Talk therapy may help social anxiety better than drugs

Talk therapy should be regarded as the best first-line treatment for people with social anxiety disorder, researchers say.

Social anxiety disorder, or social phobia, is a psychiatric condition in which people have such intense fear of social situations that it gets in the way of their normal daily lives. 

The most common treatments for the condition are talk therapy, anti-anxiety medications and antidepressants.

Social anxiety is more than just shyness. People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction.

Now, in a new study, researchers set out to compare the effects of these different therapies on people with the disorder. They looked at the findings of 101 clinical trials conducted between 1988 and 2013, involving a total of more than 13,000 participants.

Some of the studies assessed the effectiveness of medication in treating social phobia. Others looked at talk therapies, including an approach called cognitive behavioral therapy (CBT), which focuses on teaching patients ways of dealing with social situations so that they can overcome their irrational fears.

The researchers found cognitive behavioral therapy was more effective in treating patients than were any medications, according to the study published today (Sept. 25) in the journal The Lancet Psychiatry.

Still, the researchers also found that people who received cognitive behavioral therapy and those who took antidepressants (the types called selective serotonin reuptake inhibitors, or SSRIs, and serotonin–norepinephrine reuptake inhibitors, or SNRIs) had better results compared with patients who didn't receive any treatment.

The findings suggest that cognitive behavioral therapy should be regarded as the go-to treatment for people with social anxiety disorder, the researchers said. 

For patients who do not get better after talk therapy, SSRI medication could be a second choice, the researchers said.

In general, the results showed that most people with social anxiety disorder respond well to common treatments, which is good news for people suffering from the condition, the researchers said.

Because both talk therapy and antidepressants were effective in treating social phobia, the researchers looked at whether combining the two would be an even better approach. 

But few of the studies they reviewed considered this question, and the researchers didn't find evidence that such a combined approach would produce results any better than either of the treatments did alone.

The researchers noted that taking antidepressants, although effective in treating social phobia in some people, does have side effects, ranging from increased agitation to sexual dysfunction.

Talk therapy may also be superior to medication because there's a better chance that the benefits continue after the treatment ends, the researchers said. 

Previous studies have shown that most people with social phobia who improve by taking SSRI antidepressants get worse again when they stop taking the medication.

In contrast, the effects of psychological treatments are generally well-maintained after the treatment ends, and patients "can continue to apply new skills and make further gains," the researchers said.