From the Guidelines
Cognitive-behavioral therapy (CBT) is the most effective non-medication treatment for social anxiety disorder.
Key Components of CBT
- CBT helps individuals identify, challenge, and modify negative thought patterns and behaviors that maintain social anxiety.
- The treatment typically involves 12-16 weekly sessions and includes components such as:
- Cognitive restructuring (identifying and changing unhelpful thoughts about social situations)
- Gradual exposure to feared social situations
- Skills training for social interactions
- Exposure therapy, a key element of CBT for social anxiety, involves systematically facing feared social situations in a controlled manner to reduce anxiety over time.
Delivery of CBT
- CBT can be administered as individual therapy, which is prioritized due to its superiority in terms of clinical- and health-related economic effectiveness 1.
- Group therapy formats can be particularly beneficial as they provide opportunities to practice social skills in a supportive environment.
Alternative Options
- If the patient does not want face-to-face CBT, then self-help with support based on CBT is suggested 1.
Duration and Structure of CBT
- CBT should be structured with a total of approximately 14 sessions that are performed over approximately 4 months, with each individual session lasting approximately 60–90 min 1.
- Group therapy should consist of one 120- to 150-min group session (two to three patients per therapist), for a total of approximately 12 sessions that are conducted over approximately 3 months 1.
From the Research
Non-Medication Treatments for Social Anxiety Disorder
- Cognitive-behavioral therapy (CBT) is a widely studied non-pharmacologic approach for treating social anxiety disorder, with demonstrated efficacy in reducing symptoms and improving quality of life 2.
- Acceptance and commitment therapy (ACT) has also shown promise in treating social anxiety disorder, with studies indicating significant improvements in social anxiety symptoms and quality of life 3, 4.
- Both CBT and ACT have been found to be effective in reducing negative affect and improving positive affect in individuals with social anxiety disorder, although the differential effect of these therapies on positive and negative affect is still being investigated 5.
- CBT and ACT have been compared in several studies, with no significant differences observed between the two therapies in terms of outcomes, although some studies suggest that CBT may be more effective for individuals with certain characteristics, such as lower psychological flexibility 4.
- The empirical evidence supports the use of CBT for anxiety disorders, including social anxiety disorder, with exposure and cognitive therapy being two of the most commonly used CBT methods 6.