Optimal treatment of social phobia: systematic review and meta-analysis

Abstract

This article proposes a number of recommendations for the treatment of generalized social phobia, based on a systematic literature review and meta-analysis. An optimal treatment regimen would include a combination of medication and psychotherapy, along with an assertive clinical management program. For medications, selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles. The nonselective monoamine oxidase inhibitor, phenelzine, may be more potent than these two drug classes, but because of its food and drug interaction liabilities, its use should be restricted to patients not responding to selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. There are other medication classes with demonstrated efficacy in social phobia (benzodiazepines, antipsychotics, alpha-2-delta ligands), but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines, it is unclear how best to incorporate these drugs into treatment regimens. There are very few clinical trials on the use of combined medications. Cognitive behavior therapy appears to be more effective than other evidence-based psychological techniques, and its effects appear to be more enduring than those of pharmacotherapy. There is some evidence, albeit limited to certain drug classes, that the combination of medication and cognitive behavior therapy may be more effective than either strategy used alone. Generalized social phobia is a chronic disorder, and many patients will require long-term support and treatment.

Effects of resocialization on post‐weaning social isolation‐induced abnormal aggression and social deficits in rats

“…Early maltreatment is also a strong predictor of social phobia (Bruce, Heimberg, Blanco, Schneier, & Liebowitz, 2012;Lochner et al, 2010), one major symptom of which is social withdrawal (American Psychiatric Association, 2000). Psychotherapy for social phobia is reasonably successful in these conditions (Canton et al, 2012;Willutzki et al, 2012), while psychotherapy for violence produces more modest results later in life (Currie & Startup, 2012;Weiss et al, 2005). In line with these human findings, post-weaning social isolation in rats resulted in marked social deficits in social contexts, but these deficits were relatively rapidly abolished by group living.…”

“…It was shown that these adverse early conditions contribute to excessive aggressive behavior in adolescence and adulthood (Krischer & Sevecke, 2008;Maxfield & Widom, 1996;McCord, 1983;Rivera & Widom, 1990;Widom, 1989). There are reports about possible pharmacological treatments for these symptoms, as well as about psychotherapy or cognitive behavior therapy, however, treatment efficacy is unsatisfactory (Canton, Scott, & Glue, 2012;Currie & Startup, 2012;Goedhard et al, 2006;McCloskey, Noblett, Deffenbacher, Gollan, & Coccaro, 2008;Turgay, 2004;B. Weiss et al, 2005;Willutzki, Teismann, & Schulte, 2012).…”

Impact of cognitive-behavioral therapy for social anxiety disorder on the neural bases of emotional reactivity to and regulation of social evaluation

“…Cognitive-behavioral therapy (CBT) is the most effective psychosocial intervention for SAD (Gordon, Wong, & Heimberg, 2014), and CBT produces clinical improvements that are more enduring than those of pharmacotherapy (Canton, Scott, & Glue, 2012). Neuroimaging studies show that CBT modulates emotion processing brain networks (Clark & Beck, 2010; Porto et al, 2009).…”

A personality and impairment approach to examine the similarities and differences between avoidant personality disorder and social anxiety disorder

“…Of course, additional research will be needed before this could occur; however, if this does become the case, a wealth of knowledge can be consolidated across disorders that can potentially be used to better understand, assess and treat clients. The latter is especially important, as the empirical literature on treatment options for SAD is far greater than for AvPD (Canton, Scott, & Glue, 2012).…”