Treatment of Social Anxiety Disorder (Social Phobia)

About 15 million Americans have a social anxiety disorder. If you’re one of them, your treatment options include therapy, medications, mindfulness training, exercise, and more.

Getting treatment is critical, as social anxiety disorder won’t go away by itself.

The help you get now could allow you to interact with others without crippling anxiety. And some of these therapies could improve your physical health too. 

What Is Social Anxiety Disorder?

Few people enjoy climbing up on a stage and speaking in front of a crowd. Most of us feel at least a little anxious when walking into a room for a job interview. And we might all practice for an important conversation, like an introduction to a boyfriend’s parents.

But for people with social anxiety disorder, these situations aren’t just uncomfortable. They can be crippling.

Doctors use the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) to diagnose social anxiety. People with it meet the following criteria:

• A persistent fear of one or more social performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. The person fears that they will act in an embarrassing or humiliating way.
• The person recognizes that the fear is excessive or unreasonable.
• The situations are avoided or endured with anxiety and distress.
• The avoidance, anticipation of scrutiny, or distress in the situation interferes with the person’s normal routine, relationships, or functioning.
• The avoidance, anxiety, or fear lasts six months or more.
• The avoidance or fear isn’t due to the impact of a substance or another mental or physical condition.

Some people believe social anxiety disorder involves simple concerns about what might go wrong at a party or social situation. In reality, it’s a serious condition that can deeply impact a person’s life and health.

Social Anxiety Disorder Treatment Options

Researchers call social anxiety disorder a “naturally unremitting condition” unless you get treatment. Without it, you’re likely to struggle with social situations for the rest of your life.

But with help, you can learn to manage your fears and participate fully in the world around you. Several treatment options exist, and your doctor might combine many of them to give you a full suite of tools. 

Therapy

A counselor can help you unpack your concerns, practice new behaviors, and develop a healthier life.

Three main types of therapy are used in people with social anxiety disorder. This chart can help you understand how they work:

Your therapist might hold some sessions privately. But group therapy sessions could be critical for you, as you’ll practice in front of other people. Your treatment program will likely include a combination of both individual and group sessions.

Medications

Researchers say combining therapy and medications could be more helpful than using either type of treatment alone. Your medication options include the following:

Researchers are looking closely at other options like gabapentin and pregabalin to help treat social anxiety disorder. Your doctor could try them if you’re not responding to the other therapies available.

Mindfulness

During a stressful situation, your mind is focused on what could go wrong or what others think about you. Mindfulness techniques encourage you to accept what is happening now, including your feelings, and control how you react to the world around you.

Mindfulness techniques like meditation could help you relax instead of panicking.

You could also use deep-breathing exercises to help you calm down in the face of stress. Yoga could help you practice your breathing while you move, which could help introduce the concepts to people unaccustomed to mindfulness.

Techniques like this may seem unusual, but researchers say they’re particularly critical for people with anxiety disorders. Your work could help you interrupt the cycle of worry, reacting, and worrying more. You’ll build healthy habits you can use to cope instead of cycling through anxiety.

Acupuncture 

Practitioners use very tiny needles inserted in pressure points on your hands, feet, scalp, and other energy meridians. You may not feel them enter your body, but you could find the acupuncture environment soothing and calming.

Researchers aren’t sure why acupuncture helps some people with anxiety, but it’s possible that the serotonin your body releases when needles enter helps to soothe your overactive brain cells. This can have a calming effect in the short and long term.

Exercise Programs

People with anxiety disorders spend time and energy thinking. In an exercise program, you’ll spend time moving instead.

Structured walking, running, or cardiovascular programs get your heart pumping and your muscles stretching. The endorphins you release could help you feel less upset.

Choose a public exercise venue (like a gym), and you’ll also begin to sweat in front of others. And over time, you may realize that no one is looking at you or watching you while you work out. This can help to ease some social anxiety when you realize people are not watching you as closely as you thought they were.

Researchers say exercise is a promising additional treatment for people with social anxiety disorder, but they need more studies to prove why it works. Research is ongoing.

Diet Changes

Do you snack on fatty, high-calorie foods when you’re worried? Does your snack make you feel a little sick?

Adjusting your diet could help you feel a little healthier, and that could allow you to face your fears with a calmer demeanor.

People with anxiety issues benefit from a diet that fits the following criteria:

• High in fruits and vegetables 
• Low in empty calories 
• High in micronutrients and vitamins 
• Inclusive of breakfast

Cutting out caffeine could also be helpful for you. A cup of strong coffee could leave you feeling jittery and unprepared for the day’s challenges. Swapping out your drink for healthy tea or simply water could be wise. 

Social Anxiety Disorder & Fear Ladders

A fear ladder, also known as an anxiety ladder, contains a list of the items you’re afraid of. The ladder begins with items that are easy to tackle, and they progress to pieces that are harder to address.

Take these steps to build one:

1. Write down all of the situations that make your social anxiety disorder symptoms flare.
2. Group similar fears together.
3. Break big items (like handling a party) into smaller pieces (such as saying hello to someone, taking a sip of a drink in front of someone, and walking across the room without tripping).
4. Rate your fears by difficulty.
5. Organize them from smallest to largest.

With a fear ladder built, you can begin to address your fears one by one.

What if You Don’t Treat Social Anxiety Disorder?

Social anxiety disorder will persist if it’s left untreated. That can lead people to avoid activities they might otherwise enjoy, such as spending time with friends, attending weddings, or trying for a new job. Some people choose to self-medicate with marijuana or alcohol to get through these episodes, which can lead to a substance use disorder.

The consequences of untreated social anxiety disorder can also include the following:

• Loneliness
• Low self-esteem
• Reduced success in school
• Depression
• Substance misuse

Who Is Most Affected by Social Anxiety?

Although anybody can develop social anxiety, there are some populations and demographics who may be more vulnerable to this mental health condition, including:[12],[13]

• Women
• People with other anxiety disorders
• People with depression
• People with an avoidant personality disorder
• People with a family history of social anxiety disorder
• People with a substance use disorder
• Children and young adults
• Children who experience bullying or teasing
• People who are timid or withdrawn
• People who have a condition or behavior that draws attention, such as stuttering
• Veterans

Social Anxiety & Addiction in Veterans

Up to 10% of combat veterans experience symptoms of PTSD and up to 13% also have symptoms of social anxiety disorder.[14]

One study found that veterans with social anxiety disorder were more likely to have experienced childhood abuse, be racial/ethnic minorities, single, younger, and female. These individuals also had higher rates of co-occurring mental health disorders, such as major depression and PTSD.[15]

This same study found that veterans with social anxiety had three times the risk for suicidal ideation, thus emphasizing the need for timely and quality care.[15]

As with other anxiety disorders and PTSD in veterans, those with social anxiety may misuse drugs or alcohol to self-medicate symptoms, attend social events, and interact with others. However, long-term substance abuse can lead to dependence, withdrawal, addiction, and worse social anxiety symptoms. The sooner you get treatment, the sooner you can break the cycle and begin your recovery journey.

Where Should You Start?

Therapy and medications are front-line treatments for social anxiety disorder. The other treatments we’ve mentioned could be helpful, but they work best as additions to a formal treatment program.

Talk with your doctor about your social anxiety disorder symptoms and find out if treatment is right for you. They can help you determine if medication is right for you, and they can potentially refer you to a therapist who can help.

Comprehensive treatment programs can offer you medical and therapeutic support in one place. Take the first step to reach out for help today.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More