What are the treatment options for Social Anxiety Disorder (SAD)?

From the Guidelines

Social anxiety can be effectively treated with cognitive-behavioral therapy (CBT) as the first-line psychological treatment, as suggested by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021) 1.

Treatment Options

The treatment of social anxiety disorder involves a combination of therapy, medication, and self-help strategies.

• Cognitive-behavioral therapy (CBT) is the most effective psychological treatment, typically involving individual sessions with a skilled therapist, as it has been shown to be superior in terms of clinical- and health-related economic effectiveness 1.
• If the patient does not want face-to-face CBT, then self-help with support based on CBT is suggested, as indicated by the guideline 1.

Medication

For medication, selective serotonin reuptake inhibitors (SSRIs) are suggested as a first-line option, as recommended by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021) 1.

• SSRIs like sertraline, escitalopram, or paroxetine are commonly used, usually requiring 4-6 weeks to show full benefits and continued for at least 6-12 months.

Lifestyle Changes

Lifestyle changes such as limiting caffeine and alcohol, getting regular exercise, and ensuring adequate sleep can also significantly support recovery.

Key Recommendations

• The administration of cognitive behavioral therapy (CBT) through individual sessions by a skilled therapist is suggested as the first-line psychological treatment for social anxiety disorder 1.
• Selective serotonin reuptake inhibitors (SSRIs) are suggested as a first-line medication option for social anxiety disorder 1.

From the FDA Drug Label

The effectiveness of sertraline in the treatment of social anxiety disorder (also known as social phobia) was established in two multicenter placebo-controlled studies (Study 1 and 2) of adult outpatients who met DSM-IV criteria for social anxiety disorder Study 1 was a 12-week, multicenter, flexible dose study comparing sertraline (50 to 200 mg/day) to placebo, in which sertraline was initiated at 25 mg/day for the first week Study outcome was assessed by (a) the Liebowitz Social Anxiety Scale (LSAS), a 24-item clinician administered instrument that measures fear, anxiety and avoidance of social and performance situations, and by (b) the proportion of responders as defined by the Clinical Global Impression of Improvement (CGI-I) criterion of CGI-I ≤2 (very much or much improved) Sertraline was statistically significantly more effective than placebo as measured by the LSAS and the percentage of responders.

Treatment for Social Anxiety Disorder: Sertraline is effective in the treatment of social anxiety disorder. The recommended dose is 50 to 200 mg/day, with a flexible dosing schedule.

• The medication should be initiated at 25 mg/day for the first week, and then increased as needed and tolerated.
• The efficacy of sertraline in maintaining a response in adult patients with social anxiety disorder for up to 24 weeks following 20 weeks of sertraline treatment was demonstrated in a placebo-controlled trial 2.

From the Research

Treatment Options for Social Anxiety

• Cognitive-behavioral therapy (CBT) is a widely studied and effective treatment for social anxiety disorder, as demonstrated in numerous investigations 3, 4, 5, 6, 7.
• CBT approaches, including exposure and cognitive therapy, have been shown to be efficacious in reducing symptoms of social anxiety disorder and improving quality of life 3, 5.
• The effectiveness of CBT for social anxiety disorder has been demonstrated in both short-term and long-term follow-up periods 3, 7.
• Pharmacotherapy, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, has also been shown to be effective in treating social anxiety disorder 4.
• Innovative strategies, such as online psychotherapy and virtual reality exposure, are useful alternatives to traditional CBT and pharmacotherapy 4.
• Personalized treatments for social anxiety disorder are now available, and future developments in attention bias modification and pharmacological augmentation of psychotherapy may be promising 4.

Efficacy of CBT

• Studies have consistently shown that CBT is an effective treatment for social anxiety disorder, with significant reductions in symptoms and improvement in quality of life 3, 5, 7.
• CBT has been shown to be effective in treating social anxiety disorder in both clinical and routine practice settings 7.
• The effectiveness of CBT for social anxiety disorder has been demonstrated in patients with comorbid avoidant personality disorder 6.

Future Directions

• Further research is needed to determine the specific treatment components that lead to beneficial outcomes in CBT for social anxiety disorder 5.
• The development of new modalities and techniques, such as third-wave approaches and cognitive bias modification, may be useful in treating social anxiety disorder 4.
• The optimization of attention bias modification and pharmacological augmentation of psychotherapy may be promising areas for future research 4.