As social phobia is considered to be a long-lasting chronic disorder, ongoing treatment generally is needed. Treatment often consists of a combination of medication and talk therapy.
In recent years, clinical trials have been conducted to see if a class of antidepressants known as selective serotonin reuptake inhibitors (SRIs) is effective in easing the symptoms of social phobia. The U.S. Food and Drug Administration recently approved the marketing of paroxetine (Paxil¿) as a treatment for social phobia.
Other classes of drugs prescribed to treat social phobia include monoamine oxidase inhibitors, referred to as MAOIs, including phenelzine (Nardil¿); beta-blockers, including propranolol (Inderal¿); and benzodiazepines, including clonazepam (Klonopin¿).
The antidepressant medications (SRIs and MAOIs) are effective in treating social anxiety but also treat any co-existing depression. SRIs, MAOIs and benzodiazepines are also effective in treating panic disorder.
The anti-anxiety medications (benzodiazepines) do not treat depression. Individuals with a history of drug or alcohol abuse are at an increased risk of abusing this class of medication and in general should not receive benzodiazepines. Although quite safe when taken properly, benzodiazepines can result in physical dependence, requiring tapering off to safely discontinue the medication.
The beta-blockers (e.g., Inderal¿) are helpful for social anxiety that is limited to performance, such as giving a speech or musical recital. This category of medication is prohibited in treating people with asthma and related lung conditions.
The antidepressants are prescribed on a daily fixed schedule while the benzodiazepines and beta-blockers may be prescribed on an as-needed basis.
Like any medications, those prescribed for social phobia can have side effects. Not every person with social phobia will find relief with medication. But for many people, the medication can lead to a significant lifting of symptoms within a few weeks.
Cognitive-behavioral therapy (CBT)
CBT is a type of psychotherapy. People with social anxiety are taught new ways of responding to situations that trigger fear and physical symptoms. The therapist helps the person learn how to make a more reasonable appraisal of potentially embarrassing situations. Addressing inaccurate thinking helps decrease excessive fear of being judged by others. These changes in thinking patterns are combined with a gradual controlled exposure to anxiety-provoking situations.