Adding Cognitive Behavioral Therapy to Drug Treatment for Social Anxiety Disorder

Inclusion Criteria:

• Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV)criteria for generalized social phobia

• Willing and able to give written informed consent

• English-speaking

Exclusion Criteria:

• Prior or current diagnosis of schizophrenia, schizoaffective disorder, organic mentaldisorder, bipolar disorder, or antisocial, schizotypal, and schizoid personalitydisorders

• Suicidal thoughts

• History of failed paroxetine treatment of at least 6 weeks' duration at adequate dosesor a history of failed outcome of a previous adequate trial of CBT

• Clinically significant and/or unstable medical disease

• Pregnancy or breast-feeding. Women of childbearing potential will be required to signa statement indicating their intention to avoid pregnancy during the study through theuse of an effective method of contraception.

• Alcohol or substance abuse or dependence within the past 3 months. Patients with apositive drug screen but no substance abuse disorder will be eligible for the study,provided they have not met criteria for abuse/dependence within the last 6 months andprovide two clean urine samples 2 weeks apart.

• Current or past history of seizure disorder (except febrile seizure in childhood)

• Conditions that contraindicate the use of paroxetine

• Inability to tolerate or unwillingness to accept a drug-free period of 4 weeks formonoamine oxidase inhibitors (MAOIs) or fluoxetine and 2 weeks for other selectiveserotonin reuptake inhibitors (SSRIs), neuroleptics, antidepressants, benzodiazepines,mood stabilizers, buspirone, beta-adrenergic blockers, or other psychotropic drugsprior to beginning the study

• Currently receiving psychotherapy