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If left untreated, social anxiety disorder can severely impact a person’s ability to form relationships,succeed at workor school, and live a fulfilling life.
Seeking treatment for social anxiety disorder is critical to overcome distressing symptoms, regain confidence, and improve quality of life.
Constant social anxiety, isolation, and loss of opportunities can lead to depression, substance abuse issues, or other mental health problems over time if left untreated.
This article outlines some of the most effective SAD treatment options available, including medications like SSRIs and SNRIs as well as psychotherapy approaches such as cognitive behavioral therapy andexposure techniques.
Different interventions may work better for certain individuals depending on factors like symptom severity, so it is important to discuss options with a qualified mental health provider to determine the best course of action.
Medication
Several types of medications are commonly used to treat social anxiety disorder (SAD). These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and certain antidepressants.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) such as escitalopram, paroxetine, and sertralinehave demonstrated efficacyin both short-term and long-term treatment of social anxiety disorder.
A systematic reviewand meta-analysis found that SSRIs are a valid option for people with SAD, withone meta-analysissuggesting that specifically paroxetine should be used as a first-line treatment.
SSRIs may elicit side effects like nausea, headache, sleep issues, sexual dysfunction, and activation symptoms in some people.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine XRhave also shown efficacyin treating social anxiety disorder in both the short term and long term.
SNRIs also inhibit the reuptake of serotonin and norepinephrine, which can help improve mood and anxiety symptoms.
Systematic reviewsand meta-analyses suggest that SNRIs can be an effective treatment for social anxiety disorder in adults as well asin adolescents and children.
SNRIs can potentially lead to side effects such as nausea, increased blood pressure, sweating, constipation, and sexual problems
Anti-anxiety medications
Anti-anxiety medications such as benzodiazepines are sometimes used to treat social anxiety disorder (SAD) symptoms. Examples include medications like clonazepam (Klonopin), lorazepam (Ativan), and alprazolam (Xanax).
Benzodiazepines may cause side effects such as sedation, memory and coordination issues, dependence, withdrawal symptoms upon discontinuation, and abuse potential.
Therefore, treatment guidelines typically only recommend short-term benzodiazepine use for severe anxiety in SAD. Long-term treatment relies more on medications like SSRIs and SNRIs with lower abuse potential.
Other medications
Other agents that have demonstrated some efficacyinclude moclobemide(a reversible inhibitor of monoamine oxidase A or RIMA),phenelzine(a monoamine oxidase inhibitor or MAOI), andpregabalin.
However, MAOIs and RIMAs may have more side effects and drug interactions compared to first-line SSRI/SNRI treatments. MAOIs require dietary restrictions and can confer side effects like dizziness, dry mouth, and headaches.
Overall, SSRIs and SNRIs are recommended as first-line pharmacological treatments for social anxiety disorder, with optimal treatment duration of at least 6 months or longer in individual cases.
Psychotherapy
Cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT)is considered the gold standard psychological treatment for SAD. CBT targets the distorted thoughts and maladaptive behaviors that maintain social anxiety.
While not universally effective for all (depending on demographics and coexisting conditions, for instance), CBT is considered the most empirically-supported first-line psychosocial treatment for social anxiety available today.
This involves gradually and systematically exposing individuals to feared social situations so they can face anxiety-provoking cues and see that their feared outcome is unlikely to happen.
A randomized controlled trialsuggests that even virtual reality exposure therapy can be equally effective as exposure therapy conducted in a group setting.
This targets distorted negative thoughts like “Everyone will think I’m stupid,” which trigger anxiety in social situations. The goal is to identify irrational fears, challenge them, and replace them with more balanced thoughts.
For instance, a person may examine evidence against their belief from past social situations where they did fine.
People with SAD may benefit fromcognitive restructuring to target their unhelpful thoughts and imaginal self-representations.
Combining social skills application with exposure therapyhas been found to improve outcomesmore than exposure alone.
Staying grounded in the present moment with nonjudgmental awareness of anxiety-related sensations, urges, and thoughts may reduce avoidance of social cues.Mindfulnessskills allow anxiety to naturally rise and fall without escalating.
Research suggeststhat mindfulness-based interventions can be effective during CBT sessions, especially when combined with exposure techniques.
Mindfulness-based cognitive therapy (MBCT)is a therapy that combines CBT with mindfulness, and research findings suggest that it can help reduce social anxiety symptoms in a sample of students.
Below are some potential limitations for usingCBT to treat SAD:
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) is a form of psychotherapy that focuses on accepting difficult thoughts and feelings rather than trying to change or avoid them while also committing to actions that align with one’s values.
For social anxiety, ACT aims to increase “psychological flexibility” – the ability to experience anxiety and still choose to engage in valued actions.
Specific techniques used inACT for social anxietyinclude:
Individuals then make commitments to concrete goals that align with those values, using anxiety exposure strategies if needed. The goal is to accept anxiety when it arises without letting it dictate behavior.
ACT has been shown to be effectivein reducing external shame and difficulties in emotion regulation and in increasing psychological flexibility and self-compassion in those with SAD.
Although ACT is a promising treatment,it is thought to not be an effective alternativeto rival CBT, but it can act as an alternative for those who are non-responders.
Psychodynamic therapy
The therapist helps the client explore how early childhood experiences, likeinsecure attachment with caregiversor lack of nurturance, may have fostered negative beliefs about oneself and difficulties with emotional regulation.
By gaining insight into these unconscious dynamics, clients can start to separate past issues from present-day triggers.
Specific techniques focus on identifying and challenging automatic negative thoughts that precede anxiety, learning to tolerate emotional discomfort rather than avoid it, and developing awareness of emotional states before they become overwhelming.
With increased understanding, self-compassion, and coping strategies, clients are better equipped to manage social situations. Progress is gradual but can ultimately lead to reduced anxiety and healthier relationships.
A meta-analysis suggestedthat psychodynamic therapy can be used as an alternative treatment to CBT in the treatment of SAD.Another study foundthat CBT and psychodynamic therapy were effective in treating short- and long-term outcomes of those with SAD.
However, psychodynamic therapy requires individuals to have a substantial capacity for self-reflection. Those lacking in insight may struggle with this therapy approach. Even with the insight, this alone may not directly translate to behavioral change for some clients.
Self-Help Techniques
There are severalself-help techniques that can be useful for managing social anxiety disorder symptoms.While seeking professional treatment is recommended for more severe cases, these strategies may help reduce anxiety levels.
Overcoming Avoidance
It’s important to gradually expose yourself to anxiety-provoking social situations instead of avoiding them. Start small and work your way up over time tobuild confidence in your ability to cope. Reflect afterward on whether your fears were realized and rate your anxiety levels.
Dropping Safety Behaviors
Let go ofsubtle safety behaviorsyou use to cope in social situations, like excessive use of a phone or wearing headphones to avoid interacting. This prevents you from truly testing your fears.
Feel the initial discomfort and it should subside over time as you realize the situations are manageable.
Practicing Self-Care
Make time for relaxation, hobbies, and activities that support your overall well-being. Be kind to yourself and reframe negative self-talk when you get anxious.
Acknowledge your progress and strengths. Self-care can relieve anxiety levels.
Breathing Retraining
Learning breathing techniques like deep belly breathing can help revert your breathing to a calmer baseline pattern and provide coping skills to use when anxious.
Progressive Muscle Relaxation
This involves systematically tensing and relaxing muscle groups to release tension that builds up with anxiety. It can be useful before and after anxiety-provoking social situations.
Celebrate Small Victories
Recognize and appreciate even small progress you make in facing social anxiety. This reinforces positive change and boosts self-confidence over time.
Build a Support Network
Surround yourself with supportive people you can share struggles with openly and without judgment. This can reduce loneliness, provide coping strategies, and offer a safe space to practice social skills.
Considerations
When seeking treatment for social anxiety disorder, there are several factors to consider:
The most effective approach depends on the individual. Working closely with a qualified mental health professional can help determine the best treatment options.
References
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
