Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical practice guideline for social anxiety disorder (2021)

Abstract

The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for Anxiety and Obsessive–Compulsive Disorders was formed by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology to jointly develop guidelines for anxiety and obsessive–compulsive disorders. Based on the universal concept of evidence‐based medicine, three clinical questions (CQs) about pharmacotherapy and psychotherapy were developed for clinical guidelines for social anxiety disorder, panic disorders, and obsessive–compulsive disorder in accordance with the Minds “Manual for Guidelines Development 2017 by the Japan Council for Quality Health Care: CQ1—“What is the recommended pharmacotherapy for social anxiety disorder in adults?”; CQ2—“What is the recommended psychotherapy (psychological intervention) for social anxiety disorder in adults?”; and CQ3—“What are the recommendations regarding monotherapy and combination therapy for social anxiety disorder in adults in terms of pharmacotherapy and psychotherapy (psychological interventions)?” Summarized recommendations for social anxiety disorder in adults are selective serotonin reuptake inhibitors and serotonin‐norepinephrine reuptake inhibitor for CQ1, cognitive behavioral therapy for CQ2, and there are no recommendations regarding monotherapy and combination therapy for CQ3. These were answered by considering the balance between benefits and harms based on systematic reviews of each. The aim of this brief guideline for the standard‐of‐care (i.e., medical treatment) for social anxiety disorder in adults (18 years and older) was to help “shared decision making,” in which medical professionals, including physicians, and patients share scientific evidence to decide on a course of treatment.

The addition of employment support alongside psychological therapy enhances the chance of recovery for clients most at risk of poor clinical outcomes

“…Psychological therapies such as cognitive behaviour therapy have strong empirical support for the treatment of anxiety disorders and depression, and as a result are recommended by many national healthcare bodies (e.g. APA, 2019 ; Asakura et al ., 2023 ; Katzman et al ., 2014 ), including the National Institute for Health and Care Excellence (NICE) in the UK (e.g. NICE, 2009 , 2013 , 2018 ).…”

Individual cognitive therapy reduces frontal-thalamic resting-state functional connectivity in social anxiety disorder

“…In the United Kingdom, individual CT/CBT is recommended as a first-line treatment option ( 3 ). In addition, when implementing CT/CBT, guidelines from the United Kingdom and Japan recommend individual treatment to patients over group-based treatment because the group format is less clinically and cost-effective than the individual format ( 5 , 8 ). Although the guidelines clearly state treatment principles and options for SAD, it would be clinically beneficial to be able to predict the response to treatment before it is initiated.…”