What Are the Treatments for Social Anxiety Disorder?

Overview of the Treatments for Social Anxiety Disorder

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Treatments for social anxiety disorder (SAD) depend on the severity of your emotional and physical symptoms and how well you function daily. The length of treatment also varies. Some people may respond well to initial treatment and not require anything further, while others may require some form of support throughout their lives.

Both medication and therapy have been shown effective in treating social anxiety disorder. Generalized social anxiety disorder responds best to a combination of medication and therapy, while therapy alone is often sufficient for people diagnosed with "performance only" SAD. Below is a description of the main treatments for SAD.

Medication

Several different types of medications are prescribed to treat SAD. Each has its advantages and disadvantages depending on your particular situation.

Meta-analyses of the effectiveness of medication in the treatment of SAD have shown a small to medium-sized effect size for this type of treatment—with all of the following categories of medications showing improvements.

This means that several different types of medication may be helpful in improving symptoms of social anxiety disorder, and that one may be a useful form of treatment for you.

SSRIs are the first line of treatment for SAD due to their tolerable side effects and ease of administration. However, due to the potential for withdrawal effects, SSRIs should always be tapered when ending treatment.

A 2014 meta-analysis found paroxetine (brand name Paxil) to be the second most effective form of medication treatment for social anxiety disorder.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are a class of antidepressants used in the treatment of anxiety that act on the neurotransmitters serotonin and norepinephrine. Venlafaxine extended release (brand name Effexor) was found to be the third most effective type of medication for SAD in the same 2014 meta-analysis.

  • Effexor XR (venlafaxine)
  • Cymbalta (duloxetine)
  • Serzone (nefazodone)
  • Pristiq (desvenlafaxine)

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs were once considered the most useful treatment for social anxiety disorder; however these medications carry with them the risk of serious side effects if dietary and medication guidelines are not followed.

Today, MAOIs are not usually used in the treatment of SAD, unless there is reason to believe that they will be more helpful than other medications (such as a family history of good results). At the same time, a 2014 meta-analysis found that phenelzine (brand name Nardil) was the most effective form of pharmacotherapy for social anxiety disorder.

  • Nardil (phenelzine)
  • Parnate (tranylcypromine)
  • Marplan (isocarboxazid)

Beta Blockers

Beta blockers are usually taken orally prior to an anxiety-inducing event such as a performance to reduce symptoms of anxiety such as a rapid heart rate, hand tremors, and the “butterflies in the stomach” feeling. Beta blockers are useful in situations that require mental sharpness, because they do not have adverse effects on cognitive ability.

  • Inderal (propranolol)
  • Tenormin (atenolol)

Benzodiazepines

Benzodiazepines are mild tranquilizers that alleviate the symptoms of anxiety by slowing down the central nervous system. Although fast-acting and well-tolerated, benzodiazepines have the potential to be habit-forming and should not be prescribed for someone with a substance abuse disorder. This class of medications is not considered the first-line of treatment for social anxiety disorder.

Other Anxiety Medications

If you are not sure of your treatment options, talk to your doctor about the potential use of medication for your particular situation.

Psychotherapy

CBT is a form of psychotherapy designed to modify your thoughts and behaviors in order to positively influence your emotions. Three major cognitive-behavioral techniques have been shown to help treat SAD—exposure, cognitive restructuring, and social skills training.

  • Exposure: Exposure can take place either through imagining a specific performance or social situation, or in real life. If you have extremely severe social anxiety disorder, your therapist may begin with imagined exposure and eventually progress to real life exposures. The underlying principle of exposure therapy is that through practice and experience, you will become more comfortable in situations that you would otherwise avoid. Below are some exposure exercises that you can practice on your own:
  • Cognitive Restructuring: Cognitive restructuring focuses on the cognitive symptoms of SAD: poor self-concept, fear of negative evaluation by others, and negative attribution bias (attributing positive outcomes to chance and negative outcomes to your own shortcomings). Cognitive restructuring involves a series of exercises designed to identify negative thoughts, evaluate how true they are, and construct alternative thoughts to challenge original thoughts. Cognitive restructuring is thought to be important for the treatment of social anxiety disorder because of the strong cognitive aspect of the disorder and the typical chronic lifetime course.

Acceptance and commitment therapy (ACT) for social anxiety disorder is a "third-wave" technique developed after CBT that is based on Buddhist philosophy. Through ACT, you learn how to accept negative thoughts and anxiety rather than to try to eliminate them. By detaching yourself from your social anxiety, it is expected that your symptoms will naturally lessen. An ACT therapist uses experiential exercises, values-guided interventions, and mindfulness skills training as part of therapy.

Psychoanalysis is based on psychodynamic therapy and involves a therapist helping you to understand the underlying issues from childhood that may have contributed to your social anxiety. It is most useful for people who have a deeper unresolved reason for their anxiety. Psychoanalysis may also be useful in some instances to explore potential resistance to change.

Complementary and Alternative Treatments

Alternative treatments for social anxiety disorder include such things as dietary supplements, aromatherapy, and hypnotherapy. Most alternative treatments have not been scientifically proven to work in the treatment of SAD. In addition, alternative treatments may not be regulated as strictly as standard forms of treatment. Below are some alternative treatments for social anxiety disorder:

Where to Find Treatment

The steps for finding treatment for social anxiety disorder are the same as those for any mental health issue.

1. Talk to someone about the problems you are experiencing such as a family doctor or religious counselor. You could even start by telling a friend or family member and asking for his or her support in finding help.

2. If a doctor is not able to refer you to a mental health professional, look in the yellow pages in the sections for "Mental Health" or "Social Services." Professionals who provide mental health therapy services typically include psychologists, social workers, and counselors. If you require medication, you will need to speak to a psychiatrist through a referral from a doctor. If you are looking for alternative treatments, seek out a naturopathic doctor or someone who practices integrative medicine.

3. Call to make an appointment and inquire about the cost of services and whether these will be covered by insurance.

A Word From Verywell

Reaching out for help the first time can feel uncomfortable and anxiety-provoking in and of itself. Know that you are taking the best first step in the right direction to alleviate your social anxiety over the long term.

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