Social anxiety disorder (social phobia)

Treating social anxiety disorder in adults

If you've been diagnosed with social anxiety disorder, there are a number of different treatment options available.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT)is one of the most effective treatments for social anxiety disorder.

Generally, CBT works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

CBT teaches new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.

Your therapy sessions may include learning about social anxiety, graduated exposure to feared social situations (which may include some homework), examining and modifying your core beliefs and helping to prevent relapse.

CBT involves a considerable time commitment. The exact amount of time required can vary, depending on your specific condition and response to therapy. One example is 15 hourly sessions, plus one of 90 minutes. However, you may require fewer or more sessions, or you may need fewer sessions that last longer.

Supported self-help

If you wish to try a different psychological therapy, you may be offered supported self-help. This could be in the form of a CBT-based book or computer programme to try over three to four months.

One of the most widely-used self-help therapies for people with anxiety or phobias is FearFighter, which isavailable on the NHS in some areas. You can also pay to do the course privately.

Learn more about self-help therapies.

Antidepressants

Some people may benefit fromtrying a type ofantidepressant medication, usually aselective serotonin reuptake inhibitor (SSRI), either instead of or in combination with individual CBT.

SSRIs increase the level of serotonin in your brain. They can be taken on a long-term basis.

As with all antidepressants, SSRIs can take several weeks to start working. You'll usually be started on a low dose, which will gradually be increased as your body gets used to the medicine.

Escitalopram or sertraline are the two SSRIs often prescribed to treat social anxiety disorder. If you're prescribed one of these, you'll initially be asked to see your GP every few weeks to check on your progress and see if you're responding well to it.

Commonside effects of SSRIs include:

feeling agitated, shaky or anxious
feeling or being sick
indigestion
diarrhoea or constipation
loss of appetite and weight loss
dizziness
blurred vision
thirst or dry mouth
excessive sweating
sleeping problems (insomnia)
headaches
low sex drive(loss of libido)
difficulty achieving orgasm during sex or masturbation
in men, difficulty obtaining or maintaining an erection (erectile dysfunction)

When you and your GP decide that it's appropriate for you to stop taking your SSRI medication, your dose will gradually be reduced. You should only stop taking your medication whenyour GP advises you to do so.

Psychotherapy

If all ofthe above interventions aren't right for you, for whatever reason, you may be offered interpersonalpsychotherapy or short-term psychotherapy specifically designed for social anxiety disorder.

Psychotherapy generally involves talking to a trained therapist either one-to-one, in a group, or with your wife, husband or partner. It allows you to look deeper into your problems and worries, and deal with troublesome habits and a wide range of mental disorders.

Interpersonal psychotherapy aims to link social anxiety to relationship problem areas and address these. You'll probably be offered 16-20 sessions over four to five months.

Short-term psychotherapy for social anxiety disorder aims to improve your social skills,and encourageyou to face feared social situations outside therapy sessions. A course of treatment usually consists of 25-30 sessions that last 50 minutes, over a six- to eight-month period.