The two most common types of treatment for social anxiety disorder are medications and psychological counseling (psychotherapy). These two approaches may be used in combination.
Psychological counseling (psychotherapy) improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself. Cognitive behavioral therapy is the most common type of counseling for anxiety. This type of therapy is based on the idea that your own thoughts — not other people or situations — determine how you behave or react. Even if an unwanted situation won't change, you can change the way you think and behave.
Cognitive behavioral therapy may also include exposure therapy. In this type of therapy, you gradually work up to facing the situations you fear most. This allows you to become better skilled at coping with these anxiety-inducing situations and to develop the confidence to face them. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others.
Your mental health professional may help you develop relaxation or stress management techniques.
First choices in medications
Several types of medications are used to treat social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) are often the first type of medication tried for persistent symptoms of social anxiety. SSRIs your doctor may prescribe include:
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac, Sarafem, others)
The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) also may be an option for social anxiety disorder.
To reduce the risk of side effects, your doctor will start you at a low dose of medication and gradually increase your prescription to a full dose. It may take up to three months of treatment for your symptoms to noticeably improve.
Other medication options
Your doctor or mental health provider may also prescribe other medications for symptoms of social anxiety, including:
- Other antidepressants. You may have to try several different antidepressants to find which one is the most effective and has the fewest unpleasant side effects.
- Anti-anxiety medications. A type of anti-anxiety medication called benzodiazepines (ben-zo-di-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming. Because of that, they're often prescribed for only short-term use. They may also be sedating. If your doctor does prescribe anti-anxiety medications, make sure you try taking them before you're in a social situation so that you know how they will affect you.
- Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They're not recommended for general treatment of social anxiety disorder. As with anti-anxiety medications, try taking them before you need them to see how they affect you.
Stick with it
Don't give up if treatment doesn't work quickly. You can continue to make strides in psychotherapy over several weeks or months. And finding the right medication for your situation can take some trial and error.
For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.
To make the most of treatment, keep your medical or therapy appointments, take medications as directed, and talk to your doctor about any changes in your condition.
Aug. 23, 2011
- Social phobia (social anxiety disorder). In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed June 11, 2011.
- Schneier FR. Social anxiety disorder: Epidemiology, clinical manifestations, and diagnosis. http://www.uptodate.com/home/index.html. Accessed June 17, 2011.
- Hollander E, et al. Social phobia (social anxiety disorder). In: Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed June 11, 2011.
- Phobic disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec15/ch196/ch196e.html. Accessed June 17, 2011.
- Hofmann SG. Psychotherapy for social anxiety disorder. http://www.uptodate.com/home/index.html. Accessed June 17, 2011.
- Bruce TJ, et al. Pharmacotherapy for social anxiety disorder. http://www.uptodate.com/home/index.html. Accessed June 17, 2011.
- Lee RA. Anxiety disorders. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/154207005-3/0/1494/57.html?tocnode=54111716&fromURL=57.html#4-u1.0-B978-1-4160-2954-0..50014-4_229. Accessed June 10, 2011.
- Lakhan SE, et al. Nutritional and herbal supplements for anxiety and anxiety-related disorders: Systematic review. Nutrition Journal. 2010;9:42. http://www.nutritionj.com/content/9/1/42. Accessed June 17, 2011.