Social Anxiety Disorder
http://www.100md.com
《新英格兰医药杂志》
To the Editor: The article by Schneier (Sept. 7 issue)1 concerning social anxiety disorder discusses cognitive–behavioral therapy and pharmacotherapy as treatment options. There is no mention of the use of psychoanalytically informed treatment, either by itself or in conjunction with the therapies noted. I am a psychiatrist and psychoanalyst who has practiced and taught for nearly four decades. Without necessarily assigning a similar diagnostic label, I, as well as colleagues, have treated many patients with the symptoms enumerated, with or without some of the coexisting difficulties, and have observed a considerable long-term benefit and continued psychological growth well beyond symptomatic relief.2,3,4,5 I believe that psychodynamic treatment should be considered as part of the management of this disorder.
Evelyne Albrecht Schwaber, M.D.
4 Welland Rd.
Brookline, MA 02445
eschwaber@post.harvard.edu
References
Schneier FR. Social anxiety disorder. N Engl J Med 2006;355:1029-1036.
Luborsky L, Crits-Christoph P. A relationship pattern measure. In: Cooper AM, ed. Contemporary psychoanalysis in America: leading analysts present their work. Washington, DC: American Psychiatric Publishing, 2006:387-400.
Schwaber EA. A particular perspective on analytic listening. Psychoanal Study Child 1983;38:519-546.
Schwaber EA. Countertransference: the analyst's retreat from the patient's vantage point. Int J Psychoanal 1992;73:349-361.
Idem. The struggle to listen: continuing reflections, lingering paradoxes, and some thoughts on recovery of memory. In: Cooper AM, ed. Contemporary psychoanalysis in America: leading analysts present their work. Washington, DC: American Psychiatric Publishing, 2006:563-87.
The author replies: On the basis of her extensive clinical experience and that of her colleagues, Schwaber suggests that psychodynamic treatment should be part of the management of social anxiety disorder. Because psychodynamic approaches have not been studied in social anxiety disorder, however, it is difficult to assess their efficacy for this condition, and they were therefore not included in my review of evidence-based treatments. The psychodynamic literature that may be relevant to social anxiety disorder has been reviewed elsewhere.
It is impossible to know whether the diagnosis of social anxiety disorder applies to patients "with or without some of the coexisting difficulties" whom Schwaber treated "without necessarily assigning a similar diagnostic label." Diagnostic labels based on reliable criteria have been established in psychiatry during the past three decades precisely because they facilitate systematic study and clinical communication about issues such as these. Empirical research developed from clinical observations of psychodynamic therapy in patients with social anxiety disorder would be a welcome addition to our understanding of this condition.
Franklin R. Schneier, M.D.
Columbia University College of Physicians and Surgeons
New York, NY 10032
frs1@columbia.edu
Evelyne Albrecht Schwaber, M.D.
4 Welland Rd.
Brookline, MA 02445
eschwaber@post.harvard.edu
References
Schneier FR. Social anxiety disorder. N Engl J Med 2006;355:1029-1036.
Luborsky L, Crits-Christoph P. A relationship pattern measure. In: Cooper AM, ed. Contemporary psychoanalysis in America: leading analysts present their work. Washington, DC: American Psychiatric Publishing, 2006:387-400.
Schwaber EA. A particular perspective on analytic listening. Psychoanal Study Child 1983;38:519-546.
Schwaber EA. Countertransference: the analyst's retreat from the patient's vantage point. Int J Psychoanal 1992;73:349-361.
Idem. The struggle to listen: continuing reflections, lingering paradoxes, and some thoughts on recovery of memory. In: Cooper AM, ed. Contemporary psychoanalysis in America: leading analysts present their work. Washington, DC: American Psychiatric Publishing, 2006:563-87.
The author replies: On the basis of her extensive clinical experience and that of her colleagues, Schwaber suggests that psychodynamic treatment should be part of the management of social anxiety disorder. Because psychodynamic approaches have not been studied in social anxiety disorder, however, it is difficult to assess their efficacy for this condition, and they were therefore not included in my review of evidence-based treatments. The psychodynamic literature that may be relevant to social anxiety disorder has been reviewed elsewhere.
It is impossible to know whether the diagnosis of social anxiety disorder applies to patients "with or without some of the coexisting difficulties" whom Schwaber treated "without necessarily assigning a similar diagnostic label." Diagnostic labels based on reliable criteria have been established in psychiatry during the past three decades precisely because they facilitate systematic study and clinical communication about issues such as these. Empirical research developed from clinical observations of psychodynamic therapy in patients with social anxiety disorder would be a welcome addition to our understanding of this condition.
Franklin R. Schneier, M.D.
Columbia University College of Physicians and Surgeons
New York, NY 10032
frs1@columbia.edu