23 - Treatment of social anxiety disorder

Summary

This chapter reviews the evidence from randomized controlled trials for the efficacy of medication and psychotherapy treatments of social anxiety disorder (SAD), highlights important clinical issues in the treatment of SAD, and discusses the unresolved issue of how best to combine medication and CBT approaches. A growing body of research supports the efficacy of treatments incorporating both cognitive techniques and exposure. Cognitive-behavioral therapy (CBT) is by far the most extensively researched psychosocial treatment for SAD. Recent meta-analyses confirm that selective serotonin reuptake inhibitors (SSRIs) and venlafaxine yield increased response rates and greater magnitude of improvement compared to placebo. Four medications are approved by the US Food and Drug Administration (FDA) for social anxiety disorder: paroxetine, sertraline, venlafaxine and fluvoxamine. More research is needed on treatment of patients with inadequate response to first-line treatments. Further studies of augmentation strategies in combining medication and psychosocial treatments are needed.