Treatment Overview

Treatment for social anxiety disorder involves psychological counselling and sometimes medicines (such as antidepressants) to reduce related anxiety and depression.

A combination of medicines and professional counselling may be effective for long-term treatment for people who have generalized anxiety and fear over many social situations.² For those who fear only one or a few social situations (such as public speaking or eating in front of others), professional counselling to overcome the fear may be all that is needed.

Unfortunately, many people don't seek treatment for anxiety disorders. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.

Initial and ongoing treatment

Initial treatment of social anxiety disorder is based on how bad your emotional and physical symptoms are and how able you are to function in daily activities. People who have social anxiety disorder often have depression also. They may also have alcohol or substance use problems. Your doctor may ask you certain questions to see whether you might have an alcohol or substance use problem.

Social anxiety disorder often goes undetected for years before treatment is sought. By that time, you may have developed behaviours that accommodate the fears. These habits or behaviours must be overcome to successfully manage social anxiety disorder.

First, your doctor must determine whether you are generally anxious about all social encounters or whether a specific situation triggers anxiety.

Treatment with a combination of medicines and professional counselling is often effective for generalized social anxiety disorder (fear of most public interaction). Some people need treatment throughout their lives, while others may recover completely after a period of treatment with counselling and medicines

Counselling

It is possible to overcome the fears linked with social anxiety disorder. Working through fears with a specific type of therapy—cognitive-behavioural therapy that includes exposure therapy—may be the best approach for treating your anxiety. It is important to continue professional counselling even if you are taking medicines to reduce anxiety.

Types of counselling most often used to treat social anxiety disorder include:

• Cognitive-behavioural therapy, which helps you identify anxieties and the situations that provoke the anxiety. At first you may feel uncomfortable while addressing the feared situations, but it is an important part of your recovery. Several types of cognitive-behavioural therapy are used to treat social anxiety disorder, including:
  • Exposure therapy. You will be guided by a professional counsellor to imagine you are facing the feared situation until you no longer fear it, such as eating in public. Next, you may go with your counsellor to a public place and eat until, eventually, you can eat by yourself in public without fear.
  • Social skills training. This therapy helps you develop the skills you need in social situations through rehearsing and role-playing. Your anxiety is reduced as you become more comfortable with and prepared for the feared social situations.
  • Cognitive restructuring. This therapy helps you learn to identify and improve fearful thinking to help you better handle social situations.

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    Positive Thinking With Cognitive-Behavioural Therapy

  • Symptom management skills. This therapy teaches you how to reduce stress by controlling your breathing and other physical responses to anxiety.
• Supportive therapy. This can include:
  • Education about the disorder.
  • Family therapy, to support loved ones affected by your condition.
  • Group therapy or support groups, to seek support from others also diagnosed with the disorder.

Medicines

Medicines often used for chronic, severe, or generalized social anxiety disorder include:

• Selective serotonin reuptake inhibitors (SSRIs), to relieve anxiety. SSRIs are often the first type of medicine used to treat generalized social anxiety disorder.³
• Benzodiazepines, to relieve anxiety. They are fast-acting. But they may be habit-forming and are not generally used in those who have substance use problems.
• Monoamine oxidase inhibitors (MAOIs), to relieve depression and anxiety. MAOIs have potentially serious side effects when they are taken with certain foods (such as some cheeses and red wine).
• Beta-blockers, to reduce anxiety. Beta-blockers are sometimes used to treat physical symptoms of anxiety (such as tremors or rapid heart rate).
• Venlafaxine, to help relieve anxiety and depression.

Ongoing treatment of social anxiety disorder usually includes continuing psychological counselling and regular checkups to monitor any medicines you may be taking. If professional counselling alone has not reduced your anxiety symptoms, medicines may be added to your treatment.

If your anxiety is triggered by many social situations (generalized), you may need continuous and prolonged treatment with a combination of counselling and medicines. During this time, your doctor will need to monitor your medicines. If one medicine doesn't work for you, you and your doctor may decide you should try another.

Treatment if the condition gets worse

With social anxiety disorder, it is possible to progress from debilitating fear of one social situation to having anxiety about all social encounters (generalized). If this occurs, additional treatment is needed that usually includes adding medicines and increasing the amount of professional counselling you receive.

You may also feel more anxious when you start professional counselling. This is because you are thinking about the situations that cause you fear and anxiety. After the situations have been identified, the fears can be addressed through counselling—especially cognitive-behavioural therapy which includes exposure therapy—gradually exposing you to your fear.

If you are taking medicines to treat social anxiety disorder, you will need regular checkups to monitor the medicines (such as selective serotonin reuptake inhibitors) and their potential side effects. The medicines may cause bothersome side effects that may make your anxiety worse at first. These side effects may get better over time. But if they do not, you may need to take a different medicine.

If social anxiety disorder is left untreated or improperly treated, it can cause debilitating distress that interferes with daily activities. Physical symptoms such as rapid heart rate, blushing, shortness of breath, and dizziness can occur and need to be assessed.

Other psychological conditions (such as depression or substance use problems) may accompany social anxiety disorder, and these conditions need more treatment. If left untreated, the combination of social anxiety disorder and another psychological condition (such as depression) can increase the risk of attempted suicide.⁴