Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The two most common types of treatment for social anxiety disorder are psychotherapy (also called psychological counseling or talk therapy) or medications or both.
Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations.
Cognitive behavioral therapy is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups.
In exposure-based cognitive behavioral therapy, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries.
First choices in medications
Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your doctor may prescribe paroxetine (Paxil) or sertraline (Zoloft).
The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder.
To reduce the risk of side effects, your doctor may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve.
Your doctor may also prescribe other medications for symptoms of social anxiety, such as:
- Other antidepressants. You may have to try several different antidepressants to find one that's the most effective for you with the fewest side effects.
- Anti-anxiety medications. Benzodiazepines (ben-zoe-die-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they're typically prescribed for only short-term use.
- 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.
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, challenge yourself by setting goals to approach social situations that cause you anxiety, take medications as directed, and talk to your doctor about any changes in your condition.
Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies people report no benefits from their use. More research is needed to fully understand the risks and benefits.
Some herbal supplements, such as kava and valerian, increase the risk of serious liver damage. Other supplements, such as passionflower or theanine, may have a calming effect, but they're often combined with other products so it's hard to tell whether they help with symptoms of anxiety.
Before taking any herbal remedies or supplements, talk with your doctor to make sure they're safe and won't interact with any medications you take.