Social Anxiety Disorder

Finding the right treatment

Treatment

Treatment for SAD usually involves a combination of psychotherapy and medication.

Finding a therapist

Therapy has been proven to yield major improvements in the lives of those with SAD. Whether it be recognition of one's symptoms, an understanding of how one's past might have impacted them, or a simple awareness of certain thoughts and their triggers, therapy can help people become more content versions of themselves.

Most therapists have experience working with adults with SAD, and therapy is increasingly offered virtually (from the comfort of home).

There are different kinds of professionals who can provide effective therapy:

• Clinical psychologists (PhD)
• Licensed clinical social workers (LCSW or LMSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)
• National certified counselors (NCC)

There are several styles of therapy that can be helpful for SAD including psychodynamic, interpersonal, and supportive therapy. In recent years, more therapists employ cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns and challenge self-destructive cognitions, and replaces them with more constructive thinking. In the treatment of SAD, most therapists use CBT and use a specific CBT technique called exposure therapy.

A therapist may help the individual with SAD become less anxious by exposing them gradually and safely to their particular fears, while also teaching them valuable skills to help them cope with anxious feelings while socializing. Therapy can be challenging and also very rewarding; many people find relief after facing their fears and challenging their anxious thoughts with the support of a therapist.

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Medications have been proven to provide considerable help with SAD symptoms. With treatment, fears and inhibitions diminish, and the individual can develop greater capacity for social spontaneity.

SSRIs

The most commonly used medications for SAD are antidepressants called Selective Serotonin Reuptake Inhibitors (SSRI) or Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). Even though these medications are calle antidepressants and can be used for treating depression, they are also studied and approved for use in individuals who struggle with several anxiety disorders. This class of medications takes 4-6 weeks before they start working.

While these medications are used to treat a number of mental health conditions, including depression, OCD, and some pain conditions, the dosing and the use of concomitant medications differs across conditions.

In addition, sometimes anti-anxiety medications are used off-label to treat social anxiety disorders. This means that the FDA has not specifically approved these drugs to treat social anxiety disorder, but many prescribers find them beneficial when combined with antidepressants.

Benzodiazepines

Benzodiazepines are often used with SAD. These can be effective medications that work quickly, but many doctors are cautious about using benzodiazepines. This class of medications is most safely prescribed for occasional use.

Benzodiazepines have addictive potential, so individuals with a history of substance abuse are advised to stay clear of them. However, taken as a doctor directs, these medications can provide rapid relief from acute anxiety. It is best not to take benzodiazepines for long periods of time because of the risk of psychological and physical dependency. Benzodiazepines should not be taken with any opioid medications or alcohol.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.

Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.