Department of Psychiatry
Penn Behavioral Health

Center for the Treatment and Study of Anxiety

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Social Anxiety Disorder

Treatment




The term Social Phobia was introduced in the early 1900s when psychiatrists began using the phrase to describe excessively shy patients. Isaac Marks is credited for proposing Social Anxiety Disorder as a distinct anxiety disorder in 1960. Twenty years later, the disorder was finally recognized as an official diagnosis by the American Psychiatric Association in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. Initially, Social Phobia was the accepted name for the disorder, however, now the names Social Phobia and Social Anxiety Disorder are used interchangeably.


Medication

The use of antidepressant medication in the treatment of Social Anxiety Disorder has proven effective in reducing the anxiety of the disorder. Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressant drugs, are a standard treatment for Social Anxiety Disorder treatment. The three medications specifically approved by the Food and Drug Administration for treating Social Anxiety Disorder are:

  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Venlafaxine (Effexor)

Although the above SSRIs are the first choice, if they are found to be ineffective, other antidepressant medications may be used. Anti-anxiety medications, specifically benzodiazepine, are often prescribed for Social Anxiety Disorder. However, people easily become dependent therefore the medication is generally prescribed for short-term use.

SSRIs may take several weeks to become effective. Thus, one common dosing strategy is to prescribe both an anti-anxiety medication and an SSRI during the few weeks that the SSRI is ineffective. The anti-anxiety medication is tapered off as the SSRI becomes more effective.

Unfortunately, because these drugs do not treat the underlying cause of the disorder, stopping use of Social Anxiety Disorder medication is frequently associated with relapse if the patient is not receiving other forms of psychotherapy treatment. Nonetheless, when used appropriately, these medications do provide some relief.





Psychotherapy

One of the most effective and lasting treatments of Social Anxiety Disorder is cognitive behavioral therapy (CBT). CBT is a form of therapy that has been successfully used to treat a wide variety of anxiety disorders. CBT approaches designed to treat Social Anxiety Disorder have two objectives. First, therapy helps individuals approach and subsequently overcome their fears by changing their unhelpful thought patterns. Second, therapy helps individuals learn to manage their physical responses to anxiety. In this way, CBT is able to address both the physical and emotional components of the disorder.

One therapeutic CBT approach focuses on exposure therapy. The therapy introduces the patient to repeated exposure of stressful social situations. This is accomplished both by imagining these social settings as well as by physically entering discomforting social situations. For instance, an individual with Social Anxiety Disorder may give a performance in front of a small audience or they may have a conversation with someone they had not previously met. To further address the anxiety, the individual is shown audience evaluations of the conversation or performance and given video recordings of the experience to watch and discuss. After watching the recordings and reading the evaluations, patients realize that their fears of appearing awkward or speaking improperly are unsubstantiated. The exposure desensitizes the individual to his or her fear and allows the individual to recognize his or her own psychological obstacles.

Importantly, this recognition provides the tools to approach future social settings. Those with Social Anxiety Disorder are accustomed to focusing inward upon themselves: Am I sweating? Is my face red? Are my hands shaking? Discussing this fact and acknowledging it through video recordings helps individuals understand the importance of focusing outward. As they then develop the ability to focus outward, these individuals foster a new perspective that is tremendously helpful in confronting future social situations.






Psychosocial treatments

There are various psychosocial techniques that have been employed for the treatment of social anxiety. Psychosocial methods have a strong focus on therapist-patient interactions and are more discussion-based than behavioral therapy treatments. The therapy sessions may involve group counseling or they may be personal counseling for one individual. Anecdotal reports consider the treatment helpful but there is less empirical evidence that these techniques are effective in ameliorating social anxiety symptoms.





Self-help treatment

There is a collection of books about Social Anxiety Disorder that offer potentially useful self-help techniques. Many books are written for a wide range of readers and address both clinical and non-clinical social anxiety. Nonetheless, the general aim for both populations is to help individuals manage and transform their disorder by furthering their own self-awareness and understanding. Self-help texts may provide some symptomatic relief but research indicates that professional treatment is more effective.




 

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