ( FLU ) , comprehensive cognitive behavioral group therapy ( CCBT ) , placebo ( PBO ) , and the combinations of CCBT/FLU and CCBT/PBO . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING Two academic outpatient psychiatric centers . PATIENTS Subjects meeting a primary diagnosis of generalized social phobia were recruited via advertisement . Seven hundred twenty-two were screened , and 295 were r and omized and available for inclusion in an intention-to-treat efficacy analysis ; 156 ( 52.9 % ) were male , 226 ( 76.3 % ) were white , and mean age was 37.1 years . INTERVENTIONS Treatment lasted for 14 weeks . Fluoxetine and PBO were administered at doses from 10 mg/d to 60 mg/d ( or equivalent ) . Group comprehensive cognitive behavioral therapy was administered weekly for 14 sessions . MAIN OUTCOME MEASURES An independent blinded evaluator assessed response with the Brief Social Phobia Scale and Clinical Global Impressions scales as primary outcomes . A videotaped behavioral assessment served as a secondary outcome , using the Subjective Units of Distress Scale . Adverse effects were measured by self-rating . Each treatment was compared by means of chi2 tests and piecewise linear mixed-effects models . RESULTS Clinical Global Impressions scales response rates in the intention-to-treat sample were 29 ( 50.9 % ) ( FLU ) , 31 ( 51.7 % ) ( CCBT ) , 32 ( 54.2 % ) ( CCBT/FLU ) , 30 ( 50.8 % ) ( CCBT/PBO ) , and 19 ( 31.7 % ) ( PBO ) , with all treatments being significantly better than PBO . On the Brief Social Phobia Scale , all active treatments were superior to PBO . In the linear mixed-effects models analysis , FLU was more effective than CCBT/FLU , CCBT/PBO , and PBO at week 4 ; CCBT was also more effective than CCBT/FLU and CCBT/PBO . By the final visit , all active treatments were superior to PBO but did not differ from each other . Site effects were found for the Subjective Units of Distress Scale assessment , with FLU and CCBT/FLU superior to PBO at Duke University Medical Center , Durham , NC . Treatments were well tolerated . CONCLUSIONS All active treatments were superior to PBO on primary outcomes . Combined treatment did not yield any further advantage . Notwithst and ing the benefits of treatment , many patients remained symptomatic after 14 weeks Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions .  Narrative exposure therapy ( NET ) is a short-term approach based on cognitive-behavioral therapy and testimony therapy . The efficacy of narrative exposure therapy was evaluated in a r and omized controlled trial . Sudanese refugees living in a Ug and an refugee settlement ( N = 43 ) who were diagnosed as suffering from posttraumatic stress disorder ( PTSD ) either received 4 sessions of NET , 4 sessions of supportive counseling ( SC ) , or psychoeducation ( PE ) completed in 1 session . One year after treatment , only 29 % of the NET participants but 79 % of the SC group and 80 % of the PE group still fulfilled PTSD criteria . These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions Because a statistical tie between st and ard treatment and an innovation is uninterpretable , most trials intended to demonstrate efficacy of innovations in psychopharmacology employ a placebo control group , despite the existence of st and ard medications for many disorders . In this review I consider the statistical issues that inform the ethics of the decision to use a placebo condition and make the following points : 1 ) the investigator is relying on the assumption that the effects of delayed st and ard treatment are neither long-lasting nor harmful ; 2 ) the usual practice of truncating follow-up when a patient ceases to adhere to a study treatment makes it difficult to empirically test that assumption ; 3 ) placebo control trials often suffer from method ological weaknesses ( including nonr and om truncation ) that reduce their inferential power ; 4 ) these subtleties place a substantial burden on the informed consent process ; 5 ) alternative design s are available but not well explored , due to the dominant role of " regulatory " trial methodology ; and 6 ) research ers should consider other goals besides helping to introduce another treatment that improves on placebos but not the st and ard treatment BACKGROUND The dem and for effective behavior therapy for obsessive-compulsive disorder ( OCD ) by exposure and ritual prevention exceeds its supply by trained therapists . A computer-guided behavior therapy self-help system ( BT STEPS ) was created that patients access by telephone from home via interactive voice response technology . This study compared the value of computer-guided behavior therapy value with that of clinician-guided behavior therapy and systematic relaxation as a control treatment . METHOD After screening by a clinician , 218 patients with DSM-IV OCD at 8 North American sites were r and omly assigned to 10 weeks of behavior therapy treatment guided by ( 1 ) a computer accessed by telephone and a user workbook ( N = 74 ) or ( 2 ) a behavior therapist ( N = 69 ) or ( 3 ) systematic relaxation guided by an audiotape and manual ( N = 75 ) . RESULTS By week 10 , in an intent-to-treat analysis , mean change in score on the Yale-Brown Obsessive Compulsive Scale was significantly greater in clinician-guided behavior therapy ( 8.0 ) than in computer-guided ( 5.6 ) , and changes in scores with both clinician-guided and computer-guided behavior therapy were significantly greater than with relaxation ( 1.7 ) , which was ineffective . Similarly , the percentage of responders on the Clinical Global Impressions scale was significantly ( p < .05 ) greater with clinician-guided ( 60 % ) than computer-guided behavior therapy ( 38 % ) , and both were significantly greater than with relaxation ( 14 % ) . Clinician-guided was superior to computer-guided behavior therapy overall , but not when patients completed at least 1 self-exposure session ( N = 36 [ 65 % ] ) . At endpoint , patients were more satisfied with either behavior therapy group than with relaxation . Patients assigned to computer-guided behavior therapy 
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DATA SYNTHESIS There were no significant differences in attrition rates between CBT and placebo .
The strongest effect sizes were observed in obsessive-compulsive disorder and acute stress disorder , and the weakest effect size was found in panic disorder .
The advantage of CBT over placebo did not depend on placebo modality , number of sessions , or study year .
Our review of r and omized placebo-controlled trials indicates that CBT is efficacious for adult anxiety disorders .
There is , however , considerable room for improvement .