What are the treatment options for social anxiety disorder (SAD)? As with many other mental health conditions, treatment for social anxiety disorder involves a combination of medication and therapy. Complementary therapies and behavior modification strategies are additional interventions that can be especially effective for all forms of anxiety.
About half of the people with SAD develop the disorder by the age of 11, making early intervention important. While social anxiety disorder treatment differs for children and adults, they both share broad features.
Cognitive behavioral therapy (CBT) is a favored treatment for both adults and children with social anxiety disorder. Some CBT techniques are the same for people of all ages, though CBT for children focuses more on behavior modification than cognitive interventions. Medication is often, but not always, used for both adults and children.
Medications for Social Anxiety Disorder
A wide range of anxiolytic or anti-anxiety medications are used as social anxiety disorder medication. Sedative medications are sometimes used, especially in severe cases of SAD. Commonly prescribed sedative medications are benzodiazepines and may include:
Benzodiazepines are known for their powerful sedative effects and are often requested by brand name. Unfortunately, they have highly addictive properties and are not recommended for people with co-occurring substance use disorders. This can be discouraging for people seeking relief from severe anxiety but does not mean that no relief is possible.
It’s important to understand that benzodiazepines do not cure anxiety disorders. They provide relief by dulling anxiety symptoms temporarily, and constant dosing is required to maintain this effect. Other medications used to treat anxiety have a more holistic effect on brain function and are a better option for many people.
Selective serotonin reuptake inhibitors (SSRIs) are a better option for people with co-occurring social anxiety and substance use disorders. They were originally developed in the 1980s to treat depressive disorders but have since been found to be just as effective for treating anxiety disorders. These SSRIs are the five most commonly prescribed for anxiety:
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
These medications increase the availability of serotonin, a neurotransmitter, in the brain. Research shows that SSRIs’ healing effects may be secondary to serotonin levels. Increased serotonin helps the brain rebuild connections and create new nerve cells in key regions. Selective serotonin reuptake inhibitors are a particularly good choice for people with co-occurring conditions. Research by Stein, Liebowitz and Lydiard provides evidence that paroxetine is an effective medication for social anxiety disorder.
Therapy for Social Anxiety Disorder
Many people ask how to treat social anxiety disorder without medication due to concerns about side effects from SSRIs and other anxiolytic medications. However, medication is not the primary intervention for SAD. Many mental health professionals consider talk therapy to be the only necessary form of treatment for social anxiety disorder.
Social anxiety disorder therapy may come in many formats or therapeutic modalities. Traditional psychodynamic psychotherapy can illuminate the deep-rooted sources of anxiety, while trauma-related therapies like eye movement desensitization and reprocessing (EMDR) and dialectical behavior therapy (DBT) can be effective interventions for people whose social anxiety is rooted in trauma. In general, however, the best interventions for social anxiety focus on modifying cognition and behavior.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is well-suited to treat social anxiety disorder. While physical, genetic and environmental factors can all lead to the development of SAD, it is sustained by anxious thoughts about a person’s social value and ability to successfully engage in social interactions. Negative thoughts lead to maladaptive behaviors, including avoidance of the activities necessary to succeed at work and school and to maintain a social support network.
Cognitive behavioral therapy specifically targets this interaction between thought and behavior. By helping people identify cognitive distortions and false, shame-based beliefs, CBT counters the mental processes that make people afraid to engage in social situations. When thoughts about social inferiority or unworthiness are undermined, social anxiety naturally decreases.
Acceptance and Commitment Therapy
Acceptance and commitment therapy (ACT) is a related intervention and popular alternative to traditional CBT. Like CBT, it helps people identify distorted beliefs that trigger painful emotions and behavior. However, while CBT encourages people to label thoughts as false and change them, ACT encourages people to accept thoughts without trying to control them. Instead, people learn how to hold thoughts at a distance and act independently from them.
Research shows that ACT is an effective treatment for SAD, leading to significant improvement in symptoms and quality of life.
Exposure therapy for social anxiety disorder is a behavioral intervention in which people face anxiety-provoking social scenarios. Exposure therapy varies in style and pacing but usually involves gradual exposure, beginning with exercises in which people imagine themselves in the situations that make them anxious. As people become better able to tolerate imaginal exposure, they progress to proximal exposure. At this point, they confront situations that are directly or indirectly related to the scenarios that trigger their SAD symptoms. After gaining fluency in these situations, they may be ready to take on the scenario that they most fear.
Many variants of exposure therapy, including virtual reality exposure therapy, are effective in treating social anxiety.
In treatment groups, people with SAD can have the healing experience of learning they are not alone. This is especially important for people with social anxiety, as beliefs they are uniquely or especially unworthy are often at the heart of their suffering.
Group therapy for social anxiety disorder often involves a combination of CBT and exposure therapy. Many social anxiety treatment groups use CBT techniques in mock performances of social situations in which people can confront and explore their social fears with other people.
As they discuss and practice CBT techniques in social anxiety treatment groups, people can experience real-time events that contradict their negative beliefs about themselves. Research shows that group CBT is effective for people with SAD.
Treating Social Anxiety Disorder and Co-Occurring Conditions
Other behavioral health conditions frequently accompany social anxiety disorders. It is especially common for a person to have both social anxiety disorder and depression. People with attention-deficit hyperactivity disorder and post-traumatic stress disorder also have high rates of comorbid social anxiety disorder.
While these comorbidities carry significant risks and complications, they don’t necessarily require a different approach. In addition to being an effective intervention for social anxiety disorder on its own, CBT is an effective intervention for social anxiety disorder and co-occurring mental health and substance use disorders.
If you or someone you know is struggling with social anxiety and co-occurring disorders, contact The Recovery Village today. A representative can talk to you about integrated services that can help individuals control cravings and avoid triggers to use while receiving therapy to help them recover from mental health conditions.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.