Talk Therapy May Best Treat Social Anxiety Disorder

Cognitive behavioral therapy may treat social anxiety disorder more effectively than medication

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Antidepressants may be the go-to treatment for social anxiety disorder, but one type of talk therapy may be more effective and have longer-lasting effects.

A new study assessed treatments for social anxiety. These treatments included several types of medications and talk therapy.

The study authors found that individual cognitive behavioral therapy (CBT) was the most effective and longest-lasting treatment for social anxiety disorder.

"Social anxiety is more than just shyness," said lead study author Evan Mayo-Wilson, DPhil, of the Johns Hopkins Bloomberg School of Public Health, in a press release. "People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering."

CBT is a one-on-one therapy that asks the patient to assess the relationships between his or her thoughts, feelings and behaviors. Dr. Mayo-Wilson noted that it can help patients overcome irrational fears.

"CBT and especially mindfulness-based CBT prove to be very effective for treating social anxiety disorder and other anxiety disorders because this approach treats the underlying cause of the anxiety disorder, whereas antidepressants and other medications can only provide temporary relief from symptoms, but do nothing to change the underlying cognitive and psychological causes," said Peter Strong, PhD, Professional Psychotherapist at the Boulder Center for Mindfulness Therapy in Colorado.

"In my opinion, anxiety medications are over over-prescribed, and should not be the first choice for treating anxiety," Dr. Strong told dailyRx News.

Social anxiety disorder is marked by an irrational fear of social situations. It often begins in the early teen years and can color formative periods in which the patient is expected to be social but can't or refuses to.

Many patients with social anxiety disorder may never get treatment — either because they do not seek it or they do not have access to it. For those who do, medication is by far the most common approach, the study authors noted.

However, according to the study, which comprised 101 past studies for a total of 13,164 patients with social anxiety disorder, medication may not be the best approach.

About 9,000 patients had taken medication or a placebo pill. Roughly 4,000 underwent some form of therapy. 

The authors found that CBT was the most effective form of treatment among these patients. It produced results that lasted beyond treatment. 

But that doesn't mean pills won't work — the most common antidepressants to treat social anxiety, selective serotonin reuptake inhibitors, were also effective. The authors noted, however, that these and similar treatments often have severe side effects, don't work at all or don't have lasting effects when treatment stops.

The study authors said more patients with social anxiety disorder should have access to treatment.

"Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce health care costs," Dr. Mayo-Wilson said. "The health care system does not treat mental health equitably, but meeting demand isn't simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff."

The authors noted that the research did not look at the effect of CBT and medications combined.

The study was published online Sept. 25 in The Lancet Psychiatry.

The National Institute for Health and Care Excellence funded the research. Study author David M. Clark developed one type of CBT used in the study.

Review Date: 
September 24, 2014
Last Updated:
October 8, 2014