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Treatments for Social Phobia

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

The two main forms of treatment available for Social Phobia are psychotherapy and medications. See the Social Phobia guidelines for recommendations on when to consider using each of these different modalities.

Psychotherapy for Social Phobia

CBT is the therapy of choice for treating Social Phobia based on the substantial number of studies supporting its use [ref]. It can be offered in in individual and group therapy formats. Behavioral Therapy using exposure techniques (also known as Systematic Desensitization) has also been found to be effect for Social Phobia, though controversy remains about whether it is as effective as CBT [ref]. Often times CBT will incorporate these behavioral exposure techniques when used for this condition.

Although Psychodynamic Psychotherapy has also been used for treating Social Phobia [ref, ref], the number of studies supporting this practice is small, and so it would only be recommended in cases where CBT is unavailable or was unsuccessful.

Medications for Social Phobia

Antidepressants for Social Phobia

The SSRIs and Venlafaxine are considered the first choice medications for Social Phobia because of the amount of available evidence to support their use, and because of their reasonable side-effect profiles [ref].

MAOIs are also effective, but less so than the SSRIs [ref], and their side-effect profile along with the inability to combine them with many other medications and foods limits their use.

Benzodiazepines for Social Phobia

Benzodiazepines have also been shown to be effective for this condition when used alone or in combination with an SSRI [ref]. Although in studies benzodiazepines are usually prescribed on a regular basis with a consistent daily dose, in practice they are often used on an as-needed basis, such as being used just prior to potentially stressful social situations.

However, the main problem with using the benzodiazepines is that discontinuing them at the end of treatment tends to be difficult and to produce a significant rebound in symptoms, especially when shorter-acting forms like Alprazolam are used [ref, ref]. Longer-acting benzodiazepines such as Clonazepam or Diazepam are thus preferred.

Contrary to popular belief, the development of abuse or tolerance (needing higher doses for the same effect) to these medications is not a significant risk when used for conditions like Social Phobia, even when they are used for a prolonged period of time [ref, ref].

Other medications for Social Phobia

Other medications, like Gabapentin, Pregabalin, Levetiracetam, and Atypical Antipsychotics like Olanzapine, Risperidone and Aripiprazole, may be effective, though the evidence is limited [ref, ref, ref].

Surprisingly, the use of medications that increase dopamine signaling in the brain, such as Methylphenidate, Amphetamine, Bupropion or Atomoxetine, has not be studied in Social Phobia, even though there is evidence that this condition is associated with lowered dopamine activity in the brain [ref].

Combining Psychotherapy and Medications for Social Phobia

The little evidence that is available suggests that there may not be much benefit in combining these two forms of treatment from the outset [ref, ref], and that Cognitive Behavioral Therapy (CBT) may be somewhat more effective than medications [ref]. There is also some evidence that, in the long run, using medications may in fact lower people's chances of overcoming this condition, perhaps by reducing their need to develop their own skills to control their social anxiety symptoms [ref].

For these reasons, it is the recommendation of this site that, whenever possible, treatment for Social Phobia should start with psychotherapy alone, and that medications should be tried only after some time if additional help is required. Having said that, the fact remains that Social Phobia tends to be a chronic condition that is difficult to treat [ref], and most individuals likely will not respond to psychotherapy alone and will eventually require a trial of medications.

 

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