***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: Clinical trials of social anxiety disorder ( SAD ) have largely focused on the effect of treatment on symptoms of fear and avoidance , while neglecting the third clinical ly relevant dimension , physiological arousal . Data were combined from two previously reported placebo‐controlled trials of sertraline in the treatment of moderate‐to‐severe generalized SAD . Efficacy was evaluated using the Brief Social Phobia Scale ( BSPS ) . Three hundred forty‐six subjects were r and omized to 12–13 weeks of treatment with sertraline and 273 subjects to placebo .  Following treatment , significant improvement was noted in favor of sertraline on the full BSPS ( P<.001 ) , as well as on each of the individual BSPS subscales : fear ( P=.001 ) ; avoidance ( P<.0001 ) ; and physiological arousal ( P<.0001 ) . Of the physiological symptoms assessed , the treatment advantage with sertraline was maintained for blushing ( P<.003 ) and palpitations ( P<.03 ) , but not for trembling and sweating . These results confirm the efficacy of treatment with a selective serotonin reuptake inhibitor ( SSRI ) , sertraline , across the spectrum of fear , avoidance , and physiological arousal in generalized SAD ( GSAD ) . Among common physiological symptoms in this population , blushing and palpitations appear more treatment responsive than trembling and sweating to acute treatment with sertraline . Depression and Anxiety 23:6–10 , 2006 . © 2005 Wiley‐Liss , 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 BACKGROUND This double-blind , placebo-controlled , flexible-dose study was conducted to investigate the efficacy and tolerability of the controlled-release ( CR ) formulation of paroxetine in adults with social anxiety disorder . METHOD Out patients with a primary diagnosis of social anxiety disorder according to DSM-IV criteria entered a 1-week , single-blind , placebo run-in period . Eligible patients were r and omly assigned to receive paroxetine CR ( flexible dose of 12.5 - 37.5 mg/day ) or placebo for 12 weeks of treatment . The primary efficacy measures were the change from baseline in Liebowitz Social Anxiety Scale ( LSAS ) score and the proportion of responders based on Clinical Global Impressions (CGI)-Global Improvement scale score . Data were gathered from September 2001 to July 2002 . RESULTS The intent-to-treat population consisted of 186 patients r and omly assigned to paroxetine CR and 184 patients r and omly assigned to placebo .  Statistically significant differences in favor of paroxetine CR compared with placebo were observed in the change from baseline to week 12 last-observation-carried-forward ( LOCF ) data set in LSAS total score ( difference = -13.33 , 95 % confidence interval [ CI ] = -18.25 to -8.41 , p < .001 ) . In the CGI-Global Improvement responder analysis , 57.0 % of patients treated with paroxetine CR achieved response ( very much improved or much improved ) , compared with 30.4 % of patients treated with placebo at week 12 LOCF ( odds ratio = 3.12 , 95 % CI = 2.01 to 4.83 , p < .001 ) . Dropout rates due to adverse events were low and comparable in both treatment groups . CONCLUSION Paroxetine CR effectively treated the symptoms associated with social anxiety disorder and was well tolerated , with few patients stopping treatment due to adverse events . This favorable tolerability profile may enable more patients to experience the benefits of effective therapy Allgul and er C. Paroxetine in  social anxiety disorder :  a r and omized placebo‐controlled study . Acta Psychiatr Sc and 1999 : 100 : 193–198 . © Munksgaard 1999 CONTEXT The generalized type of social phobia ( social anxiety disorder ) is a severe and often disabling form of social anxiety that affects approximately 5 % of the general population . Earlier research has shown monoamine oxidase inhibitors or benzodiazepines to be effective in treating this condition , but neither has achieved widespread use . OBJECTIVE To compare the efficacy of paroxetine , a selective serotonin reuptake inhibitor , with placebo in adults with generalized social phobia . DESIGN Twelve-week , multicenter , r and omized , double-blind trial . SETTING Thirteen centers across the United States and 1 in Canada . PARTICIPANTS Between April 13 , 1995 , and February 28 , 1996 , 187 persons meeting Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria for generalized social phobia were r and omized ( and 183 returned for at least 1 efficacy assessment ) to treatment . INTERVENTION After a 1-week , single-blind , placebo , run-in period , patients received a double-blind , 11-week course of either paroxetine or matching-image placebo . The initial daily dosage of paroxetine ( or placebo ) was 20 mg with increases of 10 mg/d weekly ( flexible dosing to a maximum of 50 mg/d ) permitted after the second week of treatment . MAIN OUTCOME MEASURES Number of responders based on the Clinical Global Impression Global Improvement Item ( " much improved " or " very much improved " ) ; mean change from baseline on the Liebowitz Social Anxiety Scale total score . RESULTS Fifty ( 55.0 % ) of 91 persons taking paroxetine and 22 ( 23.9 % ) of 92 persons taking placebo were much improved or very much improved at the end of treatment ( odds ratio [ OR ] , 3.88 ; 95 % confidence interval [ CI ] , 2.81 - 5.36 ) . Mean Liebowitz Social Anxiety Scale total scores were reduced by 39.1 % ( the mean baseline score of 78.0 declined by a mean of 30.5 points at follow-up ) in the paroxetine group compared with 17.4 % ( the mean baseline score of 83.5 declined 14.5 points at follow-up ) in the placebo group , a difference of 21.7 % ( 95 % CI , 8.7%-34.7 % ) favoring paroxetine . CONCLUSIONS Paroxetine is an effective treatment for patients with generalized social phobia . Short-term ( ie , 11-week ) treatment results in substantial and clinical ly meaningful reductions in symptoms and disability . Future research should test whether these may be further reduced by extended treatment or supplementation with specific educational-cognitive-behavioral techniques BACKGROUND Evidence indicates that venlafaxine hydrochloride extended release ( ER ) effectively ameliorates anxiety symptoms . OBJECTIVES To evaluate the efficacy , safety , and tolerability of flexible-dose venlafaxine ER compared with placebo in the short-term treatment of generalized social anxiety disorder and , secondarily , to compare paroxetine with venlafaxine ER and paroxetine with placebo . DESIGN Adult out patients with DSM-IV generalized social anxiety disorder for 6 months or longer were r and omly assigned to receive venlafaxine hydrochloride ER ( 75 - 225 mg/d ) , paroxetine ( 20 - 50 mg/d ) , or placebo for 12 weeks or less at 26 centers in the United States . The primary outcome measure was the total Liebowitz Social Anxiety Scale score . Secondary measures included response ( Clinical Global Impression-Improvement score , 1 or 2 ) rates and Clinical Global Impression-Severity of Illness and Social Phobia Inventory scores . RESULTS Of 440 patients treated , 413 ( 93.9 % ) were included in the last-observation-carried-forward efficacy analysis ; of the 429 patients in the safety population , 318 ( 74.1 % ) completed the study . Mean daily doses were 201.7 mg ( SD , 38.1 mg ) of venlafaxine hydrochloride ER and 46.0 mg ( SD , 7.9 mg ) of paroxetine . Venlafaxine ER treatment was significantly superior to placebo at weeks 1 through 12 on the Liebowitz Social Anxiety Scale and Social Phobia Inventory and at week 2 and weeks 6 through 12 for Clinical Global Impression-Severity of Illness and responder status , and was significantly superior to paroxetine treatment at weeks 1 and 2 for the Social Phobia Inventory ( P < .05 for all ) . Paroxetine treatment was significantly superior to placebo at weeks 3 through 12 on the Liebowitz Social Anxiety Scale , the Clinical Global Impression-Severity of Illness scale , and the Social Phobia Inventory , and at weeks 4 through 12 for response ( P < .05 for all ) . Week 12 response rates were significantly greater for the venlafaxine ER and paroxetine groups ( 58.6 % and 62.5 % , respectively ) vs the placebo group ( 36.1 % ) ( P < .001 for both ) . CONCLUSION Venlafaxine ER is effective in the short-term treatment of generalized social anxiety disorder , with efficacy and tolerability comparable to paroxetine The Self-Regulatory Executive Function model [ S-REF ; Wells , A. , & Matthews , G. ( 1996 ) . Modelling cognition in emotional disorder : the S-REF model . Behaviour Research and Therapy , 34 , 881 - 888 ] proposes that metacognitive beliefs , inflexible self-focused attention , and perseverative thinking ( rumination and worry ) play an important role in maintaining emotional dysfunction . Attention training [ ATT ; Wells , A. ( 1990 ) . Panic disorder in association with relaxation induced anxiety : an attentional training approach to treatment . Behavior Therapy , 21 , 273 - 280 ] is a technique design ed to increase attentional control and flexibility , and thereby lessen the impact of these maintaining factors . The main aim of this study was to determine whether or not supplementing cognitive behavioral group therapy ( CBGT ) with ATT could potentiate greater changes in social anxiety , depression , attentional control , metacognitive beliefs , and anticipatory and post-event processing in a clinical sample with social phobia . Patients ( N=81 ) were allocated to CBGT with ATT or relaxation training ( RT ) . ATT did not potentiate greater change on any outcome variable , with both groups achieving significant improvements on all measures . Exploratory correlational analyses ( pre-treatment and changes scores ) showed that some metacognitive beliefs were associated with attentional control , anticipatory processing , and symptoms of social anxiety and depression . However , attentional control was more consistently associated with anticipatory processing , post-event processing , and symptoms of social anxiety and depression , than with metacognitive beliefs . Results are discussed with reference to cognitive behavioral models of social phobia . It is tentatively concluded that while supplementing CBGT with ATT does not improve outcomes , increasing attentional control during CBGT is associated with symptom relief Selective serotonin reuptake inhibitors are the pharmacological treatment of choice for the treatment of  social anxiety disorder ( SAD ) . The efficacy and tolerability of fixed doses of escitalopram were compared to those of placebo in the long‐term treatment of generalised SAD , using paroxetine as an active reference . Patients with a DSM‐IV diagnosis of SAD between 18–65 years of age were r and omised to 24 weeks of double‐blind treatment with placebo ( n = 166 ) , 5 mg escitalopram ( n = 167 ) , 10 mg escitalopram ( n = 167 ) , 20 mg escitalopram ( n = 170 ) , or 20 mg paroxetine ( n = 169 ) . Based on the primary efficacy parameter , Liebowitz Social Anxiety Scale ( LSAS ) total score at Week 12 ( LOCF ) , a significantly superior therapeutic effect compared to placebo was seen for 5 and 20 mg escitalopram and for all doses for the OC analyses . Further improvement in LSAS scores was seen at Week 24 ( OC and LOCF ) , with significant superiority over placebo for all doses of escitalopram , and 20 mg escitalopram was significantly superior to 20 mg paroxetine . Response to treatment ( assessed by a C 
    Output:
    
INTERPRETATION Individual CBT ( which other studies have shown to have a lower risk of side-effects than pharmacotherapy ) is associated with large effect sizes .
Thus , it should be regarded as the best intervention for the initial treatment of social anxiety disorder .
For individuals who decline psychological intervention , SSRIs show the most consistent evidence of benefit .