Psychoanalysis for Social Anxiety Disorder

Overview of Psychoanalysis for Social Anxiety Disorder

Psychoanalysis is sometimes used to treat SAD.
SAD can sometimes be treated through psychoanalysis. Bruce Ayres / Getty Images

Psychoanalysis for social anxiety disorder (SAD) is based on psychodynamic theory, which was originally attributed to Sigmund Freud.

From a psychodynamic perspective, social anxiety disorder is believed to be part of a larger problem that develops during childhood. Scientists with this perspective view anxiety as a disorder of childhood origin. Therefore, they see your social anxiety as resulting from your early experiences and attachments to your caregivers and other important people in your life.

Psychoanalysis Versus Psychodynamic Therapy

While these terms are often used interchangeably, psychoanalysis refers to intense long-term psychotherapy, whereas psychodynamic therapy is brief in format. While psychoanalysis might involve meeting several times a week over a period of years, psychodynamic therapy can take place in as little as 15 weeks with once-a-week meetings.

In this way, psychodynamic therapy is more similar to cognitive-behavioral therapy (CBT) in terms of its format. Whereas a certified psychoanalyst will conduct psychoanalysis, psychodynamic therapy can be administered by any psychologist trained in this orientation.

Psychodynamic Theory of Social Anxiety Disorder

Although there is no comprehensive psychoanalytic theory of SAD, there are several beliefs about the origins of social anxiety from this perspective.

According to psychodynamic theory, your social anxiety may be the result of the following:

  • an expectation of shame and humiliation elicited by critical or harsh parents
  • a conflict between your need to achieve and succeed, and your fear of success
  • a conflict between your need for independence and your fear of rejection or abandonment by your parents
  • your narcissistic fear of being unable to make a perfect impression

Each of these conflicts is believed to result in shame, social withdrawal, insecurity, and low self-esteem.

Psychodynamic Therapy for Social Anxiety Disorder

The goal of psychodynamic therapy for SAD is to uncover underlying conflicts believed to cause the disorder and work through these issues. Your mental health professional will work with you to determine the unique conflicts and childhood issues that may be linked to your social anxiety.

In addition, your therapist will discuss potential issues that may affect therapy that are unique to social anxiety disorder. For example, you may find yourself expecting that your therapist will judge you negatively. Or, you may have trouble trusting your therapist.

Relevant Research Findings

In a 2013 study, 495 patients with social anxiety disorder received either cognitive-behavioral therapy (CBT), psychodynamic therapy, or were put on a wait-list (control condition). The patients  were given assessments (e.g., the Liebowitz Social Anxiety Scale) at the start of the study and then again at the end of treatment.

Patients receiving CBT showed response to treatment in 60% of cases, while those who received psychodynamic therapy responded in 52% of cases. Those who were put on the wait list only showed improvement in 15% of cases.

In terms of remission over time, 36% of those who received CBT remained in remission, compared to 26% who received psychodynamic therapy and 9% who were put on the wait-list.

These findings show that receiving CBT or psychodynamic therapy is better than being on a wait list both in the short and long term. However, cognitive-behavioral therapy appears to be more helpful than psychodynamic therapy when it comes to treatment effects lasting over the long term for social anxiety disorder.

However, in a 2014 study of CBT versus psychodynamic psychotherapy for SAD, both treatments were found to be equally effective. In another 2014 study of the long-term outcomes of CBT and psychodynamic therapy for social anxiety disorder, participants were followed for 24 months. Response rates were about 70% for both treatments at 2-year follow-up and remission rates were nearly 40% for both. This suggests that both CBT and psychodynamic therapy may be helpful for SAD.

Finally, in a 2016 multi-center trial of patient characteristics that predict outcomes of psychodynamic psychotherapy for social anxiety disorder, it was found that the most important predictor of treatment outcomes was the level of severity of social anxiety prior to treatment. This means that your doctor should consider how severe your symptoms are when choosing the best type of therapy for your situation.

A Word From Verywell

Based on current research evidence, psychodynamic therapy is likely as good as CBT in terms of immediate improvement. However, over the long-term, cognitive-behavioral therapy may be more effective.

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