Treating Social Anxiety Disorder

Treatments for social anxiety disorder (SAD) depend on the severity of your emotional and physical symptoms and how well you function daily. The length of treatment also varies. Some people may respond well to initial treatment and not require anything further, while others may require some form of support throughout their lives.

Both medication and therapy have been shown effective in treating social anxiety disorder. Social anxiety that occurs in all situations responds best to a combination of medication and therapy, while therapy alone is often sufficient for people with anxiety specific to one type of performance or social situation.  So, if you've been diagnosed or think you may have SAD, know that it's possible to overcome it.

Prescription Medications

Several different types of medications are prescribed to treat SAD. Each has its advantages and disadvantages depending on your particular situation.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are considered the first-line pharmacotherapy treatment due to their tolerable side effects and ease of administration. However, due to the potential for withdrawal effects, SSRIs should always be tapered when ending treatment. Options include:

• Paxil CR (paroxetine)
• Luvox CR (fluvoxamine)
• Zoloft (sertraline)
• Lexapro (escitalopram)
• Celexa (citalopram)
• Prozac (fluoxetine)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are a class of antidepressants used in anxiety treatment that act on the neurotransmitters serotonin and norepinephrine. Options include:

• Effexor XR (venlafaxine)
• Cymbalta (duloxetine)
• Pristiq (desvenlafaxine)

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs were once considered the most useful treatment for social anxiety disorder; however, these medications carry with them the risk of serious side effects if dietary and medication guidelines are not followed. Options included:

• Nardil (phenelzine)
• Parnate (tranylcypromine)
• Marplan (isocarboxazid)

Beta Blockers

Beta blockers are usually taken orally prior to an anxiety-inducing event such as a performance to reduce symptoms of anxiety such as rapid heart rate, hand tremors, and the “butterflies in the stomach” feeling. Options include:

• Inderal (propranolol)
• Tenormin (atenolol)

Benzodiazepines

Benzodiazepines are mild tranquilizers that alleviate the symptoms of anxiety by slowing down the central nervous system. Although fast-acting and well-tolerated, benzodiazepines have the potential to be habit-forming and should not be prescribed for someone with a substance abuse disorder. Options include:

• Ativan (lorazepam)
• Valium (diazepam)
• Xanax (alprazolam)
• Klonopin (clonazepam)

Other Anxiety Medications

There are several other medication options doctors may consider, including:

• Vistaril (hydroxyzine)
• BuSpar (buspirone hydrochloride)

Psychological Therapies

Psychotherapy can be used alone or together with prescription medications. The various options are psychological methods geared towards helping someone change their behavior to something desirable. There is a common stigma associated with going to a psychotherapist or psychiatrist, but millions of people go and benefit from it. There is nothing to be embarrassed or ashamed of.

You can try asking your primary care physician for a referral to a therapist or mental health professional. There is also an increasing number of websites that can help match you with a professional based on your symptoms, schedule, and health insurance.

Try taking a few notes on your thoughts and feelings so you have a starting point for discussion on your first appointment. Though it may feel difficult at first, the more honest you are with your doctor, the more progress you can begin to make with managing your anxiety.

Social Anxiety Disorder Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Download PDF

Learn the best ways to manage stress and negativity in your life.

Sign Up

You're in!

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.

Cognitive-Behavioral Therapy (CBT)

CBT is the first-line psychotherapeutic treatment for SAD. It is a form of psychotherapy designed to modify your thoughts and behaviors in order to positively influence your emotions.

Exposure

Exposure can take place either through imagining or experiencing a specific performance or social situation in real life. If you have extremely severe social anxiety disorder, your therapist may begin with imagined exposure and eventually progress to real-life exposures.

The underlying principle of exposure therapy is that through practice and experience, you will become more comfortable in situations that you would otherwise avoid. Below are some exposure exercises that you can practice on your own.

Cognitive Restructuring

Cognitive restructuring focuses on the cognitive symptoms of SAD: Poor self-concept, fear of negative evaluation by others, and negative attribution bias (attributing positive outcomes to chance and negative outcomes to your own shortcomings).

Cognitive restructuring involves a series of exercises designed to identify negative thoughts, evaluate how true they are, and construct alternative thoughts to challenge original thoughts.

Cognitive restructuring is thought to be important for the treatment of social anxiety disorder because of the strong cognitive aspect of the disorder and how longstanding these underlying beliefs often are.

Social Skills Training

Social skills training involves various exercises such as modeling, rehearsal, and role-playing designed to help people learn appropriate behaviors and decrease anxiety in social situations.

Not everyone will require social skills training as part of their treatment. These exercises are designed specifically for people who have actual deficits in social interaction above and beyond social anxiety. Areas that might be targeted for social skills training include eye contact, conversation, assertiveness, and telephone calls.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) for social anxiety disorder is a "third-wave" technique developed after CBT. It is based on Buddhist philosophy.

Through ACT, you learn how to accept negative thoughts and anxiety rather than trying to eliminate them. By detaching yourself from your social anxiety, it is expected that your symptoms will naturally lessen.

An ACT therapist uses experiential exercises, values-guided interventions, and mindfulness skills training as part of therapy.

Psychoanalysis

Psychoanalysis and psychodynamic therapy involve a therapist helping you to understand underlying issues from childhood that may have contributed to your social anxiety. It is most useful for people who have deeper unresolved conflicts contributing to their anxiety. Psychoanalysis may also be useful in some instances to explore potential resistance to change.

Complementary Treatments

Alternative treatments for social anxiety disorder include such things as dietary supplements, aromatherapy, and yoga.

Finding Treatment

The steps for finding treatment for social anxiety disorder are the same as those for any mental health issue.

1. Talk to someone, such as a family doctor or religious counselor, about the problems you are experiencing. You could even start by telling a friend or family member and asking for his or her support in finding help.
2. If a doctor is not able to refer you to a mental health professional, you may consider searching terms such as "find a social anxiety disorder therapist near me." Professionals who provide mental health therapy services typically include psychologists, social workers, and counselors. If you require medication, you will need to speak to a psychiatrist through a referral from a doctor. If you are looking for alternative treatments, seek out a physician who practices integrative medicine.
3. Call to make an appointment and inquire about the cost of services and whether they will be covered by insurance.

A Word From Verywell

Reaching out for help the first time can feel uncomfortable and anxiety-provoking in and of itself. Know that you are taking the best first step in the right direction to alleviate your social anxiety over the long term.