Healthy Living

Treating Social Anxiety Disorder With Talk Therapy Works Better Than Antidepressants, But Using Both Is Best

Talk therapy
A study found it's better to treat social anxiety with talk therapy, not antidepressants. Photo courtesy of Shutterstock

Antidepressant medication may be the more accessible treatment option for people suffering from social anxiety disorder, but it may not be the most effective, a new study published in The Lancet Psychiatry found.

Social anxiety, according to the National Institute of Mental Health (NIMH), has many faces, including obsessive compulsive disorder, post-traumatic stress disorder, social phobia, and general anxiety. A reported eight percent of teens aged 13 to 18 have the disorder, yet very few seek treatment. For the teens that do, there are antidepressants or talk therapy. Is one more effective than the other? That’s what researchers from the Johns Hopkins Bloomberg School of Public Health, Oxford University, and University College London set out to see.

Researchers conducted a meta-analysis of data collected from 13,164 patients participating in over a hundred clinical trials. A little more than half of the patients received medication for severe social anxiety while the rest underwent a psychological intervention in the form of talk cognitive behavioral therapy, one of the many types of talk therapy (CBT). They found CBT treated anxious patients more effectively than antidepressants. That isn’t to say antidepressants are completely ineffective. The common selective serotonin reuptake inhibitors do help, the researchers added, but as with most medications, patients run the risk of experiencing negative side effects.

"Social anxiety is more than just shyness," said Dr. Evan Mayo-Wilson, lead study author and research scientist in the Department of Epidemiology at Johns Hopkins, in a press release. "People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering."

In 2010, The Child/Adolescent Anxiety Multimodal Study (CAMS) arrived at a similar conclusion when it found that high-quality CBT given with or without medication can effectively treat social anxiety disorder in children. CBT falls under the umbrella of talk therapy, with other forms including group therapy and counseling. Each works by having patients talk about their problems and issues, so that they can gain insight into themselves and find relief.

As scientists work to better understand the treatments available for those suffering from social anxiety and mental disorders, it’s becoming clear that the most effective option isn’t reduced to either medication or therapy; it’s a combination of both. For example, severely depressed patients showed less symptoms over time when they took antidepressants and participated in CBT.

"Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs," Mayo-Wilson said. "The health care system does not treat mental health equitably, but meeting demand isn't simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff."

Source: Mayo-Wilson E, Dias S, Mavranezouli I, et al. Psychological and Pharmacological Interventions for Social Anxiety Disorder in Adults: A Systematic Review and Network Meta-Analysis. The Lancet Psychiatry. 2014. 

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