What Sorts of Treatments are Available for Social Anxiety?

Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are currently among the most popular medications used in treating Social Phobia. They have been demonstrated as effective in several studies, and they have relatively few major side effects. Commonly used SSRIs are listed below. Although most of these have been found to be effective treatments for social phobia, only two are officially approved by the US Food and Drug Administration (FDA) for the treatment of social phobia (paroxetine, sertraline).

• Citalopram (Celexa)
• Escitalopram (Lexapro, Cipralex)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs act on two brain chemicals, rather than just serotonin like the SSRIs. They are often used for Social Phobia in a similar way to the SSRI medications. Two SNRIs (listed below) are currently on the market, though only venlafaxine-XR has been studied as a treatment for Social Phobia.

• Duloxetine (Cymbalta)
• Venlafaxine-XR (Effexor-XR)

Benzodiazepines: Benzodiazepines are very effective at lowering anxiety levels quickly, which led to their being very commonly used for several decades. However, they also have a number of significant side effects and can be addictive. Because of this, SSRI medications are now more commonly used for long-term management; however, benzodiazepines may still be appropriate, particularly for short term use. This category includes several familiar medications, though clonazapam and alprazolam are the two that have been studied most in the treatment of Social Phobia. Benzodiazepines that are often used to treat anxiety problems include:

• Alprazolam (Xanax)
• Clonazepam (Klonopin, Rivotril)
• Diazepam (Valium)
• Lorazepam (Ativan)

Beta-Blockers: Beta-blocker medications such as propanolol (Inderal) can be used to lower the physical symptoms of social anxiety, such as shaking, sweating, and racing heart. Because of this, they are commonly used for anxiety in performance situations such as public speaking or performing music. They do not usually have significant effects on anxious thoughts or anxious behaviors. Nor are they an effective treatment for generalized Social Phobia.
Monoamine Oxidase Inhibitors (MAOIs): MAOIs are another type of medication that is occasionally used to treat Social Phobia. One MAOI in particular, phenelzine (Nardil), has shown strong effectiveness in treating the disorder. Unfortunately, the MAOI medications also have a number of significant side effects and require a strict diet that eliminates several common foods to avoid life-threatening reactions. As a result, MAOIs are relatively uncommon as a treatment for Social Phobia.
Cognitive-Behavioral Therapy
The most effective psychological treatment for Social Phobia currently available is called cognitive behavioral therapy, or CBT. Numerous research trials have demonstrated a clear advantage for CBT, and the treatment is now widely accepted as a first choice treatment for Social Phobia. While the specific ways in which CBT for Social Phobia can be administered may vary somewhat between therapists, a number of features distinguish this approach from other commonly used psychotherapies:

• CBT is collaborative - the client and therapist work together as a team. The therapist does not simply tell you what to do or think. Together, you and your therapist develop strategies for overcoming anxiety.
• CBT includes a focus on developing new skills. You will learn several strategies for counteracting Social Phobia.
• CBT is brief and time-limited. You and the therapist will set specific goals and remain focused on these goals throughout treatment, which generally lasts 12 to 16 sessions. The ultimate aim is to assist you in becoming your own "therapist."
• CBT is focused on the present. While a CBT therapist is likely to agree that the roots of Social Phobia may be due, in part, to experiences during childhood, the emphasis of treatment is on uncovering the current cognitive and behavioral patterns that are maintaining symptoms and on making changes in your present life.
• CBT is structured. Each session, as well as the overall course of treatment, has specific objectives and agendas that you develop in cooperation with your therapist.
• CBT emphasizes between-session exercises (often referred to as homework) that you complete on your own. These tasks are planned with your therapist and are intended to provide you with actual, "real-life" experience working with new ways of thinking and behaving.
• CBT is research-based. The strategies used in CBT to address symptoms of Social Phobia have been subjected to numerous clinical studies and have been shown to be effective.

Cognitive behavioral treatment draws on a number of therapeutic strategies when addressing Social Phobia. While the specific approaches used may vary based on your symptoms, your therapist, and the setting in which you are being treated, CBT for Social Phobia often includes many of the following components:
Psychoeducation: Perhaps one of the most difficult aspects of coping with Social Phobia is simply understanding what it is, where it came from, why it's so hard to change, and how it keeps coming back with a vengeance. Psychoeducation involves you and your therapist working together to develop a better way to understand your Social Phobia, and subsequently, how to work with it.
Cognitive Restructuring: As discussed earlier, individuals with Social Phobia frequently hold negative beliefs about themselves and others, which often show up as unhelpful thoughts in social situations. Cognitive restructuring is an important component of CBT, and it involves working with your therapist to identify these thoughts and look for patterns within them. As you become skilled at noticing these thoughts, you then develop strategies for gaining flexibility in your thinking and considering more helpful ways of looking at your experiences.
In Vivo Exposure: In vivo (real life) exposure is another core element of CBT for Social Phobia. You and the therapist identify situations that you avoid because of Social Phobia, and then gradually enter these situations while accepting your anxiety and allowing it to naturally dissipate. While this step probably sounds quite intimidating, it is important to know that exposure is done at a very gradual, planned pace, and that your therapist will support you throughout the process. Many clients report exposure practices as being among the most useful elements in their treatment.
Interoceptive Exposure: Some individuals with Social Phobia are fearful not only of social situations, but also of the anxious physical sensations (such as blushing, shaking, sweating, etc.) that can accompany them. Interoceptive exposure practices deliberately bring about these sensations through such activities as wearing a warm sweater to induce sweating in social situations. Just as exposure to feared situations leads to reductions in situational fear, exposure to feared sensations will lead to a reduction in anxiety over experiencing these feelings in social situations.
Social Skills Training: In the midst of a tense social situation, many people with Social Phobia fear that they do not have the necessary social skills to successfully navigate the exchange. While this may be due to negative self-talk and self-consciousness (rather than an actual lack of skill), many people find it helpful to discuss such topics as carrying on conversations, being assertive, and effective listening. Social skills training provides a chance to work on these areas in therapy.