Highlights & Basics
- Social anxiety disorder is characterized by an excessive fear of social and performance situations where the individual is afraid of being negatively evaluated or rejected by others.
- One of the most common and impairing mental disorders with a high risk for comorbid anxiety, depressive, and substance-use disorders; it may be associated with severe impairments in daily functioning, including reduced quality of life, difficulty forming relationships, and impaired school and work performance.
- Assessment is based on self-reporting, clinical interview, and behavioral observation.
- Selective serotonin-reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and cognitive behavioral therapy are considered the first-line treatments.
- Long-term clinical management and monitoring are typically required, as patients are prone to relapse following discontinuation of acute treatment.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. May 2013 [internet publication].[Full Text]
Katzman MA, Bleau P, Blier P, et al; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(suppl 1):S1.[Abstract][Full Text]
Williams T, Hattingh CJ, Kariuki CM, et al. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database Sys Rev. 2017 Oct 19;(10):CD001206.[Abstract][Full Text]
Schaffer A, McIntosh D, Goldstein BI, et al. The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders. Ann Clin Psychiatry. 2012 Feb;24(1):6-22.[Abstract]
1. Fehm L, Wittchen HU. Comorbidity in social anxiety disorder. In: Bandelow B, Stein DJ, eds. Social anxiety disorder. New York, NY: Marcel Dekker; 2004:49-63.
2. Stein DJ, Lim CCW, Roest AM, et al. The cross-national epidemiology of social anxiety disorder: data from the World Mental Health Survey Initiative. BMC Med. 2017 Jul 31;15(1):143.[Abstract][Full Text]
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
4. Poole KL, Cunningham CE, McHolm AE, et al. Distinguishing selective mutism and social anxiety in children: a multi-method study. Eur Child Adolesc Psychiatry. 2021 Jul;30(7):1059-69.[Abstract]
5. Szuhany KL, Simon NM. Anxiety disorders: a review. JAMA. 2022 Dec 27;328(24):2431-45.[Abstract]
6. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602.[Abstract][Full Text]
7. Merikangas KR. Vulnerability factors for anxiety disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2005 Oct;14(4):649-79;vii.[Abstract]
8. Asher M, Asnaani A, Aderka IM. Gender differences in social anxiety disorder: a review. Clin Psychol Rev. 2017 Aug;56:1-12.[Abstract]
9. Busa S, Wernick J, Kellerman J, et al. A descriptive case study of a cognitive behavioral therapy group intervention adaptation for transgender youth with social anxiety disorder. Behav Ther (N Y N Y). 2022 Apr;45(4):135-41.[Abstract][Full Text]
10. Bergero-Miguel T, García-Encinas MA, Villena-Jimena A, et al. Gender dysphoria and social anxiety: an exploratory study in Spain. J Sex Med. 2016 Aug;13(8):1270-8.[Abstract]
11. Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008 Mar 29;371(9618):1115-25.[Abstract]
12. Carter MM, Mitchell FE, Sbrocco T. Treating ethnic minority adults with anxiety disorders: current status and future recommendations. J Anxiety Disord. 2012 May;26(4):488-501.[Abstract][Full Text]
13. Brook CA, Schmidt LA. Social anxiety disorder: a review of environmental risk factors. Neuropsychiatr Dis Treat. 2008 Feb;4(1):123-43.[Abstract][Full Text]
14. Spence SH, Rapee RM. The etiology of social anxiety disorder: an evidence-based model. Behav Res Ther. 2016 Nov;86:50-67.[Abstract]
15. Stein MB, Gelernter J, Smoller JW. Genetic aspects of social anxiety and related traits. In: Brandelow B, Stein DJ, eds. Social anxiety disorder. New York, NY: Marcel Dekker; 2004:197-214.
16. Barlow DH. Anxiety and its disorders, 2nd ed. New York, NY: Guilford Press; 2002.
17. Stein MB, Chen CY, Jain S, et al. Genetic risk variants for social anxiety. Am J Med Genet B Neuropsychiatr Genet. 2017 Mar;174(2):120-31.[Abstract][Full Text]
18. Sandstrom A, Uher R, Pavlova B. Prospective association between childhood behavioral inhibition and anxiety: a meta-analysis. J Abnorm Child Psychol. 2020 Jan;48(1):57-66.[Abstract]
19. Xu J, Ni S, Ran M, et al. The relationship between parenting styles and adolescents' social anxiety in migrant families: a study in Guangdong, China. Front Psychol. 2017 Apr 20:8:626.[Abstract][Full Text]
20. Plasencia ML, Alden LE, Taylor CT. Differential effects of safety behaviour subtypes in social anxiety disorder. Behav Res Ther. 2011 Oct;49(10):665-75.[Abstract]
21. Piccirillo ML, Taylor Dryman M, Heimberg RG. Safety behaviors in adults with social anxiety: review and future directions. Behav Ther. 2016 Sep;47(5):675-87.[Abstract]
22. Roth DA, Heimberg RG. Cognitive behavioral models of social anxiety disorder. Psychiatr Clin North Am. 2001 Dec;24(4):753-71.[Abstract]
23. Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther. 2007;36(4):193-209.[Abstract][Full Text]
24. Etkin A, Wager TD. Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry. 2007 Oct;164(10):1476-88.[Abstract][Full Text]
25. Freitas-Ferrari MC, Hallak JE, Trzesniak C, et al. Neuroimaging in social anxiety disorder: a systematic review of the literature. Prog Neuropsychopharmacol Biol Psychiatry. 2010 May 30;34(4):565-80.[Abstract]
26. Schwartz CE, Wright CI, Shin LM, et al. Inhibited and uninhibited infants "grown up": adult amygdalar response to novelty. Science. 2003 Jun 20;300(5627):1952-3.[Abstract]
27. Condren RM, O'Neill A, Ryan MC, et al. HPA axis response to a psychological stressor in generalised social phobia. Psychoneuroendocrinology. 2002 Aug;27(6):693-703.[Abstract]
28. van West D, Claes S, Sulon J, et al. Hypothalamic-pituitary-adrenal reactivity in prepubertal children with social phobia. J Affect Disord. 2008 Dec;111(2-3):281-90.[Abstract]
29. Gelernter J, Page GP, Stein MB, et al. Genome-wide linkage scan for loci predisposing to social phobia: evidence for a chromosome 16 risk locus. Am J Psychiatry. 2004 Jan;161(1):59-66.[Abstract]
30. Doehrmann O, Ghosh SS, Polli FE, et al. Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry. 2013 Jan;70(1):87-97.[Abstract]
31. Hirshfeld-Becker DR, Micco JA, Simoes NA, et al. High risk studies and developmental antecedents of social anxiety disorder. Am J Med Genet. 2008 May 15;148C(2):99-117.[Abstract]
32. Aune T, Stiles TC. Universal-based prevention of syndromal and subsyndromal social anxiety: a randomized controlled study. J Consult Clin Psychol. 2009 Oct;77(5):867-79.[Abstract]
33. Steenen SA, van Wijk AJ, van der Heijden GJ, et al. Propranolol for the treatment of anxiety disorders: systematic review and meta-analysis. J Psychopharmacol. 2016 Feb;30(2):128-39.[Abstract][Full Text]
34. Garakani A, Murrough JW, Freire RC, et al. Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychiatry. 2020 Dec 23:11:595584.[Abstract][Full Text]
35. Liebowitz, MR, Schneier F, Campeas R, et al. Phenelzine vs atenolol in social phobia. A placebo-controlled comparison. Arch Gen Psychiatry. 1992 Apr;49(4):290-300.[Abstract]
36. Turner SM, Beidel DC, Jacob RG. Social phobia: a comparison of behavior therapy and atenolol. J Consult Clin Psychol. 1994 Apr;62(2):350-8.[Abstract]
37. Falloon IR, Lloyd GG, Harpin RE. The treatment of social phobia: real-life rehearsal with nonprofessional therapists. J Nerv Ment Dis. 1981 Mar;169(3):180-4.[Abstract]
38. Stein MB, Sareen J, Hami S, et al. Pindolol potentiation of paroxetine for generalized social phobia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry. 2001 Oct;158(10):1725-7.[Abstract]
39. Wang PS, Berglund P, Olfson M, et al. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):603-13.[Abstract][Full Text]
40. Wagner R, Silove D, Marnane C, et al. Delays in referral of patients with social phobia, panic disorder, and generalized anxiety disorder attending a specialist anxiety clinic. J Anxiety Disord. 2006;20(3):363-71.[Abstract]
41. Canadian Paediatric Society. Position statement: anxiety in children and youth: part 1-diagnosis. Oct 2022 [internet publication].[Full Text]
42. Taylor CT, Laposa JM, Alden LE. Is avoidant personality disorder more than just social avoidance? J Pers Disord. 2004 Dec;18(6):571-94.[Abstract]
43. Cox BJ, Pagura J, Stein MB, et al. The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey. Depress Anxiety. 2009;26(4):354-62.[Abstract]
44. Lampe L, Malhi GS. Avoidant personality disorder: current insights. Psychol Res Behav Manag. 2018 Mar 8:11:55-66.[Abstract][Full Text]
45. Dalrymple K, Martinez J, Tepe E, et al. A clinically useful social anxiety disorder outcome scale. Compr Psychiatry. 2013 Oct;54(7):758-65.[Abstract][Full Text]
46. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7.[Abstract][Full Text]
47. Mennin DS, Fresco DM, Heimberg RG, et al. Screening for social anxiety disorder in the clinical setting: the Liebowitz Social Anxiety Scale. J Anxiety Disord. 2002;16(6):661-73.[Abstract]
48. Connor K, Kobak KA, Churchill E, et al. Mini-SPIN: a brief screening assessment for generalized social anxiety disorder. Depress Anxiety. 2001;14(2):137-40.[Abstract]
49. Caporino NE, Sakolsky D, Brodman DM, et al. Establishing clinical cutoffs for response and remission on the screen for child anxiety related emotional disorders (SCARED). J Am Acad Child Adolesc Psychiatry. 2017 Aug;56(8):696-702.[Abstract][Full Text]
50. US Preventive Services Task Force. Final recommendation statement: anxiety in children and adolescents: screening. Oct 2022 [internet publication].[Full Text]
51. US Preventive Services Task Force. Final recommendation statement: anxiety disorders in adults: screening. Jun 2023 [internet publication].[Full Text]
52. Gregory KD, Chelmow D, Nelson HD, et al. Screening for anxiety in adolescent and adult women: a recommendation from the Women's Preventive Services Initiative. Ann Intern Med. 2020 Jul 7;173(1):48-56.[Abstract]
53. Runyon K, Chesnut SR, Burley H. Screening for childhood anxiety: a meta-analysis of the screen for child anxiety related emotional disorders. J Affect Disord. 2018 Nov;240:220-9.[Abstract]
54. Kroenke K, Spitzer RL, Williams JB, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007 Mar 6;146(5):317-25.[Abstract]
55. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13.[Abstract][Full Text]
56. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70.[Abstract]
57. Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003 Aug 1;1:29.[Abstract][Full Text]
58. Walter HJ, Bukstein OG, Abright AR, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2020 Oct;59(10):1107-24.[Abstract][Full Text]
59. British Columbia Medical Association Guidelines & Protocols Advisory Committee. Anxiety and depression in children and youth: diagnosis and treatment. July 2024 [internet publication].[Full Text]
60. National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. May 2013 [internet publication].[Full Text]
61. Andrews G, Bell C, Boyce P, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry. 2018;52(12):1109-72.[Full Text]
62. Canton J, Scott KM, Glue P. Optimal treatment of social phobia: systematic review and meta-analysis. Neuropsychiatr Dis Treat. 2012;8:203-15.[Abstract][Full Text]
63. Katzman MA, Bleau P, Blier P, et al; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(suppl 1):S1.[Abstract][Full Text]
64. Bandelow B, Seidler-Brandler U, Becker A, et al. Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. World J Biol Psychiatry. 2007;8(3):175-87.[Abstract]
65. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - version 3. part I: anxiety disorders. World J Biol Psychiatry. 2023 Feb;24(2):79-117.[Abstract]
66. James AC, Reardon T, Soler A, et al. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2020 Nov 16;(11):CD013162.[Abstract][Full Text]
67. Walkup JT, Albano AM, Piacentini J, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008 Dec 25;359(26):2753-66.[Abstract][Full Text]
68. Ginsburg GS, Kendall PC, Sakolsky D, et al. Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol. 2011 Dec;79(6):806-13.[Abstract][Full Text]
69. Wang Z, Whiteside SPH, Sim L, et al. Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: a systematic review and meta-analysis. JAMA Pediatr. 2017 Nov 1;171(11):1049-56.[Abstract][Full Text]
70. Solmi M, Fornaro M, Ostinelli EG, et al. Safety of 80 antidepressants, antipsychotics, anti-attention-deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta-review of 78 adverse effects. World Psychiatry. 2020 Jun;19(2):214-32.[Abstract][Full Text]
71. Butler AC, Chapman JE, Forman EM, et al. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006 Jan;26(1):17-31.[Abstract]
72. Ponniah K, Hollon SD. Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials. Psychol Med. 2008 Jan;38(1):3-14.[Abstract]
73. Rowa K, Antony MM. Psychological treatments for social phobia. Can J Psychiatry. 2005 May;50(6):308-16.[Abstract][Full Text]
74. Beidel DC, Ferrell C, Alfano CA, et al. The treatment of childhood social anxiety disorder. Psychiatr Clin North Am. 2001 Dec;24(4):831-46.[Abstract]
75. Fedoroff IC, Taylor S. Psychological and pharmacological treatments of social phobia: a meta-analysis. J Clin Psychopharmacol. 2001 Jun;21(3):311-24.[Abstract]
76. Acarturk C, Cuijpers P, van Straten A, et al. Psychological treatment of social anxiety disorder: a meta-analysis. Psychol Med. 2009 Feb;39(2):241-54.[Abstract]
77. 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. Lancet Psychiatry. 2014 Oct;1(5):368-76.[Abstract][Full Text]
78. Barkowski S, Schwartze D, Strauss B, et al. Efficacy of group psychotherapy for social anxiety disorder: a meta-analysis of randomized-controlled trials. J Anxiety Disord. 2016 Apr;39:44-64.[Abstract]
79. Bandelow B, Sagebiel A, Belz M, et al. Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies. Br J Psychiatry. 2018 Jun;212(6):333-8.[Abstract][Full Text]
80. Ougrin D. Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry. 2011 Dec 20;11:200.[Abstract][Full Text]
81. Canadian Paediatric Society. Position statement: anxiety in children and youth: part 2 - the management of anxiety disorders. Oct 2022 [internet publication].[Full Text]
82. Scaini S, Belotti R, Ogliari A, et al. A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disorder in children and adolescents. J Anxiety Disord. 2016 Aug;42:105-12.[Abstract]
83. Aderka IM. Factors affecting treatment efficacy in social phobia: the use of video feedback and individual vs. group formats. J Anxiety Disord. 2009 Jan;23(1):12-7.[Abstract]
84. Hedman E, Ljótsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res. 2012 Dec;12(6):745-64.[Abstract]
85. Andrews G, Basu A, Cuijpers P, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J Anxiety Disord. 2018 Apr;55:70-8.[Abstract][Full Text]
86. National Institute for Health and Care Excellence. Digitally enabled therapies for adults with anxiety disorders: early value assessment. Dec 2023 [internet publication].[Full Text]
87. National Institute for Health and Care Excellence. Guided self-help digital cognitive behavioural therapy for children and young people with mild to moderate symptoms of anxiety or low mood: early value assessment. Sep 2023 [internet publication].[Full Text]
88. Dear BF, Staples LG, Terides MD, et al. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for social anxiety disorder and comorbid disorders: a randomized controlled trial. J Anxiety Disord. 2016 Aug;42:30-44.[Abstract][Full Text]
89. Hedman E, Andersson G, Ljotsson B, et al. Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial. PLoS One. 2011 Mar 25;6(3):e18001.[Abstract][Full Text]
90. Hedman E, Furmark T, Carlbring P, et al. A 5-year follow-up of internet-based cognitive behavior therapy for social anxiety disorder. J Med Internet Res. 2011 Jun 15;13(2):e39.[Abstract][Full Text]
91. Olthuis JV, Watt MC, Bailey K, et al. Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2016 Mar 12;3(3):CD011565.[Abstract][Full Text]
92. Horigome T, Kurokawa S, Sawada K, et al. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychol Med. 2020 Nov;50(15):2487-97.[Abstract]
93. Emmelkamp PMG, Meyerbröker K, Morina N. Virtual reality therapy in social anxiety disorder. Curr Psychiatry Rep. 2020 May 13;22(7):32.[Abstract][Full Text]
94. Hofmann SG, Gómez AF. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin North Am. 2017 Dec;40(4):739-49.[Abstract][Full Text]
95. Hoge EA, Bui E, Mete M, et al. Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2023 Jan 1;80(1):13-21.[Abstract][Full Text]
96. Haller H, Breilmann P, Schröter M, et al. A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders. Sci Rep. 2021 Oct 14;11(1):20385.[Abstract][Full Text]
97. Roy-Byrne P, Craske MG, Sullivan G, et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA. 2010 May 19;303(19):1921-8.[Abstract][Full Text]
98. Craske MG, Stein MB, Sullivan G, et al. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Arch Gen Psychiatry. 2011 Apr;68(4):378-88.[Abstract][Full Text]
99. Clark DM. Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. Int Rev Psychiatry. 2011 Aug;23(4):318-27.[Abstract][Full Text]
100. Gyani A, Shafran R, Layard R, et al. Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther. 2013 Sep;51(9):597-606.[Abstract][Full Text]
101. Wakefield S, Kellett S, Simmonds-Buckley M, et al. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: a systematic review and meta-analysis of 10-years of practice-based evidence. Br J Clin Psychol. 2021 Mar;60(1):1-37.[Abstract][Full Text]
102. Baigent M, Smith D, Battersby M, et al. The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess. J Ment Health. 2020 May 12;1-10.[Abstract]
103. Knapstad M, Smith ORF. Social anxiety and agoraphobia symptoms effectively treated by Prompt Mental Health Care versus TAU at 6- and 12-month follow-up: secondary analysis from a randomized controlled trial. Depress Anxiety. 2021 Mar;38(3):351-60.[Abstract][Full Text]
104. Williams T, Hattingh CJ, Kariuki CM, et al. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database Sys Rev. 2017 Oct 19;(10):CD001206.[Abstract][Full Text]
105. Stein DJ, Baldwin DS, Bandelow B, et al. A 2010 evidence-based algorithm for the pharmacotherapy of social anxiety disorder. Curr Psychiatry Rep. 2010 Oct;12(5):471-7.[Abstract]
106. Roy-Byrne PP, Veitengruber JP, Bystritsky A, et al. Brief intervention for primary care anxiety: a medication focused approach. J Am Board Fam Med. 2009 Mar-Apr;22(2):175-86.[Abstract][Full Text]
107. de Menezes GB, Coutinho ES, Fontenelle LF, et al. Second-generation antidepressants in social anxiety disorder: meta-analysis of controlled clinical trials. Psychopharmacology (Berl). 2011 May;215(1):1-11.[Abstract]
108. Kimmel RJ, Roy-Byrne PP, Cowley DS. Pharmacological treatments for panic disorder, generalized anxiety disorder, specific phobia, and social anxiety disorder. In: Nathan PE, Gorman JM, eds. A guide to treatments that work. 4th ed. New York, NY: Oxford University Press; 2015:463-506.[Full Text]
109. Kobak KA, Greist JH, Jefferson JW, et al. Fluoxetine in social phobia: a double-blind, placebo-controlled pilot study. J Clin Psychopharmacol. 2002 Jun;22(3):257-62.[Abstract]
110. Stein DJ, Stein MB, Pitts CD, et al. Predictors of response to pharmacotherapy in social anxiety disorder: an analysis of 3 placebo-controlled paroxetine trials. J Clin Psychiatry. 2002 Feb;63(2):152-5.[Abstract]
111. Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39.[Abstract]
112. Dell'osso B, Lader M. Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal. Eur Psychiatry. 2013 Jan;28(1):7-20.[Abstract]
113. Davidson JR, Potts N, Richichi E, et al. Treatment of social phobia with clonazepam and placebo. J Clin Psychopharmacol. 1993 Dec;13(6):423-8.[Abstract]
114. Otto MW, Pollack MH, Gould RA, et al. A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia. J Anxiety Disord. 2000 Jul-Aug;14(4):345-58.[Abstract]
115. Davidson JR, Tupler LA, Potts NL. Treatment of social phobia with benzodiazepines. J Clin Psychiatry. 1994 Jun;(suppl 55):28-32.[Abstract]
116. Kennedy KM, O'Riordan J. Prescribing benzodiazepines in general practice. Br J Gen Pract. 2019 Mar;69(680):152-3.[Abstract][Full Text]
117. Seedat S, Stein MB. Double-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder. J Clin Psychiatry. 2004 Feb;65(2):244-8.[Abstract]
118. Pollack MH, Van Ameringen M, Simon NM, et al. A double-blind randomized controlled trial of augmentation and switch strategies for refractory social anxiety disorder. Am J Psychiatry. 2014 Jan;171(1):44-53.[Abstract]
119. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017 Jun;19(2):93-107.[Abstract][Full Text]
120. The International Multicenter Clinical Trial Group on Moclobemide in Social Phobia. Moclobemide in social phobia: a double-blind, placebo-controlled clinical study. Eur Arch Psychiatry Clin Neurosci. 1997;247(2):71-80.[Abstract]
121. Noyes R, Moroz G, Davidson JR, et al. Moclobemide in social phobia: a controlled dose-response trial. J Clin Psychopharmacol. 1997 Aug;17(4):247-54.[Abstract]
122. Schneier FR, Goetz D, Campeas R, et al. Placebo-controlled trial of moclobemide in social phobia. Br J Psychiatry. 1998 Jan;172:70-7.[Abstract]
123. Pande AC, Davidson JR, Jefferson JW, et al. Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol. 1999 Aug;19(4):341-8.[Abstract]
124. Pande AC, Feltner DE, Jefferson JW, et al. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol. 2004 Apr;24(2):141-9.[Abstract]
125. Tassone DM, Boyce E, Guyer J, et al. Pregabalin: a novel gamma-aminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin Ther. 2007 Jan;29(1):26-48.[Abstract]
126. Feltner DE, Liu-Dumaw M, Schweizer E, et al. Efficacy of pregabalin in generalized social anxiety disorder: results of a double-blind, placebo-controlled, fixed-dose study. Int Clin Psychopharmacol. 2011 Jul;26(4):213-20.[Abstract]
127. Greist JH, Liu-Dumaw M, Schweizer E, et al. Efficacy of pregabalin in preventing relapse in patients with generalized social anxiety disorder: results of a double-blind, placebo-controlled 26-week study. Int Clin Psychopharmacol. 2011 Sep;26(5):243-51.[Abstract]
128. Beaumont G. A large open multicentre trial of clomipramine (Anafranil) in the management of phobic disorders. J Int Med Res. 1977;5(suppl 5):116-23.[Abstract]
129. Simpson HB, Schneier FR, Campeas RB, et al. Imipramine in the treatment of social phobia. J Clin Psychopharmacol. 1998 Apr;18(2):132-5.[Abstract]
130. Muehlbacher M, Nickel MK, Nickel C, et al. Mirtazapine treatment of social phobia in women: a randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol. 2005 Dec;25(6):580-3.[Abstract]
131. Davis ML, Smits JA, Hofmann SG. Update on the efficacy of pharmacotherapy for social anxiety disorder: a meta-analysis. Expert Opin Pharmacother. 2014 Nov;15(16):2281-91.[Abstract]
132. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017 Sep 25;358:j4461.[Abstract][Full Text]
133. Craske MG, Stein MB. Anxiety. Lancet. 2016 Dec 17;388(10063):3048-59.[Abstract]
134. Connor KM, Davidson JR, Potts NL, et al. Discontinuation of clonazepam in the treatment of social phobia. J Clin Psychopharmacol. 1998 Oct;18(5):373-8.[Abstract]
135. Palmer EG, Sornalingam S, Page L, et al. Withdrawing from SSRI antidepressants: advice for primary care. Br J Gen Pract. 2023 Mar;73(728):138-40.[Abstract][Full Text]
136. National Institute for Health and Care Excellence. Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. Apr 2022 [internet publication].[Full Text]
137. Haug T, Blomhoff S, Hellstrom K, et al. Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial. Br J Psychiatry. 2003 Apr;182:312-8.[Abstract][Full Text]
138. Schneier FR, Johnson J, Hornig CD, et al. Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry. 1992 Apr;49(4):282-8.[Abstract]
139. Kessler KC, Stein MB, Berglund P. Social phobia subtypes in the National Comorbidity Survey. Am J Psychiatry. 1998 May;155(5):613-9.[Abstract][Full Text]
140. Schaffer A, McIntosh D, Goldstein BI, et al. The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders. Ann Clin Psychiatry. 2012 Feb;24(1):6-22.[Abstract]
141. Feldman G. Cognitive and behavioral therapies for depression: overview, new directions, and practical recommendations for dissemination. Psychiatr Clin North Am. 2007 Mar;30(1):39-50.[Abstract]
142. Ott CA. Treatment of anxiety disorders in patients with comorbid bipolar disorder. Ment Health Clin. 2018 Nov;8(6):256-63.[Abstract][Full Text]
143. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.[Abstract]
144. Liebowitz MB, Gelenberg AJ, Munjack D. Venlafaxine extended release vs placebo and paroxetine in social anxiety disorder. Arch Gen Psychiatry. 2005 Feb;62(2):190-8.[Abstract][Full Text]
145. Barnett SD, Kramer ML, Casat CD, et al. Efficacy of olanzapine in social anxiety disorder: a pilot study. J Psychopharmacol. 2002 Dec;16(4):365-8.[Abstract]
146. Schutters SI, van Megen HJ, Westenberg HG. Efficacy of quetiapine in generalized social anxiety disorder: results from an open-label study. J Clin Psychiatry. 2005 Apr;66(4):540-2.[Abstract]
147. Depping AM, Komossa K, Kissling W, et al. Second-generation antipsychotics for anxiety disorders. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD008120.[Abstract][Full Text]
148. Van Ameringen M, Mancini C, Wilson C. Buspirone augmentation of selective serotonin reuptake inhibitors (SSRIs) in social phobia. J Affect Disord. 1996 Jul 8;39(2):115-21.[Abstract]
149. Guastella AJ, Richardson R, Lovibond PF, et al. A randomized controlled trial of D-cycloserine enhancement of exposure therapy for social anxiety disorder. Biol Psychiatry. 2008 Mar 15;63(6):544-9.[Abstract]
150. Tolin DF, Lord KA, Knowles KA. Cognitive-behavioral therapy enhancement strategies. Psychiatr Clin North Am. 2024 Jun;47(2):355-65.[Abstract]
151. Mataix-Cols D, Fernández de la Cruz L, Monzani B, et al. D-Cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data. JAMA Psychiatry. 2017 May 1;74(5):501-10.[Abstract][Full Text]
152. Smits JAJ, Pollack MH, Rosenfield D, et al. Dose timing of D-cycloserine to augment exposure therapy for social anxiety disorder: a randomized clinical trial. JAMA Netw Open. 2020 Jun 1;3(6):e206777.[Abstract][Full Text]
153. Pelissolo A, Abou Kassm S, Delhay L. Therapeutic strategies for social anxiety disorder: where are we now? Expert Rev Neurother. 2019 Dec;19(12):1179-89.[Abstract]
154. Hertenstein E, Trinca E, Schneider CL, et al. Augmentation of psychotherapy with neurobiological methods: current state and future directions. Neuropsychobiology. 2021;80(6):437-53.[Abstract][Full Text]
155. Markowitz JC, Lipsitz J, Milrod BL. Critical review of outcome research on interpersonal psychotherapy for anxiety disorders. Depress Anxiety. 2014 Apr;31(4):316-25.[Abstract][Full Text]
156. Tang L, Xu F, Yu G, et al. Efficacy of interpersonal psychotherapy in mainland China: a systematic review and meta-analysis. Front Psychiatry. 2023 Jul 12:14:1160081.[Abstract][Full Text]
157. Amir N, Bomyea J, Beard C. The effect of single-session interpretation modification on attention bias in socially anxious individuals. J Anxiety Disord. 2010 Mar;24(2):178-82.[Abstract][Full Text]
158. Liu H, Li X, Han B, et al. Effects of cognitive bias modification on social anxiety: a meta-analysis. PLoS One. 017 Apr 6;12(4):e0175107.[Abstract][Full Text]
159. Norton PJ, Barrera TL. Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depress Anxiety. 2012 Oct;29(10):874-82.[Abstract][Full Text]
160. Ito M, Horikoshi M, Kato N, et al. Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial. Psychol Med. 2023 May;53(7):3009-20.[Abstract][Full Text]
161. Barlow DH, Farchione TJ, Bullis JR, et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2017 Sep 1;74(9):875-84.[Abstract][Full Text]
162. Jayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014 Feb;48(3):187-96.[Abstract]
163. Zika MA, Becker L. Physical activity as a treatment for social anxiety in clinical and non-clinical populations: a systematic review and three meta-analyses for different study designs. Front Hum Neurosci. 2021 Jun 11:15:653108.[Abstract][Full Text]
164. Griffiths C, da Silva K, Jiang H, et al. Alpha-Stim AID cranial electrotherapy stimulation (CES) anxiety treatment: anxiety, depression and health-related quality-of-life outcomes in primary health-care social prescribing services. Ment Health Rev J. 2023 May 25;28(4):337-49.[Full Text]
165. National Institute for Health and Care Excellence. Alpha-stim AID for anxiety disorders. Mar 2021 [internet publication].[Full Text]
166. Blanco C, Schneier FR, Schmidt A, et al. Pharmacological treatment of social anxiety disorder: a meta-analysis. Depress Anxiety. 2003;18(1):29-40.[Abstract]
167. Ipser JC, Kariuki CM, Stein DJ. Pharmacotherapy for social anxiety disorder: a systematic review. Expert Rev Neurother. 2008 Feb;8(2):235-57.[Abstract]
168. US Food and Drug Administration. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. May 2007 [internet publication].
169. Reisman Y. Post-SSRI sexual dysfunction. BMJ. 2020 Feb 27;368:m754.[Abstract][Full Text]
170. Reisman Y. Sexual Consequences of post-SSRI syndrome. Sex Med Rev. 2017 Oct;5(4):429-33.[Abstract]
171. Krause KR, Chung S, Adewuya AO, et al. International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. Lancet Psychiatry. 2021 Jan;8(1):76-86.[Abstract]