Reviewed by John M. Grohol, Psy.D. on September 27, 2014
While antidepressants are the most commonly used treatment for social anxiety disorder, cognitive behavioral therapy (CBT) is more effective and — unlike medication — can have lasting effects long after treatment has stopped, according to a new study. CBT is one of the most common forms of talk therapy or psychotherapy.
According to researchers at John Hopkins University, social anxiety disorder, which is characterized by intense fear and avoidance of social situations, affects up to 13 percent of Americans and Europeans.
Most people never receive treatment. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists, according to the researchers.
“Social anxiety is more than just shyness,” said study leader Evan Mayo-Wilson, D.Phil., a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.
“People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction.
“The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering.”
The study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.
For the new study, the researchers analyzed data from 13,164 participants in 101 clinical trials. All had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo, while more than 4,000 received a psychological intervention.
Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone, the researchers noted.
After comparing several different types of talk therapy, the researchers found that individual CBT was the most effective. CBT, which focuses on relationships between thoughts, feelings and behaviors, helps people challenge irrational fears and overcome their avoidance of social situations, according to Mayo-Wilson.
For people who don’t want talk therapy, or who lack access to CBT, the most commonly used antidepressants — selective serotonin reuptake inhibitors (SSRIs) — are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn’t work at all for some people, and that improvements in symptoms do not last after patients stop taking the pills.
The researchers acknowledge that medication is important, but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy.
According to Mayo-Wilson, the analysis has already led to new treatment guidelines in the U.K. and it could have a “significant impact on policymaking and the organization of care in the U.S.”
“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce health care costs,” Mayo-Wilson said.
“The health care system does not treat mental health equitably, but meeting demand isn’t simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff,” he said.
The study was published in The Lancet Psychiatry.
Source: Johns Hopkins University