The Best Treatments for Social Anxiety Disorder

The Best Treatments for Social Anxiety Disorder Social Anxiety Disorder Treatment and Therapy Print Treating Social Anxiety Disorder By Arlin Cuncic 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. Learn about our editorial policy Arlin Cuncic Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on August 09, 2019 Social Anxiety Disorder Overview Symptoms & Diagnosis Causes Treatment Living With In Children In This Article Table of Contents Expand Prescription Medications Psychological Therapies Complementary Treatments Finding Treatment View All 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 social anxiety disorder. Social anxiety that occurs in all situations responds best to a combination of medication and therapy, while therapy alone is often sufficient for people with anxiety specific to one type of performance or social situation.???? So, if youve been diagnosed or think you may have SAD, know that its possible to overcome it. Illustration by Brianna Gilmartin, Verywell Prescription Medications Several different types of medications are prescribed to treat  SAD. Each has its advantages and disadvantages depending on your particular situation.?? A meta-analysis of the effectiveness of medication in SAD treatment showed a small to medium-sized effectâ€"with all of the following categories of medications showing improvements.This means that several different types of medication may be helpful in improving symptoms of social anxiety disorder, and that one may be a useful form of treatment for you. Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs are considered the first-line pharmacotherapy treatment due to their tolerable side effects and ease of administration. However, due to the potential for withdrawal effects, SSRIs should always be tapered when ending treatment.?? Options include: Paxil CR (paroxetine)Luvox CR (fluvoxamine)Zoloft (sertraline)Lexapro (escitalopram)Celexa (citalopram)Prozac (fluoxetine) A 2014 meta-analysis found paroxetine (brand name Paxil) to be the second most effective form of medication treatment for social anxiety disorder. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) SNRIs are  a class of antidepressants  used in anxiety treatment that act on the neurotransmitters  serotonin  and norepinephrine. Options include: Effexor XR (venlafaxine)Cymbalta (duloxetine)Pristiq (desvenlafaxine) Venlafaxine extended-release (brand name Effexor) was found to be the third most effective type of medication for SAD in the same 2014 meta-analysis. Monoamine Oxidase Inhibitors (MAOIs) MAOIs were once considered the most useful treatment for social anxiety disorder; however, these medications carry with them the risk of serious side effects if dietary and medication guidelines are not followed. Options included: Nardil (phenelzine)Parnate (tranylcypromine)Marplan (isocarboxazid) Today, due to concerns about side effects, MAOIs are not often used in the treatment of SAD. At the same time, a 2014 meta-analysis found that phenelzine (brand name Nardil) was the most effective form of pharmacotherapy for social anxiety disorder. Beta Blockers Beta blockers are usually taken orally prior to an anxiety-inducing event such as a performance to reduce symptoms of anxiety such as rapid heart rate, hand tremors, and the “butterflies in the stomach” feeling. Options include: Inderal (propranolol)Tenormin (atenolol) Beta blockers are useful in situations that require mental sharpness because they do not have adverse effects on cognitive ability. Benzodiazepines Benzodiazepines are mild tranquilizers that alleviate the symptoms of anxiety by slowing down the  central nervous system. Although fast-acting and well-tolerated, benzodiazepines have the potential to be habit-forming and should not be prescribed for someone with a substance abuse disorder. Options include: Ativan (lorazepam)Valium (diazepam)Xanax (alprazolam)Klonopin (clonazepam) This class of medications is not considered the first-line of treatment for social anxiety disorder. Other Anxiety Medications There are several other medication options doctors may consider, including: Vistaril (hydroxyzine)BuSpar (buspirone hydrochloride) If you are not sure of your treatment options, talk to your doctor about the potential use of medication for your particular situation. Psychological Therapies Psychotherapy can be used alone or together with prescription medications. The various options are psychological methods geared towards helping someone change their behavior to something desirable. There is a common stigma associated with going to a psychotherapist or psychiatrist, but millions of people go and benefit from it. There is nothing to be embarrassed or ashamed of. You can try asking your primary care physician for a referral to a therapist or mental health professional. There is also an increasing number of websites that can help match you with a professional based on your symptoms, schedule, and health insurance. The Best Online Therapy Programs Try taking a few notes on your thoughts and feelings so you have a starting point for discussion on your first appointment. Though it may feel difficult at first, the more honest you are with your doctor, the more progress you can begin to make with managing your anxiety. Social Anxiety Disorder Discussion Guide Get our printable guide to help you ask the right questions at your next doctors appointment. Download PDF Cognitive-Behavioral Therapy (CBT) CBT is the first-line psychotherapeutic treatment for SAD. It is a form of psychotherapy designed to modify your thoughts and behaviors in order to positively influence your emotions. 3 Types of CBT Techniques exposurecognitive restructuringsocial skills training Exposure Exposure can take place either through imagining or experiencing a specific performance or social situation in real life. If you have extremely severe social anxiety disorder, your therapist may begin with imagined exposure and eventually progress to real-life exposures. 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. Try It Out Exposure  for  shy bladder syndromeExposure  for  phone fears 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 original thoughts. Cognitive restructuring is thought to be important for the treatment of social anxiety disorder because of the strong cognitive aspect of the disorder and how longstanding these underlying beliefs often are. What Is Cognitive Restructuring? 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. Areas that might be targeted for social skills training include eye contact, conversation, assertiveness, and telephone calls. An Overview of Social Skills Training Acceptance and Commitment Therapy Acceptance and commitment therapy (ACT) for social anxiety disorder is a third-wave technique developed after CBT. It is based on Buddhist philosophy. Through ACT, you learn how to accept negative thoughts and anxiety rather than trying to eliminate them. By detaching yourself from your social anxiety, it is expected that your symptoms will naturally lessen. An ACT therapist uses experiential exercises, values-guided interventions, and mindfulness skills training as part of therapy. Why Acceptance and Commitment Therapy Is Used to Treat SAD Psychoanalysis Psychoanalysis and psychodynamic therapy involve a therapist helping you to understand underlying issues from childhood that may have contributed to your social anxiety. It is most useful for people who have deeper unresolved conflicts contributing to their anxiety. Psychoanalysis may also be useful in some instances to explore potential resistance to change. How Psychoanalysis Is Used in Treating Social Anxiety Disorder Complementary Treatments Alternative treatments for social anxiety disorder include such things as dietary supplements, aromatherapy, and yoga. 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. Finding Treatment The steps for finding treatment for social anxiety disorder are the same as those for any mental health issue. Talk to someone, such as a family doctor or religious counselor, about the problems you are experiencing. You could even start by telling a friend or family member and asking for his or her support in finding help.If a doctor is not able to refer you to a mental health professional, you may consider searching terms such as find a social anxiety disorder therapist near me. Professionals who provide mental health therapy services typically include psychologists, social workers, and counselors. If you require medication, you will need to speak to a psychiatrist through a referral from a doctor. If you are looking for alternative treatments, seek out a physician who practices integrative medicine.Call to make an appointment and inquire about the cost of services and whether they will be covered by insurance. A Word From Verywell Reaching out for help the first time can feel uncomfortable and anxiety-provoking in and of itself. Know that you are taking the best first step in the right direction to alleviate your social anxiety over the long term. Living Well With Social Anxiety Disorder