4 treatments for Social Anxiety Disorder

The social anxiety disorder (SAD) is generally treated by:

  1. Medications
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Benzodiazepines
  • Beta blockers
  1. Psychotherapy
  • Cognitive-behavioral therapy (CBT)
  • Exposure therapy
  • Group therapy
  1. Alternative treatment
  • Hypnosis
  • Herbal remedies
  1. Self-help strategies
  • Deep breathing
  • Relaxation techniques

 

  1. Medications used in SAD treatment

SSRIs are commonly used to treat depressive and anxiety disorders. This class of compounds prevents the re-absorption of the neurotransmitter called serotonin in the brain. The deficit of serotonin has an important impact on mood, social behavior, sleep, sex drive, and appetite.

The most prescribed SSRIs for SAD are:

  • Sertraline
  • Paroxetine
  • Citalopram
  • Fluoxetine
  • Sertraline (Zoloft)

Sertraline, mostly known under its trade name Zoloft, has been accepted by FDA since 2003 as a basic medication used to relieve the symptoms of social anxiety. Zoloft is also approved to be administered for a long-term treatment.

Compared to other SSRIs side effects, it was noticed a higher rate of diarrhea occurrence when taking Zoloft.

  • Paroxetine (Paxil)

Paxil has positive effects in better keeping under control fear, negative thoughts, and restoring interest in daily activity. The effectiveness of paroxetine in treatments that last more than 12 weeks has not been clearly stated yet therefore, for extended periods it is required a periodical re-evaluation of the patient’s response to the drug.

  • Citalopram (Celexa) and Fluoxetine (Prozac)

Citalopram is often prescribed for patients suffering from social anxiety who failed with other types of SSRIs. It is well tolerated and has a positive side-effect profile.

Prozac is used more for people dealing with major depressions than for those struggling with anxiety. However, many physicians prescribe this medicine off-label for social anxiety together with cognitive behavioral therapy sessions.

  • Effexor

Effexor is included in the group of SNRIs. Differently from SSRIs that act only upon the serotonin level, SNRIs inhibits the reuptake of two neurotransmitters: serotonin and norepinephrine.

Effexor is usually administered after a prior treatment trial with SSRIs that did not provide the expected results. Effexor has a slow onset action taking about 3-4 weeks until noticeable changes appear. It was admitted by FDA for treating social anxiety with a recommended dose of 75 mg per day. Some doctors go for an increased dose (225 mg/day) in patients with intense anxiety symptoms.

  • Xanax

FDA approved for social phobia, Xanax is the marketed name of Alprazolam, a benzodiazepine with peak effects released within the first hour after administration. Xanax is a depressant for the central nervous system because regulates the action of gamma-amino butyric acid (GABA) in the brain.

Xanax is a popular and effective option to cope with anxious moments, but it also has an increased risk to developing dependence during a prolonged treatment.

The usage of benzodiazepines is quite limited because they proved to be habit-forming medications. Their prescription is taken into account when it comes to helping people to deal with a certain feared social situation.

Beta blockers are helpful to control the physical signs of anxiety that accompany a given social activity. Just like in the case of benzodiazepines, beta blockers represent short-term solutions for social anxiety treatment.

  1. Psychotherapy
  • Cognitive-behavioral therapy

CBT is considered one of the most effective psychological methods for overcoming anxiety. Its main goal is to:

  • help people identifying their distorted thoughts about themselves, life, or future
  • replace negative thinking with a rational one
  • improve behavioral patterns during social interactions

The starting point in CBT is that our thoughts have a strong influence on how we feel, and our feelings affect our behavior as well.

CBT requires time and commitment from both patient and psychologist.

  • Exposure therapy

Exposure therapy encourages the person to gradually confront with the fear provoking stimuli. The purpose is to diminish step-by-step the individual’s fearful response to a particular situation that usually triggers his anxiety.

The person is firstly exposed to a possible stressful situation inside the therapist’s office and once the self-confidence grows, he/she will be asked to step into the real world.

  • Group therapy

Group therapy offers the chance to learn and practice social skills while interacting with other people that face the same problem. Medical studies show that one in three patients diagnosed with social anxiety experience more significant improvements when participating to group psychiatric treatments, than during individual therapy.

Psychotherapy is highly effective especially when is performed by therapists who acquired an extensive experience in treating social anxiety.

  1. Alternative treatment
  • Hypnosis

Hypnosis is a medical procedure that artificially creates a deep state of relaxation called trance, which is meant to open the individual’s subconscious mind. The subconscious mind stores our core beliefs, memories, and emotions related to past experiences.

The hypnotherapist’s role is to spot the triggering event of anxiety and build inside the patient’s mind positive suggestions that can change his perception about fearful situations.

Applied in tandem with CBT, hypnosis can be an effective alternative to anti-anxiety medications.

  • Herbal remedies

Herbal remedies based on plants like St. John’s Wort, kava, passionflower, valerian, and green tea have been used for a long time to relieve fears and depression. The risks as well as the benefits provided by plants in treating social anxiety still require thorough studies to be well understood. Due to possible interaction with standard medications, it is important to talk to your doctor before taking herbal supplements.

  1. Self-help strategies
  • Deep breathing

Breathing exercises help you slowing down the respiratory rate, which tends to increase dramatically when dealing with social situations.

  • Progressive muscle relaxation (PMR)

PMR was introduced for the first time in the 1930s. When it is correctly performed, major groups of muscles are relaxed. This technique is beneficial for persons with social anxiety, who usually complain of muscle tension.

  • Guided imagery

Guided imagery uses visualization techniques to enable the body’s entrance into a relaxed state.

In general, self-help strategies are meant to complement traditional treatments based on psychotherapy and drugs.

Conclusion

Alternative therapies and self-help techniques work well for people with mild forms of social anxiety. Anti-anxiety medications act faster or slower, depending on the active ingredient, but their side effects cannot be neglected and in some cases anxiety returns once the treatment has stopped.

Psychotherapy in combination with medications seems to be the best approach to achieve long-term results against social anxiety.