Importance Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.

中文翻译：

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基线严重程度作为等待名单控制的认知行为治疗与社交焦虑症症状变化关联的调节因素：系统评价和个体患者数据荟萃分析。

重要性 社交焦虑症（SAD）可以通过认知行为疗法（CBT）得到充分治疗。然而，对于与预后相关的因素的认识存在很大差距，并且尚不清楚症状严重程度是否可以预测 CBT 对 SAD 的反应。目的 检查基线 SAD 症状严重程度，作为 CBT 与 SAD 患者症状变化之间关联的调节因素。数据源 对于本次系统评价和个体患者数据荟萃分析 (IPDMA)，检索了 1990 年 1 月 1 日至 2023 年 1 月 13 日期间的 PubMed、PsycInfo、Embase 和 Cochrane 图书馆。主要检索主题是社交焦虑症、认知障碍行为疗法和随机对照试验。研究选择纳入标准是对初步临床诊断为 SAD 的成人进行比较 CBT 与等待名单上的随机临床试验，并使用 Liebowitz 社交焦虑量表 (LSAS)。数据提取和综合纳入研究的作者被要求提供个人水平的数据。数据由两位作者按照系统评价和荟萃分析报告指南的首选报告项目提取，并使用 Cochrane 工具评估偏倚风险。IPDMA 采用两阶段方法进行，用于将 CBT 与从基线到治疗后的 LSAS 评分变化关联起来，并使用随机效应模型研究基线 LSAS 评分与条件的交互作用。主要结果和测量 主要结果是 LSAS 测量的症状严重程度的治疗后变化的基线。结果 荟萃分析共纳入 12 项研究，包括 1246 名 SAD 患者（平均 [SD] 年龄，35.3 [10.9] 岁；738 [59.2%] 女性）。发现 CBT 与治疗前和治疗后 LSAS 变化之间存在等待名单控制的关联（b = -20.3；95% CI，-24.9 至 -15.6；P < .001；Cohen d = -0.95；95% CI，-1.16 至-0.73）。基线 LSAS 评分调节了 CBT 和等待名单之间在治疗前到治疗后症状减轻方面的差异（b = -0.22；95% CI，-0.39 至 -0.06；P = .009），表明症状严重的个体等待时间较长CBT 后列表控制症状减轻（对于非常严重的 SAD 患者，Cohen d = -1.13 [95% CI，-1.39 至 -0.88]；对于患有严重 SAD 的患者，Cohen d = -0.54 [95% CI，-0.80 至 -0.29]轻度悲伤）。结论和相关性 在本次系统评价和 IPDMA 中，SAD 患者基线 SAD 症状严重程度越高，与 CBT 后症状减轻幅度越大（绝对而非相对）相关。研究结果表明临床医生可以自信地向患有严重 SAD 症状的个体提供 CBT，从而有助于个性化护理。