Social Anxiety Disorder

Treatment Overview

Treatment for social anxiety disorder involves psychological counseling and sometimes medications (such as antidepressants) to reduce associated anxiety and depression.

A combination of medications and professional counseling is most effective for people who have generalized anxiety and fear over many social situations.⁴ For those who fear only one or a few social situations (such as public speaking or eating in front of others), professional counseling to overcome the fear may be all that is needed.²

Unfortunately, many people don't seek treatment for anxiety disorders. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.

Initial and ongoing treatment

Initial treatment of social anxiety disorder is based on the severity of your emotional and physical symptoms and your ability to function in daily activities. People who have social anxiety disorder often have depression as well. They may also have alcohol or substance abuse problems. Your health professional may ask you certain questions to see whether you might be drinking too much or abusing drugs.

Social anxiety disorder often goes undetected for years before treatment is sought—by that time, you may have developed behaviors that accommodate the fears. These habits or behaviors must be overcome to successfully manage social anxiety disorder.

First, your health professional must determine whether you are generally anxious about all social encounters, or whether a specific situation triggers anxiety.

Treatment with a combination of medications and professional counseling is often effective for generalized social anxiety disorder (fear of most public interaction). Some people need treatment throughout their lives, while others may recover completely after a period of treatment with counseling and medications.

It is possible to overcome the fears associated with social anxiety disorder. Working through fears with a specific type of therapy—cognitive-behavioral therapy that includes exposure therapy—may be the best approach for treating your anxiety. It is important to continue professional counseling even if you are taking medications to reduce anxiety.

Types of counseling most often used to treat social anxiety disorder include:²

• Cognitive-behavioral therapy, which helps you identify anxieties and the situations that provoke the anxiety. Initially, you may feel uncomfortable while addressing the feared situations, but it is an important part of your recovery. Several types of cognitive-behavioral therapy are used to treat social anxiety disorder, including:
  • Exposure therapy. You will be guided by a professional counselor to imagine you are facing the feared situation until you no longer fear it, such as eating in public. Next, you may go with your counselor to a public place and eat until, eventually, you can eat by yourself in public without fear.
  • Social skills training. This therapy helps you develop the skills you need in social situations through rehearsing and role-playing. Your anxiety is reduced as you become more comfortable with and prepared for the feared social situations.
  • Cognitive restructuring. This therapy helps you learn to identify and improve fearful thinking to help you better handle social situations.
  • Symptom management skills. This therapy teaches you how to reduce stress by controlling your breathing and other physical responses to anxiety.
• Supportive therapy. This can include:
  • Education about the disorder.
  • Family therapy, to support loved ones affected by your condition.
  • Group therapy or support groups, to seek support from others also diagnosed with the disorder.

Medications often used for chronic, severe, or generalized social anxiety disorder include:^{5, 2}

• Selective serotonin reuptake inhibitors (SSRIs), to relieve anxiety. SSRIs are often the first type of medication used to treat generalized social anxiety disorder.⁶
• Benzodiazepines, to relieve anxiety. They are fast-acting; however, they may be habit-forming and are not generally used in those with substance abuse problems.
• Monoamine oxidase inhibitors (MAOIs), to relieve depression and anxiety. MAOIs have potentially serious side effects when they are taken with certain foods (such as some cheeses and red wine).
• Beta-blockers, to reduce anxiety. Beta-blockers are sometimes used to treat physical symptoms of anxiety (such as tremors or rapid heart rate).
• Venlafaxine, to help relieve anxiety and depression.

Ongoing treatment of social anxiety disorder usually includes continuing psychological counseling and regular checkups to monitor any medications you may be taking. If professional counseling alone has not reduced your anxiety symptoms, medications may be added to your treatment.

If your anxiety is triggered by many social situations (generalized), you may need continuous and prolonged treatment with a combination of counseling and medications. During this time, your health professional will need to monitor your medications. If one medication is ineffective, you and your health professional may decide you should try another.

Treatment if the condition gets worse

With social anxiety disorder, it is possible to progress from debilitating fear of one social situation to having anxiety about all social encounters (generalized). If this occurs, additional treatment is needed that usually includes adding medications and increasing the amount of professional counseling you receive.

You may also feel more anxious when starting professional counseling. This is because you are thinking about the situations that cause you fear and anxiety. Once the situations have been identified, the fears can be addressed through counseling—especially cognitive-behavioral therapy which includes exposure therapy—gradually exposing you to your fear.

If you are taking medications to treat social anxiety disorder, you will need regular checkups to monitor the medications (such as selective serotonin reuptake inhibitors) and their potential side effects. The medications may cause bothersome side effects that may make your anxiety worse at first. These side effects may get better over time. But if they do not, you may need to take a different medicine.

If social anxiety disorder is left untreated or improperly treated, it can cause debilitating distress that interferes with daily activities. Physical symptoms such as rapid heart rate, blushing, shortness of breath, and dizziness can occur and need to be assessed.

Other psychological conditions (such as depression or substance abuse) may accompany social anxiety disorder, and these conditions need additional treatment. If left untreated, the combination of social anxiety disorder and another psychological condition (such as depression) can increase the risk of attempted suicide.³

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Author:	Jeannette Curtis	Last Updated: August 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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