Mayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Treatments and drugs
Social anxiety disorder typically persists for life, often waxing and waning. But don't lose hope. Treatment can help you control symptoms and become more confident and relaxed in social situations.
The two most effective types of treatment are medications and a form of psychotherapy called cognitive behavioral therapy. These two approaches are often used in combination.
Psychotherapy
Cognitive behavioral therapy improves symptoms in up to 75 percent of people with social anxiety disorder. This type of therapy is based on the idea that your own thoughts — not other people or situations — determine how you behave or react. Even if an unwanted situation won't change — you still have to give a presentation to management, for instance — you can change the way you think and behave in a positive way. In therapy, you learn how to recognize and change negative thoughts about yourself.
Cognitive behavioral therapy may also include exposure therapy. In this type of therapy, you gradually work up to facing the situations you fear most. This allows you to become better skilled at coping with these anxiety-inducing situations and to develop the confidence to face them. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Relaxation or stress management techniques may be included in your treatment plan.
First choices in medications
Several types of medications are used to treat social anxiety disorder. However, selective serotonin reuptake inhibitors (SSRIs) are generally considered the safest and most effective treatment for persistent symptoms of social anxiety. SSRIs your doctor may prescribe include:
- Paroxetine (Paxil, Paxil CR)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox, Luvox CR)
- Fluoxetine (Prozac, Sarafem, others)
The serotonin and norepinephrine reuptake inhibitors (SNRI) drug venlafaxine (Effexor, Effexor XR) also may be used as a first-line therapy for social anxiety disorder.
To reduce the risk of side effects, your doctor will start you at a low dose of medication and gradually increase your prescription to a full dose. It may take up to three months of treatment for your symptoms to noticeably improve.
Other medication options
Your doctor or mental health provider may also prescribe other medications for symptoms of social anxiety, including:
- Other antidepressants. You may have to try several different antidepressants to find which one is the most effective and has the fewest unpleasant side effects.
- Anti-anxiety medications. A type of anti-anxiety medication called benzodiazepines (ben-zo-di-AZ-uh-penes) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming. Because of that, they're often prescribed for only short-term use. They may also be sedating.
- Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They're not recommended for general treatment of social anxiety disorder.
Stick with it
Don't give up if treatment doesn't work quickly. You can continue to make strides in therapy over several weeks or months. And remember that finding the right medication for your situation can take some trial and error.
For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse.
- Social phobia (social anxiety disorder). In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed June 11, 2009.
- Hollander E, et al. Social phobia (social anxiety disorder). In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed June 11, 2009
- Bruce TJ, et al. Social anxiety disorder. http://www.uptodate.com/home/index.html. Accessed June 11, 2009.
- Phobic disorders. The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec15/ch196/ch196e.html. Accessed June 11, 2009.
- Social phobia (social anxiety disorder). National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/social-phobia-social-anxiety-disorder/index.shtml#SocialPhobia. Accessed June 11, 2009.
- Feldman MD, et al. Phobias. In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008: http://www.mdconsult.com/das/book/body/142893743-5/851356429/1701/448.html#4-u1.0-B978-0-323-04134-8..50019-7--subchapter28_9560. Accessed June 11, 2009.
- Abramowitz JS. Self-help cognitive-behavioral therapy with minimal therapist contact for social phobia: A controlled trial. Journal of Behavior Therapy and Experimental Psychiatry. 2009;40:98.
- Ebell MH. Diagnosis of anxiety disorders in primary care. American Family Physician. 2008;78:501.
- Whiteside SP (expert opinion). Mayo Clinic, Rochester, Minn. June 17, 2009.
