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Social Anxiety Disorder: Treatments
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The social anxiety disorder patient will seek to control their phobia through behaviors of escape and avoidance. They may suddenly exit the room in the middle of a presentation on the job or in a class and will do everything they can not to be put in such a situation in the first place. The individual may avoid contact or engage in self-protective stances such as crossing their arms tightly across their bodies. Preventing these automatic responses is one of the most difficult aspects of social anxiety disorder treatment.
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SSRIs have demonstrated effectiveness for disabling social anxiety disorder and selective mutism. Experts postulate that SSRIs modulate anxiety symptoms both in the brain and peripherally in the gastrointestinal/autonomic nervous system. Peripheral gastrointestinal and autonomic nervous system activation account for the usual anxiety symptoms experienced (ie, cramping, dry mouth, tightness of the chest, palpitations, lightheadedness, dizziness). Drugs should be used only when symptoms significantly affect a patient's daily activities. Many people are mildly socially anxious, and only a small percentage need medication. Before treatment with SSRIs and when increasing or decreasing dosage, query about a history of self-harm and potentially suicidal behavior, as these are potential contraindications to treatment with fluoxetine (or other SSRIs or serotonin and norepinephrine reuptake inhibitors [SNRIs]).
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Medication treatment is the "tried and true" method to effectively treat Social Anxiety Disorder. Research trials for the treatment of Social Anxiety are still limited primarily to "monotherapy" treatment (one drug by itself). In actual practice, it is often the case that 2 or more medications are used in combination (polypharmacy). There are likely to be many different treatments (single drug or combinations) which are helpful for a given individual. Experimentation affords one an opportunity to find out which treatments are most satisfactory for them. Despite increasing recognition of "the world's most neglected anxiety disorder" - most Dr's even now in *2007* continue to have relatively little experience (and even less skill) in treating patients with Social Anxiety.
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There is hope and treatment for those persons who suffer with social anxiety disorder. There have been more and more drugs capable of helping control the feelings one may suffer with. The antidepressants Paxil and Effexor are excellent and wide used to help suffers of social phobia. It can take two to four weeks for the medications to start to take effect and it can ... take some time to find the right dosage that works the best with the least side effects.
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Research suggests that "general" or "supportive" psychotherapy is ... helpful for many patients with Social Anxiety Disorder. This is probably especially true in more moderate and severe cases where issues such as low self esteem and other psychological and/or adjustment difficulties may be more pervasive. Currently there is no evidence that CBT is more, or less, effective than other psychotherapy techniques in the treatment of Social Anxiety. There are no clear guidelines, and one is probably best off trusting their own instincts of what is best for them.
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The most frequently used form of psychotherapy for the treatment of social anxiety disorder, or social phobia, is cognitive behavioral therapy (CBT). This type of therapy is based on the premise that your own thoughts — not other people or situations — determine how you behave or react. Even if an unwanted situation doesn’t change — you still have to make that presentation at work; your sister still expects you at her wedding — you can change the way you think and behave in a positive way. CBT teaches you how to quell the anxiety you feel in social situations so you can face such situations, rather than avoiding them.
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