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.
Overall, both medication and therapy have been shown to be effective in treating SAD. People with generalized SAD often respond best to a combination of medication and therapy while people with specific SAD may find that therapy alone is sufficient. Below you will find a description of the main types of medication used as well as the components of cognitive-behavioral therapy, the most effective form of therapy for SAD.
Medication
Several different types of medication are prescribed to treat SAD. Each has its advantages and disadvantages depending on your particular situation.
- Benzodiazepines
Benzodiazepines are mild tranquilizers that prevent or reduce the symptoms of anxiety by slowing down the central nervous system. Some examples of brand name benzodiazepines are Xanax, Ativan and Valium. 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
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.
- 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 if strict dietary and medication restrictions are not followed. 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 (such family history of good results).
- Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs have become the preferred type of medication for treating SAD. Some examples of brand name SSRIs include Celexa, Prozac, Paxil, and Zoloft. Prescription of SSRIs will generally begin at low dosage and gradually increase over time; it may take several weeks for the medication to be effective. SSRI’s are preferred because the side effects are generally well-tolerated and the medication is generally easy to dispense and monitor. If you are prescribed an SSRI, it is important to take the medication as prescribed and never to stop cold turkey (a period of tapering is used to end treatment).
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a form of psychotherapy designed to modify your everyday 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
- Cognitive Restructuring
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 that have actual deficits in social interacting above and beyond social anxiety.
Exposure can take place either through imagining the specific performance or social situation or in-vivo (in the real-life feared situation). 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.
Other Psychotherapies
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. It may also help address the potential influence of family on the person receiving SAD treatment.
Source:
Hales, R.E., & Yudofsky, S.C. (Eds.). (2003). The American psychiatry publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric.
