Challenging the role of challenge in intensive short-term dynamic psychotherapy for social anxiety disorder: A randomized controlled trial

Objectives: Intensive short-term dynamic psychotherapy (ISTDP) requires the technique of challenge to defenses when treating resistant patients. As the technique of challenge is difficult for some therapists to practice, it leads us to question whether challenge can be replaced by clarification of defenses without losing treatment effectiveness. This study compared ISTDP with two different technical emphases while treating social anxiety disorder (SAD). Method: Forty-two subjects with DSM-5 SAD were randomly assigned to either a waitlist control, 10 sessions of ISTDP with the use of challenge or 10 sessions of ISTDP without the use of challenge. Results: ISTDP led to significant, sustained symptom reduction on the Liebowitz Social Anxiety Scale (LSAS-SR) compared with the control group. There were no significant outcome differences between standard ISTDP and ISTDP where challenge was restricted. Conclusion: ISTDP is efficacious for SAD. ISTDP may be effective for SAD without the use of challenge elements.