What is the up- to- date treatment of social anxiety disorder?

Question

I am a 64-year-old man ,is there any appropriate
therapy available that could improve my long standing anxiousness?

Answer 1

Social anxiety is an experience of fear, apprehension or worry regarding social situations and being evaluated by others. People vary in how often they experience anxiety in this way or in which kinds of situations. Anxiety about public speaking, performance, or interviews is common.

Social anxiety disorder (SAD), also referred to clinically as social phobia, is a psychiatric anxiety disorder involving overwhelming anxiety and excessive self-consciousness in everyday social situations. People experiencing social anxiety often have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. Often the triggering social stimulus is a perceived or actual scrutiny by others. Their fear may be so severe that it significantly impairs their work, school, social life, and other activities. While many people experiencing social anxiety recognize that their fear of being around people may be excessive or unreasonable, they encounter considerable difficulty overcoming it. This differs from shyness, in that the person is functionally debilitated and avoids such anxiety provoking situations by all means. At the same time, a person with social anxiety may only feel the fear of the disorder during certain situations. For example, an actor or singer may feel fine on stage, but afraid of social situations in everyday life.

Social anxiety is often part of only a certain situation—such as a fear of speaking in formal or informal situations, or eating, or writing in front of others—or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Many people have the specific fear of public speaking, called glossophobia. In this case, the fear is not actually of public speaking, but a fear of doing or saying something which may cause embarrassment. Approximately 13.3% of the general population will experience social phobia at some point in their lifetime; with the male to female ratio being 1.4:1.0, respectively. Physical symptoms often accompany social anxiety, and include blushing, profuse sweating, trembling, nausea, and stammering. Panic attacks may also occur under intense fear and discomfort. An early diagnosis helps in minimizing the symptoms and having other mental illnesses such as depression. Some sufferers also use alcohol or drugs to reduce fears and inhibitions at social events.

A person with the disorder may be treated with therapy, medication, or both. Research has shown cognitive behavior therapy, whether individually or in a group, to be effective in treating social phobics. The cognitive and behavioral components seek to change thinking patterns and physical reactions to anxious situations. This may be done through a technique called role playing. Prescribed medication consists of a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Such treatment has a high response rate and low risk of dependency but has been criticized for its adverse side-effects and possible increase in suicide risk.

Attention given to social anxiety disorder has significantly increased since 1999 with the approval of drugs for its treatment. Marketing campaigns by pharmaceutical companies may be largely responsible for driving this.

Treatment

Arguably the most important clinical point to emerge from studies of comorbid social anxiety disorder is the necessity for early diagnosis and treatment. Social anxiety disorder remains underrecognized in primary care practice, with patients presenting for treatment only after the onset of complications such as major depression or substance use disorders. Up to 80% of those treated for social phobia claim to have their anxiety under control, according to the Anxiety Disorders Association of America. Improvement is lower for those with more severe social phobia and with comorbid disorders, such as avoidant personality disorder and depression. The patients who achieve full resolution are usually far fewer; there are still many who, after receiving treatment, are unable to function in the long-term without anxiety symptoms.

Research supported by the NIMH has shown that there are two effective forms of treatment available for social phobia (and anxiety disorders): certain medications and a specific form of short-term psychotherapy called cognitive-behavioral therapy (CBT), the central component being gradual exposure therapy. Medications include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), as well as a benzodiazepene.

Pharmacological treatments

SSRIs

Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are considered the first choice by doctors in defusing fears associated with social phobia and related anxiety disorders. These drugs are designed to elevate the level of the neurotransmitter serotonin. The first drug formally approved by the Food and Drug Administration was paroxetine, sold as Paxil. Compared to older forms of medication, there is little risk of tolerability and drug dependency. However, their efficacy and increased suicide risk has been subject to controversy.

In a 1995 double-blind, placebo-controlled trial, the SSRI paroxetine was shown to result in clinically meaningful improvement in 55% of patients with generalized social anxiety disorder, compared with 23.9% of those taking placebo. An October 2004 study yielded similar results. Patients were treated with either fluoxetine, psychotherapy, fluoxetine and psychotherapy, placebo and psychotherapy, and a placebo. The first four sets saw improvement in 50.8 to 54.2% of the patients. Of those assigned to receive only a placebo, 31.7 percent achieved a rating of 1 or 2 on the Clinical Global Impression-Improvement scale. Those who sought both therapy and medication did not see a boost in improvement.

General side-effects are common during the first weeks while the body adjusts to the drug. Symptoms may include headaches, nausea, insomnia and changes in sexual behavior. Treatment safety during pregnancy has not been established. In late 2004 much media attention was given to a proposed link between SSRI use and juvenile suicide. For this reason, the use of SSRIs in pediatric cases of depression is now recognized by the Food and Drug Administration as warranting a cautionary statement to the parents of children who may be prescribed SSRIs by a family doctor. Recent studies have shown no increase in rates of suicide. These tests, however, represent those diagnosed with depression, not necessarily with social anxiety disorder. However, it should be noted that due to the nature of the conditions, those taking SSRIs for social phobias are far less likely to have suicidal ideation than those with depression.

Other drugs

Although SSRIs are often the first choice for treatment, other prescription drugs are also commonly issued.

Benzodiazepines are a more potent alternative to SSRIs. The drug is often used for short-term relief of severe, disabling anxiety. Although benzodiazepines are prescribed for long-term use, there is much concern over the development of drug tolerance, dependency and recreational abuse. Benzodiazepines, such as Xanax augment the action of GABA, the major inhibitory neurotransmitter in the brain; effects usually begin to appear within minutes or hours.

In 1985, before the introduction of SSRIs, anti-depressants such as monoamine oxidase inhibitors (MAOIs) were frequently used in the treatment of social anxiety by researchers such as Donald Klein and Michael Liebowitz. Irreversible MAOIs, most notably phenelzine, has been more efficacious than benzodiazepines in the short-term (8-12 weeks). Relapse is common, which may result in long-term usage. Because of the dietary restrictions required, high toxicity in overdose, and incompatibilities with other drugs, its usefulness as a treatment for social phobics is limited. Reversible inhibitors of monoamine oxidase subtype A (RIMAs) also inhibit monoamine oxidase. In contrast with MAOIs, reversibility means that they can inhibit the enzyme only temporarily. Because their action is short-lived and selective, they have a better safety profile than the older MAOI drugs. A special diet does not need to be strictly adhered to.

Some people with a form of social phobia called performance phobia have been helped by beta-blockers, which are more commonly used to control high blood pressure. Taken in low doses, they control the physical shaking of anxiety and can be taken before a public performance.

Psychotherapy

Research has shown that a form of psychotherapy that is effective for several anxiety disorders, particularly panic disorder and social phobia, is cognitive-behavioral therapy (CBT) (Burns, 1999). It has two components. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. A person with social phobia might be helped to overcome the belief that others are continually watching and harshly judging him or her. The behavioral component of CBT seeks to change people's reactions to anxiety-provoking situations. A key element of this component is gradual exposure, in which people confront the things they fear in a structured, sensitive manner. This is done with support and guidance when the therapist feels the patient is ready and only with the permission of the patient and at the pace the patient wishes. Cognitive-behavior therapy for social phobia also includes anxiety management training, such as teaching people techniques such as deep breathing to control their levels of anxiety.

Cognitive behavioral group therapy (CBGT), founded upon research done by Richard Heimberg, is a similar psychotherapeutic approach. It is generally held for 12 weekly sessions which run for two or three hours. A range of 4-10 patients and two therapists are involved in sharing individual experiences, participating in simulated exposures, and completing homework assignments in the goal of replacing irrational and automatic negative thoughts in social situations. A sample homework assignment might include reading a book or initiating a conversation with an acquaintance. Even in CBGT, sufferers are treated individually. Each person is exposed to different levels of anxious situations, depending on the severity of their illness.

These two types of cognitive behavior therapy have proven effective in reducing anxiety among social phobics. A 1998 study by Heimberg and Michael Liebowitz and a 2004 experiment showed the efficacy of CBGT.

Answer 2

1

Answer 3

Social anxiety also known Social Phobia.
Go to a mental health clinic, get seen by therapist,
you might tap into what started these, find ways to work around the cause. Often medications are given such as Prozac, seroquel, xanex, elavil, just to name a few. It might be you need it in low doses to start, plus do follow through with the clinic.
Social anxiety/social phobia can and will ruin your life of many things you enjoy, can/will cause family/relationship problems if untreated.

Answer 4

If you are a natural person you should try cognitive behavioral therapy. It was the only thing that has helped me with my horrible health anxiety. Read here https://tr.im/BjxJK

Your thinking determines your quality of life. Your thinking is what causes you these feelings:

Anxious, fearful, stressed or depressed
Constantly worried, or angry about something that is happening in your life
Struggling to overcome obsessive and negative thoughts.

If you change your thinking, you will change your life. This is the basic idea behind CBT for anxiety. The Cognitive part is where you learn nee methods and ways to change your same old habits and thinking patterns. If you keep thinking and expecting the worst – You will continue to suffer.

Answer 5

It is learned by environment and examples/experiences. It can be unlearned with a focused introspection into its origins, and an appropriate de-structuring and rebuilding of the subconscious mind. You, for instance, just said "I am always thinking that they are thinking negitive about me and it makes me feel negative about myself." This implies several facts about your reality. 1 - you are responsible. (I am) 2 - you have a choice (thinking) 3 - you understand the cause and effect relationship of your experience (it makes me) Your situation is self-perpetual. The same would be true of a positive cycle. By expecting Good things you will find good things. You will draw good things from people around you. You will not need for anyone else to make you complete. It won't matter what anyone thinks of you, so long as you are satisfied with your actions. This is what moral values are for. Change your thoughts. Forgive your faults. The past is the past. There is only right now. Start deciding who you want to be and making choices about your thoughts to guide them in a direction that produces the results you desire.

Answer 6

The medicine dont do anything, your just shy! no offense i was once like this the Gov just labels everybody I just told myself to go up to someone and talk, it was hard but i did it without drugs , Also theripy
is a rip. Dont you think its better to get a pet. Or talk to a freind?
+ The medicines can cause well guess ANXITY and sexual dysfuncution and even a heart attack! If you want some kind of pill i would reccomend natrual medicine :) Works good for my memory!
Plus NO NO NO Side effects.

Answer 7

I think possibly the most effective treatment nowadays is Cognitive Behavioural Therapy. You should see your GP about this and they should refer you to your local mental health clinic who will seek the best treatment for you. Dont let them force you to take medication straight away. Ask what resourses are available and mention that you have heard about Cognitive Behavioural Therapy being effective.

I wish you luck with this :o).

Answer 8

Your best bet is to speak to your family doctor. There are several medications out that have good results. The doctor I work for recommends Lexapro or Paxil CR to is patients. Do some research on the internet on anti-anxiety meds. Good luck to you.

Answer 9

Social anxiety disorder is a common psychiatric illness that imposes persistent functional impairment and disability on persons who have the disorder. The disorder is characterized by a marked and persistent fear of social or performance situations in which embarrassment may occur. It is the most prevalent of any anxiety disorders and is the third most common psychiatric disorder after depression and alcohol abuse. Social anxiety disorder typically begins during childhood with a mean age at onset between 14 and 16 years and is sometimes preceded by a history of social inhibition or shyness. Persons who have social anxiety disorder either endure or avoid social situations altogether because the fear of embarrassment causes such intense anxiety; such avoidance may ultimately interfere with occupational and/or social functioning and lead to significant disability. The duration of social anxiety disorder is frequently lifelong, and there is a high degree of comorbidity with other psychiatric disorders. Social anxiety disorder is a serious illness that frequently runs a chronic course and is associated with significant morbidity. Patients should be treated aggressively using pharmacotherapeutic agents that can be tolerated over the long term. Cognitive-behavioral therapy should also be considered in treatment planning. Efforts to increase the recognition of social anxiety disorder as a common, distressing, and disabling condition are critical. This article discusses the comorbidity, neurobiology, and pharmacotherapy of social anxiety disorder.

Treatments for Social Anxiety Disorder:
Psychological Treatment:
Among possible psychological treatments for Social Anxiety Disorder, the best studied are CBT (Cognitive Behavioral Therapy) and CGBT (Cognitive Group Behavioral Therapy). While CBT and CGBT can often be helpful, medication treatments have been shown to produce more robust and dramatic improvement of symptoms. Patients with mild symptoms (as well as children or adolescents with Social Anxiety), may wish to pursue CBT or CGBT treatment methods as their first approach, while those with more significant or stubborn symptoms may prefer to use CBT as an adjunct to medication treatment. Good CBT therapists for SP are located primarily in larger cities. The best places to look are probably at large University Clinics or Health Centers.

Research suggests that "general" or "supportive" psychotherapy is also helpful for many patients with Social Anxiety Disorder. This is probably especially true in more moderate and severe cases where issues such as low self esteem and other psychological and/or adjustment difficulties may be more pervasive. Currently there is no evidence that CBT is more, or less, effective than other psychotherapy techniques in the treatment of Social Anxiety. There are no clear guidelines, and one is probably best off trusting their own instincts of what is best for them.

Medication Treatment:
Medication treatment is the "tried and true" method to effectively treat Social Anxiety Disorder. Research trials for the treatment of Social Anxiety are still limited primarily to "monotherapy" treatment (one drug by itself). In actual practice, it is often the case that 2 or more medications are used in combination (polypharmacy). There are likely to be many different treatments (single drug or combinations) which are helpful for a given individual. Experimentation affords one an opportunity to find out which treatments are most satisfactory for them. Despite increasing recognition of "the world's most neglected anxiety disorder" - most Dr's even now in *2006* continue to have relatively little experience (and even less skill) in treating patients with Social Anxiety. Patient self-education continues to play a key role for those wishing to ensure that they receive the appropriate medical intervention they deserve.
VR

Answer 10

you're 71 this year!!!!! congrats hope all is going well xx