Study: For social anxiety disorder, talk therapy beats meds

Oct. 9, 2014—About 15 million Americans live with social anxiety disorder, a phobia characterized by avoidance of social situations. And though antidepressants are a common form of treatment, the results of a new study published in The Lancet Psychiatry suggest that cognitive behavior therapy (CBT) may be the better choice—especially in the long term.

About the study

To analyze the effectiveness of various social anxiety disorder treatments, researchers reviewed data from more than 13,000 participants with the disorder in 101 studies. Over 4,000 participants underwent psychological interventions, while approximately 9,000 received medication or placebo pills.

Among the psychological intervention group, CBT was found to be most effective. A form of talk therapy, CBT involves learning how to identify distorted or irrational thoughts, why they influence behavior, and how to overcome them. This process involves active involvement from both patient and therapist to focus on the patient’s current problems and determine the best way to resolve them.

SSRIs versus CBT

SSRIs, a class of antidepressants, were found to be the most effective medication included in the study. However, these drugs may come with adverse side effects that include increased agitation and sexual dysfunction—issues that may further complicate social anxiety.

In addition, negative symptoms of social anxiety disorder tend to return when people stop taking SSRIs. CBT, however, provided greater long-term results, as researchers reported those who followed this course of talk therapy had maintained their progress well when researchers followed up with them, and they continued to make positive gains over social anxiety after treatment had ended.

The findings suggest that social anxiety disorder is highly treatable, but that certain treatments may be better than others. While antidepressants can help social anxiety sufferers manage symptoms in the short term, CBT is more likely to teach people to cope with their fears after treatment ends.

For more details, read the study published in The Lancet Psychiatry, here.


The take-home message

According to the National Institute of Mental Health (NIMH), social anxiety disorder—or social phobia—often begins in childhood or adolescence and may be accompanied by other anxiety issues or depression. Often, the disorder is characterized by symptoms such as:

  • Anxiety about being with other people or having difficulty talking to them
  • Feeling self-conscious or embarrassed in front of people
  • Fear of being judged by others
  • Worrying for days and weeks before a social event
  • Staying away from social situations
  • Having a hard time making or keeping friends
  • Blushing, sweating or trembling around people
  • Feeling nauseated around people

Treating social anxiety disorder

The NIMH says antidepressants, especially SSRIs, can help ease symptoms of social anxiety disorder. However, they may also cause side effects such as headache; nausea; difficulty sleeping; and, in some people, suicidal thoughts. What’s more, the medications aren’t recommended for long-term use, and once a person stops taking them, symptoms can reappear.

CBT may be a more effective treatment. With the help of a psychotherapist, people learn skills for coping with their social anxieties. The NIMH suggests this process can help them manage their disorder in the long term.

If you are experiencing symptoms of social anxiety disorder, talk with your doctor. Together, you can determine the best way to address your symptoms—and work to begin to feeling more comfortable in social situations.

Learning more about anxiety can be the first step to seeking help. Find out more about anxiety and how it can affect health and well-being.


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