human
***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 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 Background and Aims Cognitive behavioral group therapy ( CBGT ) is an effective , well-established , but not widely available treatment for  social anxiety disorder ( SAD ) .  Internet-based cognitive behavior therapy ( ICBT ) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD . However , ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical setting s. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting . Methods We conducted a r and omized controlled non-inferiority trial with allocation to ICBT ( n = 64 ) or CBGT ( n = 62 ) with blinded assessment immediately following treatment and six months post-treatment . Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks . The Liebowitz Social Anxiety Scale ( LSAS ) was the main outcome measure . The following non-inferiority margin was set : following treatment , the lower bound of the 95 % confidence interval ( CI ) of the mean difference between groups should be less than 10 LSAS-points . Results Both groups made large improvements . At follow-up , 41 ( 64 % ) participants in the ICBT group were classified as responders ( 95 % CI , 52%–76 % ) . In the CBGT group , 28 participants ( 45 % ) responded to the treatment ( 95 % CI , 33%–58 % ) . At post-treatment and follow-up respectively , the 95 % CI of the LSAS mean difference was 0.68–17.66 ( Cohen ’s d between group = 0.41 ) and −2.51–15.69 ( Cohen ’s d between group = 0.36 ) favoring ICBT , which was well within the non-inferiority margin . Mixed effects models analyses showed no significant interaction effect for LSAS , indicating similar improvement across treatments ( F = 1.58 ; df = 2 , 219 ; p = .21 ) . Conclusions ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT . Trial Registration Clinical Trials.gov 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 Clinical Global Impression‐Improvement score ≤2 ) was significantly higher for all active treatments than for placebo at Week 12 . Clinical relevance was supported by a significant decrease in all the Sheehan disability scores , and the good tolerability  of escitalopram treatment . It is concluded that doses of 5–20 mg escitalopram are effective and well tolerated in the short‐ and long‐term treatment of generalised SAD . Depression and Anxiety 00:000–000 , 2004 . © 2004 Wiley‐Liss , Background : Generalized social anxiety disorder is a highly prevalent anxiety disorder with deleterious effects on social and family relationships , as well as work performance . We report the results of a multicenter , r and omized , placebo-controlled trial comparing the efficacy , safety , and tolerability of fluvoxamine controlled release ( CR ) to placebo in patients with generalized social anxiety disorder . Methods : A total of 279 adult patients meeting all inclusion /exclusion criteria was recruited at 23 United States sites and r and omly assigned to receive either fluvoxamine CR ( 10 
    Output:
    
agent
Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
***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 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 Background and Aims Cognitive behavioral group therapy ( CBGT ) is an effective , well-established , but not widely available treatment for  social anxiety disorder ( SAD ) .  Internet-based cognitive behavior therapy ( ICBT ) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD . However , ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical setting s. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting . Methods We conducted a r and omized controlled non-inferiority trial with allocation to ICBT ( n = 64 ) or CBGT ( n = 62 ) with blinded assessment immediately following treatment and six months post-treatment . Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks . The Liebowitz Social Anxiety Scale ( LSAS ) was the main outcome measure . The following non-inferiority margin was set : following treatment , the lower bound of the 95 % confidence interval ( CI ) of the mean difference between groups should be less than 10 LSAS-points . Results Both groups made large improvements . At follow-up , 41 ( 64 % ) participants in the ICBT group were classified as responders ( 95 % CI , 52%–76 % ) . In the CBGT group , 28 participants ( 45 % ) responded to the treatment ( 95 % CI , 33%–58 % ) . At post-treatment and follow-up respectively , the 95 % CI of the LSAS mean difference was 0.68–17.66 ( Cohen ’s d between group = 0.41 ) and −2.51–15.69 ( Cohen ’s d between group = 0.36 ) favoring ICBT , which was well within the non-inferiority margin . Mixed effects models analyses showed no significant interaction effect for LSAS , indicating similar improvement across treatments ( F = 1.58 ; df = 2 , 219 ; p = .21 ) . Conclusions ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT . Trial Registration Clinical Trials.gov 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 Clinical Global Impression‐Improvement score ≤2 ) was significantly higher for all active treatments than for placebo at Week 12 . Clinical relevance was supported by a significant decrease in all the Sheehan disability scores , and the good tolerability  of escitalopram treatment . It is concluded that doses of 5–20 mg escitalopram are effective and well tolerated in the short‐ and long‐term treatment of generalised SAD . Depression and Anxiety 00:000–000 , 2004 . © 2004 Wiley‐Liss , Background : Generalized social anxiety disorder is a highly prevalent anxiety disorder with deleterious effects on social and family relationships , as well as work performance . We report the results of a multicenter , r and omized , placebo-controlled trial comparing the efficacy , safety , and tolerability of fluvoxamine controlled release ( CR ) to placebo in patients with generalized social anxiety disorder . Methods : A total of 279 adult patients meeting all inclusion /exclusion criteria was recruited at 23 United States sites and r and omly assigned to receive either fluvoxamine CR ( 10 
    Output:
    