Social Anxiety Disorder Treatments

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Social anxiety disorder (SAD) involves a persistent fear or anxiety in social settings. This can make group interactions incredibly anxiety-provoking, to the point where some people with this condition avoid them altogether. But help does exist, with the most common social anxiety disorder treatments being medication and psychotherapy.

Here we talk about some of the most common—and most effective—social anxiety disorder medication and therapy options, as well as how to find help if you think that you may have this mental health disorder. The main thing to remember is that treatment is available to ease the fear and anxiety you feel in social situations.

At a Glance

Social anxiety disorder treatments typically include medication, therapy, or both. There are a variety of options for each, including serotonin reuptake inhibitor and beta-blocker medications, along with various forms of "talk therapy." A physician or mental health therapist can help determine the best treatment plan for you based on your condition's severity and symptoms.

Social anxiety disorder treatments
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Social Anxiety Disorder Medication Options

Several different types of medications can help treat SAD. This provides your healthcare provider with multiple psychopharmacological options to try when working to resolve or reduce your specific social anxiety symptoms.

Here's an overview of the most common or preferred social anxiety disorder medication options. Drugs within all these categories have been found to be effective in treating this disorder.

Some of these medications are approved by the U.S. Food and Drug Administration (FDA) for treating social anxiety disorder, whereas others may be prescribed off-label due to their potential for providing benefits even if the drug's safety and efficacy have not been established for this purpose.

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) ease social anxiety by reducing the body's ability to absorb or "reuptake" the neurotransmitter serotonin. This increases serotonin levels in the brain, which helps better regulate feelings of anxiousness and mood.

Research indicates that SSRIs are the most consistent social anxiety disorder medication for providing benefits, especially when used as a standalone treatment. They're also the one drug category that has been shown to best reduce the risk of relapse with this disorder.

SSRI medications include:

  • Paxil CR (paroxetine)
  • Luvox CR (fluvoxamine)
  • Zoloft (sertraline)
  • Lexapro (escitalopram)
  • Celexa (citalopram)
  • Prozac (fluoxetine)

Due to the potential for withdrawal effects, SSRIs should always be tapered or their dosage reduced slowly when ending treatment.

Serotonin-Norepinephrine Reuptake Inhibitors

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressants used to treat anxiety disorders. As their name suggests, these drugs act on the neurotransmitters serotonin and norepinephrine. Serotonin affects social behaviors while norepinephrine impacts alertness and attention.

SNRIs have been found to be as effective as SSRIs for treating social anxiety. They may be used as an initial treatment, or they may be used if you've tried SSRIs but haven't obtained the desired therapeutic effects.

SNRI medication options include:

  • Effexor XR (venlafaxine)
  • Cymbalta (duloxetine)
  • Pristiq (desvenlafaxine)
  • Fetzima (levomilnacipran)

Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors (MAOIs) block the enzyme monoamine oxidase. This helps reduce social anxiety because monoamine oxidase breaks down the neurotransmitters serotonin, norepinephrine, and dopamine. Thus, blocking it helps increase the level of these neurotransmitters.

MAOIs were once a first-line treatment for social anxiety disorder. However, these medicines carry a risk of serious side effects if certain dietary and medication guidelines are not followed. This can make them a less desirable treatment option.

That said, if you've tried other social anxiety disorder medications and they haven't worked, your care provider may switch you to an MAOI. This is because MAOIs have been found to be useful when social anxiety symptoms are treatment-resistant.

MAOI medications include:

  • Nardil (phenelzine)
  • Parnate (tranylcypromine)
  • Marplan (isocarboxazid)

Beta-Blockers

Beta-blockers are an off-label social anxiety treatment. These drugs can help reduce feelings of anxiousness by blocking adrenaline receptors, with adrenaline being a hormone that your body produces when faced with a situation that instigates a fight-or-flight response.

Because they are quick-acting, beta-blockers are usually taken orally prior to an anxiety-inducing event, such as before a performance or speaking in public. They can help reduce the physical symptoms of anxiety, which include a rapid heart rate, hand tremors, and the “butterflies in the stomach” feeling.

Beta-blockers can be especially useful when faced with anxiety-provoking situations that require mental sharpness because they don't adversely affect cognitive ability.

Drug options in this category include:

  • Inderal (propranolol)
  • Tenormin (atenolol)
  • Zebeta (bisoprolol)

Benzodiazepines

Benzodiazepines are mild tranquilizers that slow down the central nervous system. They work by enhancing GABA activity, a neurotransmitter that creates feelings of calmness, resulting in both sedative and anti-anxiety effects.

Although fast-acting and well-tolerated, benzodiazepine drugs have the potential to be habit-forming. In addition to becoming dependent on the drug, taking benzodiazepines long-term can also increase a person's risk of cognitive decline and falls.

Clinical guideline recommendations suggest that benzodiazepines should not be used to treat anxiety for longer than eight weeks.

Options in this drug category include:

  • Ativan (lorazepam)
  • Valium (diazepam)
  • Xanax (alprazolam)
  • Klonopin (clonazepam)

Other Anxiety Medications

Although evidence of treatment is small, there are a few other medication options that healthcare providers may consider prescribing for social anxiety disorder. They include:

  • Anticonvulsants such as Neurontin (gabapentin) and Lyrica (pregabalin)
  • Antidepressant medications like Wellbutrin (bupropion), or tricyclic antidepressants such as Tofranil (imipramine)
  • Antihistamines like Vistaril (hydroxyzine)
  • Antipsychotics such as Zyprexa (olanzapine)
  • Anxiolytic or anti-anxiety medicines like BuSpar (buspirone hydrochloride)

Your physician or mental health therapist can help determine if you might benefit from a social anxiety disorder medication and, if so, which one to try.

Social Anxiety Disorder Psychotherapy Options

Psychotherapy, also known as "talk therapy," is another common social anxiety disorder treatment. It can be used alone or it may be used in combination with a social anxiety disorder medication.

The best approach for you depends, in part, on your particular symptoms. People with social anxiety in all group situations often respond best to a combination of medication and therapy, while therapy alone is often sufficient for those with anxiety specific to one type of performance or social situation.

Like the medications, people with social anxiety have various therapy-based options. Each psychological method is geared toward helping create a more positive response when faced with social situations. Here are several to consider.

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Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a first-line psychotherapeutic treatment for SAD. This form of psychotherapy is designed to modify a person's thoughts and behaviors in order to positively influence their emotions. Research indicates that CBT is the best intervention for treating social anxiety, especially in the initial treatment phases.

There are three CBT techniques that can help ease social anxiety symptoms:

  • Exposure
  • Cognitive restructuring
  • Social skills training

Exposure

Exposure therapy involves either imagining or actually experiencing a specific social situation in real life. The underlying principle is that, through practice and experience, you will become more comfortable in situations that you might otherwise avoid.

The type of exposure can depend on the severity of your symptoms. If you have severe social anxiety, for example, your therapist may begin with imagined exposure. Once you're more comfortable with imagined experiences, you may then progress to real-life exposures.

Cognitive Restructuring

Cognitive restructuring focuses on the mental symptoms of SAD. This can include having a 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 identifying negative thoughts, evaluating how true—or untrue—they are, and then constructing more positive thoughts to replace the original thoughts. Challenging negative self-imagery is important to treating social anxiety disorder.

Social Skills Training

Social skills training decreases anxiety in social situations by teaching individuals the skills needed to positively interact with others in these types of settings. Areas that might be targeted include learning how to maintain good eye contact, engage in conversation, and ways to be assertive when needed.

Social skills training can include modeling, rehearsal, and role-playing. While it does teach important skills, this type of social anxiety therapy isn't for everyone as it is more focused on helping people with social interaction deficits above and beyond social anxiety.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is another social anxiety disorder treatment. This therapeutic approach is based on Buddhist philosophy.

Through ACT, people with social anxiety disorder learn how to accept their negative thoughts and anxiety rather than trying to eliminate them. This helps reduce their inner struggle, enabling the symptoms to naturally lessen.

An ACT therapist can use a variety of techniques to help patients accept their social anxiety and make a commitment to change their behaviors. Options include engaging in experiential exercises, values-guided interventions, or mindfulness training.

Psychodynamic Therapy

Psychodynamic therapy involves identifying any underlying issues from childhood that may have contributed to social anxiety development. Research indicates that, over the long term, this type of therapy works just as well for treating social anxiety disorder as CBT.

Psychodynamic therapy can be most useful for people with deep, unresolved conflicts contributing to their social anxiety. It may also be helpful in some instances to explore a potential resistance to change.

Some people may respond well to initial treatment and not require anything further, while others may require some form of therapy throughout their lives.

Alternative Social Anxiety Disorder Treatments

Roughly 43% of people with anxiety disorders look for alternative therapies. These can be used in combination with or in place of more traditional treatment methods. While not all alternative treatments have been scientifically proven to help reduce SAD symptoms, some do show promise.

For example, one analysis found that both yoga and mindfulness-based meditation have been found to enhance anxiety disorder treatment when used in conjunction with other treatment options. Massage therapy has shown positive results for anxiety disorders as well.

One thing to keep in mind is that most studies address the use of alternative treatments for anxiety disorders in general. Thus, it is unclear whether these approaches will work for social anxiety specifically.

Finding Social Anxiety Disorder Treatment

Reaching out for help can feel uncomfortable and anxiety-provoking in and of itself. Know that by seeking treatment, you are taking a step in the right direction to alleviate your social anxiety over the long term.

To find the best social anxiety disorder treatment for you, here are some steps you can take:

  1. Talk to someone you trust, such as your primary care physician or a religious counselor, about the problems you are experiencing. You could also talk to a friend or family member and ask for their support in finding help.
  2. Look online for social anxiety disorder treatment. There is an increasing number of websites that can help match you with a professional based on your symptoms, schedule, and health insurance. You also do a search for "social anxiety disorder therapists near me."
  3. Consider the type of treatment you want or need. Professionals who provide mental health therapy services include psychologists, social workers, and counselors. If you require medication, you will need to speak to a psychiatrist. If you are looking for alternative treatments, seek out a physician who practices integrative medicine.
  4. Make an appointment. Once you find a treatment provider you'd like to work with, the next step is to call and make an appointment. When making this call, it can be helpful to inquire about the cost of their services and whether they accept your insurance.

The best treatment for your social anxiety disorder can depend on the severity of your symptoms and how much this condition affects your daily functioning. The length of treatment also varies. 

Before your first appointment, it can also help to take a few notes on your thoughts and feelings so you have a starting point for discussion. Though it may feel difficult initially, the more honest you are with your care provider, the more progress you can begin to make with managing your social anxiety.

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By Arlin Cuncic, MA
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." She has a Master's degree in psychology.