TALK THERAPY - NOT MEDICATION- BEST FOR SOCIAL ANXIETY DISORDER
While antidepressants
are the most commonly used treatment for social anxiety disorder, new research
suggests that cognitive behavioral therapy (CBT) is more effective and, unlike
medication, can have lasting effects long after treatment has stopped.
Social anxiety
disorder is a psychiatric condition characterized by intense fear and avoidance
of social situations and affects up to 13 percent of Americans and Europeans.
Most people never receive treatment for the disorder. For those who do,
medication is the more accessible treatment because there is a shortage of
trained psychotherapists.
The findings of the
study, a network meta-analysis that collected and analyzed data from 101
clinical trials comparing multiple types of medication and talk therapy, are
published online Sept. 26 in The Lancet Psychiatry.
"Social anxiety
is more than just shyness," says study leader Evan Mayo-Wilson, DPhil, a
research scientist in the Department of Epidemiology at the Johns Hopkins
Bloomberg School of Public Health. "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."
The research was a
collaboration between the Johns Hopkins Bloomberg School of Public Health,
Oxford University and University College in London, where Mayo-Wilson formerly
worked.
For the study,
Mayo-Wilson and his colleagues analyzed data from 13,164 participants in 101
clinical trials. The participants all had severe and longstanding social
anxiety. Approximately 9,000 received medication or a placebo pill, and more
than 4,000 received a psychological intervention. Few of the trials looked at
combining medication with talk therapy, and there was no evidence that combined
therapy was better than talk therapy alone.
The data compared
several different types of talk therapy and found individual CBT was the most
effective. CBT is a form of treatment that focuses on relationships between
thoughts, feelings and behaviors. It helps people challenge irrational fears
and overcome their avoidance of social situations, Mayo-Wilson says.
For people who don't
want talk therapy, or who lack access to CBT, the most commonly used
antidepressants -- selective serotonin reuptake inhibitors (SSRIs) -- are
effective, the researchers found. But they caution that medication can be
associated with serious adverse events, that it doesn't work at all for many
people, and that improvements in symptoms do not last after people stop taking
the pills.
The researchers
acknowledge that medication remains important but say it should be used as a
second-line therapy for people who do not respond to or do not want
psychological therapy. The group's analysis has already led to new treatment
guidelines guidance in the U.K. and, Mayo-Wilson says, it could have a
significant impact on policymaking and the organization of care in the U.S.
Social anxiety
disorder typically begins in adolescence or early adulthood, and it can
severely impair a person's daily functioning by impeding the formation of
relationships, by negatively affecting performance at work or school, and by
reducing overall quality of life. Because it strikes people at critical times
in their social and educational development, social anxiety disorder can have
important and lasting consequences.
"Greater
investment in psychological therapies would improve quality of life, increase
workplace productivity, and reduce healthcare costs," Mayo-Wilson says.
"The healthcare 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."
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