Methods of treatment

METHODS OF TREATMENT

Psychotherapy and medication are the major two treatments commonly used. There are different types of psychotherapy and different medications available.

Psychotherapy

Cognitive Behavioral Therapy (CBT)

Psychotherapy is generally known as mainly talk therapy that helps the patient change their perception of themselves and improve their self esteem; people with social anxiety tend to put themselves down, so the therapist would help the patient bring the patient's confidence up and change their negative thought patterns. A special type of psychotherapy, cognitive behavioral therapy (CBT), has been shown to be the most effective type of therapy for SAD. It works and seems to remain effective in patients over time (Cuijpers & Straten, 2014). It can be used one-on-one or in a group setting. CBT is tailored to SAD by using exposure cognitive therapy, where the patient will be gradually working on their feared social situations by exposure to them and working up to the situations that they fear the most. They will have a gradual, planned exposure and will learn role-play techniques. These are training for coping strategies they will learn during the sessions, and they get skill training as well. They will practice exposing the person to certain social situations and allowing them to manage their anxiety in the situation and gradually lessen it so that it is no longer stressful (Belzer, Liebowitz, & McKee, 2013).

Self-Help Psychotherapy

Guided self-help or internet treatments are becoming more popular because of the limits of the number of clinicians who do CBT for SAD in certain areas of the country. These programs are found to be effective, although slightly less so than individual CBT. These programs make it easier for people to seek help and get effective treatment. They would help increase the number of people able to get relief for their SAD, possibly at a lower cost (Cuijpers & Straten, 2014).

Social Skills Training

Social Skills Training (SST) is often part of SAD therapy programs to help improve conversation, listening and assertiveness skills. SST is often done in a group setting. Patients get instruction and modeling of the different skills, do role play, and then they have a chance to practice them and get feedback from their peers. This helps reinforce good behavior and gives them positive support (Alfano & Beidel, 2011).

Medications

There are a number of different medications depending on what is right for the patient based on their symptoms.

Antidepressants

The most commonly used of this type of medicine are called selective serotonin reuptake inhibitors, (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). The first one of these drugs to receive FDA approval to treat SAD was paroxetine. Later, sertraline, fluvoxamine CR, and venlafaxine XR were approved (Belzer, Liebowitz, & McKee, 2013). Other SSRIs that have been shown to be effective for SAD are escitalopram and citalopram. The drug fluoxetine is not as effective as the other drugs in this category. These drugs take 2 to 3 weeks before they begin to be effective (Blanco, Bragdon, Schneier, & Liebowitz, 2012).

Antianxiety agents

These drugs are also known as benzodiazepines.They are useful because they work quickly and people tolerate them well. One antianxiety agent, clonazepam, was shown in clinical trials to be effective in treating SAD alone or together with SSRI. But antianxiety agents are not often used because clinicians worry about the side effects of drowsiness and mental fog. This class of drugs can also cause a dependence, making stopping them hard, and has a potential for abuse (Belzer, Liebowitz, & McKee, 2013). But because they work so well for SAD, they can be useful alternatives in cases where the SSRIs don’t work well, and in patients that have a low potential to abuse them with careful monitoring (Blanco, Bragdon, Schneier, & Liebowitz, 2012).

Beta Blockers

These medications act to block the stimulus of epinephrine (adrenaline), a neurotransmitter released under stressful situations that cause the symptoms of rapid breathing and heart rate (Mayo Clinical Staff, 2017)

Usually, β-adrenergic blockers are only used for people who have anxiety in situations where they must perform, like singing or in a play, because they lessen the unpleasant physical feelings people get like rapid heart rate, shaky voice, and trembling. They are not so useful in helping with other SAD because they don’t do anything to lessen the anxiety brought on by anticipation of a fearful event that most SAD people have (Belzer, Liebowitz, & McKee, 2013).

Commonly used beta blockers include propranolol and atenolol (Blanco, Bragdon, Schneier, & Liebowitz, 2012).

Combined Treatments

The use of CBT in combination with drug therapy continues to be studied. So far there is an indication that a combination treatment will work faster and be longer lasting; more clinical studies continue to be done to confirm this (Cuijpers & Straten, 2014).

Alternative Therapies

Other treatments for social anxiety like herbs and supplements have shown mixed results. The supplement Kava has been shown to decrease anxiety in some studies, but may cause liver damage, so is not recommended at this time. Another supplement, Valerian, also shows some possible relaxation benefits but causes sleepiness. More studies need to be done on these and other alternative supplements to see if they would be useful for SAD. Other practices, like meditation and progressive muscle relaxation, may also be useful, and more studies are being done (Bystritsky, et al., 2012).