Psychotherapy is a very effective method for treating social anxiety disorder. Examples of psychotherapy are cognitive behavioural therapy, exposure therapy and social skills training. Both in combination or separately exposure therapy, cognitive behavioural therapy and social skills training are effective ways to treat social anxiety disorder. An overview:
If avoiding social situations is the patients biggest problem, then exposure therapy is the best type of psychotherapy for social anxiety treatment. Exposure therapy involves the repeated exposure of the patients feared context without any danger, in order to overcome their fear. This way the patient feels an increasing sense of control over the situation and the patient’s anxiety diminishes. There are 3 different types of exposure therapy: exposure in real-life, exposure through imagination, and interoceptive: focusing on the physical symptoms that accompany anxiety.
If irrational fear is the patients biggest problem, then CBT is the best type of psychotherapy for social anxiety treatment. CBT focuses on irrational thoughts (Are people really looking at you all the time?) and on people’s responses to anxiety-provoking situations. Slowly the person experiences that the thoughts are irrational and that social situations do not provoke so much anxiety.
Social skills training is an effective treatment for social anxiety as well. Social skills training for social anxiety focuses on: initiating conversations, initiating conversations/interacting with other sex, establishing friendships, constructing a speech and assertiveness skills. The idea behind social skills training is that by practicing these social skills someone gains confidence and has a bigger chance of succeeding.
There are several different types of medication that can be prescribed as social anxiety treatment: SSRIs, SNRIs, MAOIs, beta-blockers and anti-anxiety medications. Unfortunately every type of medication has a different effect on its user and therefore it can happen that someone needs to try out a few different types of medications in order to find an effective one for social anxiety treatment. An overview:
In people with social anxiety the neurotransmitters (such as, serotonin) are reabsorbed too quickly after being released, resulting in a neurotransmitter imbalance. A neurotransmitter imbalance is believed to cause social anxiety symptoms. SSRIs make sure that the neurotransmitter serotonin is not reabsorbed too quickly, so that this imbalance does not exist. This way the neurotransmitter can be active for a longer period of time. Serotonin affects mood, appetite and sleep. Side effects of SSRIs could be: sleeplessness, nausea, decreased appetite, sexual problems and constipation.
Effectiveness: According to a meta-analyses of van der Linden, Stein, & van Balkom (2000)* SSRIs are effective social anxiety treatment medications. SSRIs reduce the total levels of anxiety and improve the overall clinical condition of the patient. SSRIs are the medication of choice according to International Journey of Neuropsychiatric medicine***.
SNRIs work in the same way as do SSRIs. The difference is: besides re-uptaking serotonin, SNRIs also re-uptake norepinephrine and sometimes even dopamine. Side effects of SNRIs are: sleepiness, hypertension, gastrointestinal symptoms, weight gain or loss, restlessness, tremors, yawning, sedation, insomnia, and sexual dysfunction (abnormal erection and ejaculation, decreased libido).
Effectiveness: SNRIs are approximately equally effective as SSRIs.
MAOIs work in the same way as SSRIs and SNRIs: they make sure serotonin, norepinephrine and dopamine are not being reabsorbed and are therefore longer active in the brain. Nowadays doctors and psychiatrists only prescribe MAOI types A and B. MAO-A has an anti-depressive effect and is used for treating depression and dysthymia. MAO-B is used in Parkinson’s disease. Side effects of MAOIs are: sexual dysfunction, weight gain and feelings of a burning skin.
Effectiveness: MAOIs have found to be effective in treating social anxiety according to Blanco et al (2003)**. But they are less safe and less better tolerated by the body.
Beta-blockers do not affect emotional symptoms (such as: anxiety) but do block the flow of adrenaline when you are anxious. This reduces physical symptoms such as: shaky hands or voice, sweating or an increased heartbeat. For performance anxiety beta-blockers are a good medication. The problem with beta-blockers is that they reduce symptoms, but do not take away your social anxiety disorder. Another problem with beta-blockers is: they can become a safety behaviour: this means that someone will not attend social activities without taking beta-blockers.
Effectiveness: Beta-blockers are not the best social anxiety treatment medications; SSRIs, SNRIs and MAOIs are more effective medications to treat social anxiety. However, for treating performance anxiety Beta-blockers are a good choice.
Benzo’s are anti-anxiety medications that slow down the nervous system. They reduce or prevent symptoms such as: anxiety, sleeplessness, muscle spasms and seizures. Some benzo’s work for maximum 6 hours, others work a little longer: between 6-10 hours, or the ones that last longer. A general rule is: the longer the benzodiazepine works, the more side effects someone might experience.
Effectiveness: They are not the first medication of choice, because you can get addicted to them and because you over time need a higher dose to reach the same effect***. Furthermore Benzodiazepines are effective in treating social anxiety.
* Van der Linden, G. J., Stein, D. J., & van Balkom, A. J. (2000). The efficacy of the selective serotonin reuptake inhibitors for social disorder (social phobia): a meta-analyses of randomized controlled trials. International Clinical Psychopharmacology, 15, 15-23.
** Blanco, C., Schneier, F. R., Schmidt, A., Blanco-Jerez, C.-R., Marshall, R. D., Sánchez-Lacay, A. and Liebowitz, M. R. (2003). Pharmacological treatment of social anxiety disorder: A meta-analysis. Depress. Anxiety, 18: 29–40. doi: 10.1002/da.10096
*** International journey of neuropsychiatric medicine (see page 42).