SHAFAQNA – New research in The Lancet Psychiatry suggests that for people with social anxiety, talk therapy may be a better option than medication. The study is one of a growing number that suggests that talk therapy may rival medication for certain mental health disorders. And in the current study, cognitive behavior therapy (CBT) lives up to its reputation as the gold standard in psychotherapy. In CBT, a person is taught to identify the negative thought patterns one falls back on and replace them with more positive and effective ones. Numerous studies have illustrated the value of CBT and other types of therapy for treating other mental health issues – most notably, depression – and the new one adds some compelling evidence that it may also work well as well as, or even better than, medication for social anxiety.
About 12-14% of people in the U.S. will suffer from social anxiety, also called social phobia, over their lifetimes. The symptoms include a sometimes-debilitating discomfort around people; fear or avoidance of social situations; blushing, trembling, sweating, and feeling nauseous or panicky when around people; self-consciousness or embarrassment when talking with others; and the fear that others are judging them. Social anxiety often goes hand-in-hand with other psychological issues, like generalized anxiety disorder and depression.
“Social anxiety is more than just shyness,” said study author Evan Mayo-Wilson in a news 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.”
To tease apart which treatments are most effective for treating social anxiety, Mayo-Wilson and his team from Johns Hopkins University, Oxford University and University College in London looked back over data from 101 earlier studies including over 13,000 people with severe and long-term social anxiety. Some had been assigned to various types of talk therapy for treatment, some to medication or to placebo, and some had both therapy and medication.
Those who went to talk therapy had much greater improvement in symptoms than those in the other groups – CBT was especially effective, compared to other types of therapy like psychodynamic psychotherapy (which was also effective, but less so than CBT), interpersonal psychotherapy, mindfulness, and supportive therapy. Some of the medications were effective, compared to placebo, including the antidepressants MAOIs, and SSRIs and SNRIs, although the improvement in symptoms wasn’t quite as great as with talk therapy.
Interestingly, talk therapy and medication didn’t seem to offer any particular benefit over one or the other alone. This is somewhat surprising, since for depression, at least, antidepressants and talk therapy have been found to offer the greatest benefit when used together. But this may be due partly to the fact that there weren’t very many studies looking at combined treatments.
The study had some shortcomings, like a small sample size for some of the treatments, a lack of long-term follow-up, and uncertainty about some of the control conditions in the studies. These issues will need to be addressed moving forward, but from the current study, it seems fairly clear that talk therapy can offer at least as much relief from social anxiety as medication.
The authors point out that one drawback of antidepressants is that their effects stop as soon as the treatment is stopped. With therapy, the effects are typically long-lasting, since the person has learned different ways of coping with the disorder. “For this reason,” the authors conclude, “and because of the lower risk of side-effects, psychological interventions should be preferred over pharmacological interventions for initial treatment.”
Mayo-Wilson points out that mental health still doesn’t get the attention it deserves – but improving it isn’t just about getting health insurance companies to pay for service, it’s about getting more well-trained psychologists and staff out there, too. “We need to improve infrastructure to treat mental health problems,” he says, “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.”
Hopefully this will become a reality in the future – it seems to be happening already, if slowly.