Treatments for social anxiety disorder (SAD) depend on the severity of your emotional and physical symptoms and how well you function daily. The length of treatment also varies. Some people may respond well to initial treatment and not require anything further, while others may require some form of support throughout their lives.
Both medication and therapy have been shown effective in treating SAD. Generalized SAD responds best to a combination of medication and therapy, while therapy alone is often sufficient for specific SAD. Below is a description of the main treatments for SAD.
Several different types of medication are prescribed to treat SAD. Each has its advantages and disadvantages depending on your particular situation.
Benzodiazepines are mild tranquilizers that prevent or reduce the symptoms of anxiety. They have several effects on the brain that are generally sedative. Some examples of brand name benzodiazepines are:
Although fast-acting and well-tolerated, benzodiazepines have the potential to be habit-forming and would not be prescribed for someone with a substance abuse disorder. This class of medications is not considered the first-line of treatment for SAD.
Beta blockers are a form of medication that can be taken orally a few hours before a performance to reduce symptoms of anxiety such as a rapid heart rate, hand tremors, and the “butterflies in the stomach” feeling. Beta blockers are considered a better alternative than benzodiazepines for performance situations because they do not have adverse effects on mental sharpness. Some brand name beta blockers include:
Monoamine Oxidase Inhibitors (MAOIs)
Until recently, MAOIs were considered the most effective family of medications for SAD. However, this class of medications can have potentially serious side effects. Because of the risks associated with MAOIs, they are generally not considered for treatment of SAD unless other medications have not been helpful, or other reasons suggest using this class of medications. Here are some brand name MAOIs:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs have become the preferred type of medication for treating SAD. SSRIs are preferred because the side effects are generally well-tolerated and the medication is generally easy to dispense and monitor. Some examples of brand name SSRIs include:
Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are a group of antidepressants used in the treatment of anxiety, depression, and related disorders. SNRIs act on both serotonin and norepinephrine in the brain; norepinephrine has been linked to energy and alertness. Below are a list of SNRIs. Only Effexor has been approved for the treatment of SAD.
Other Medications for SAD
There are several other medications used off-label for SAD that do not fall into the above classes. Some examples include:
CBT is a form of psychotherapy designed to modify your thoughts and behaviors in order to positively influence your emotions. Three major cognitive-behavioral techniques have been shown to help treat SAD -- exposure, cognitive restructuring, and social skills training.
Exposure can take place either through imagining the specific performance or social situation, or in-vivo. If you have extremely severe SAD, your therapist may begin with imagined exposure and eventually progress to in-vivo. The underlying principle of exposure therapy is that through practice and experience, you will become more comfortable in situations that you would otherwise avoid.
Below are some exposure exercises that you can practice on your own:
Cognitive restructuring focuses on the cognitive symptoms of SAD: poor self-concept, fear of negative evaluation by others, and negative attribution bias (attributing positive outcomes to chance and negative outcomes to your own shortcomings).
Cognitive restructuring involves a series of exercises designed to identify negative thoughts, evaluate how true they are, and construct alternative thoughts to challenge the original thoughts. Cognitive restructuring is thought to be important for the treatment of SAD because of the strong cognitive aspect of the disorder and the typical chronic lifetime course.
Social Skills Training
Social skills training involves various exercises such as modeling, rehearsal and role-playing designed to help people learn appropriate behaviors and decrease anxiety in social situations. Not everyone will require social skills training as part of their treatment. These exercises are designed specifically for people who have actual deficits in social interaction above and beyond social anxiety. Below are some areas that might be targeted for social skills training:
Psychodynamic therapy, in which a therapist tries to elicit a person’s underlying emotions so that he can work through them, is helpful for some people with SAD. It will be most useful for people who have a deeper unresolved reason for their anxiety. Psychodynamic therapy may help address the potential influences of the patient's early life experiences, and also may be useful in some instances to explore potential resistance to change.
Alternative TreatmentsAlternative treatments for SAD include such things as dietary supplements, aromatherapy, and hypnotherapy. It is important to realize that most alternative treatments have not been scientifically proven to work in the treatment of SAD. In addition, alternative treatments may not be regulated as strictly as standard forms of treatment. Below are some alternative treatments for SAD:
Hales, R.E., & Yudofsky, S.C. (Eds.). (2003). The American psychiatry publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric.