Social phobia is characterized by a persistent fear of social situations in which the person may feel embarrassed, scrutinized, rejected, or humiliated. This disorder is usually treated with psychotherapy, but in more severe cases, certain medications may be used. In fact, both options have proven to be quite effective, especially when combined.
It should be clarified that most people who suffer from social phobia need psychological help to overcome it, but in some cases, especially the less severe ones or when the phobia has not been fully established, it is possible to control the symptoms by resorting to self-help techniques.
What is psychotherapy like for social phobia?
Psychotherapy is one of the most effective treatments for overcoming social phobia. In therapy, it’s not just about talking about what’s happening to you; you’ll learn, step by step, to understand your fears and face them more assertively.
In this regard, cognitive-behavioral therapy has the strongest scientific backing and has proven to be the most effective. It includes techniques such as gradual exposure, working with negative thoughts, and social skills training.
In many cases, this type of therapy can be completed in about four months, usually with one session per week. Throughout the process, you will learn to manage your anxiety, build self-confidence, and feel more secure in social situations. By the end of the treatment, symptoms are usually significantly reduced and, in many cases, even disappear completely.
In addition to cognitive behavioral therapy, other approaches can also be helpful in treating social phobia, such as social skills training, relaxation techniques, cognitive therapy, and even hypnosis. However, most therapists agree that gradual exposure is a fundamental part of treatment. This technique involves gradually exposing yourself to the situations you fear in a safe and controlled environment.
Initially, this is usually done in therapy sessions, imagining scenarios or practicing with the therapist. Later, when you feel ready, you can apply what you’ve learned in real life, taking small steps until you regain your self-confidence. This way, your brain gets used to it and realizes that these scenarios don’t represent a real threat.
What are the medications for social phobia and how do they work?
The pharmacological treatment of social phobia involves various medications that act on the brain neurotransmitters responsible for regulating anxiety and mood. These drugs do not “cure” social phobia on their own, but they can help reduce fear, avoidance, and physical symptoms when used in conjunction with psychotherapy and under medical supervision.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are usually the first-line treatment, the most commonly used for social phobia, and those with the strongest evidence base. They work by increasing the amount of serotonin available in neuronal synapses, a neurotransmitter involved in regulating mood and anxiety. Some of the most common SSRIs are:
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
How do they work? By gradually increasing the amount of available serotonin, over time they improve emotional regulation and decrease anticipatory anxiety and avoidance behaviors.
Studies show that SSRIs are effective in 50–80% of patients with social anxiety disorder, and most people tolerate them well. The full effect is usually seen after 4–6 weeks of continuous treatment, and it is recommended to continue treatment for several months to consolidate improvement. In fact, they have been found to be the most effective medications for social anxiety disorder, as they tend to prevent relapses.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs work similarly to SSRIs, but in addition to serotonin, they also increase norepinephrine , another neurotransmitter related to attention and the stress response. The best-known example is venlafaxine (Effexor XR).
How do they work? By influencing two neurotransmitter systems, these drugs can be useful in the most resistant cases, when SSRIs are not enough or if the person presents symptoms such as fatigue or depressed mood.
It’s important to note that, like SSRIs, these medications don’t produce an immediate effect. It’s normal to need between 4 and 8 weeks of continuous use to notice a significant improvement in social anxiety.
Benzodiazepines
Benzodiazepines are commonly used for their anxiolytic, hypnotic, and muscle relaxant effects, especially in cases of anxiety, insomnia, depression, schizophrenia, psychosis, and many other conditions.
How do they work? Basically, they enhance the effect of the neurotransmitter GABA, which decreases neuronal excitability and produces sedation and calmness. Some of the most commonly used medications for treating phobias are:
- Alprazolam (Xanax)
- Clonazepam (Klonopin/Rivotril)
- Lorazepam (Ativan/Orfidal)
- Diazepam (Valium)
The advantage of these medications is that they quickly relieve anxiety, even within a week. The disadvantage is that they create a risk of dependence or tolerance with prolonged use. Therefore, they are generally reserved for occasional or short-term use.
Generally, both in clinical practice and in scientific studies, it has been found that medications alone are not enough to address social phobia and that pharmacological treatment is much more effective when combined with psychological therapy.
Therefore, if you suffer from social phobia, it’s best to consult a psychologist. They will assess whether you need medication and refer you to a psychiatrist, so that both can work together to manage your case until you achieve remission.
References:
Sun, L. et. Al. (2025) Psychotherapies for social anxiety disorder in adults: A systematic review and Bayesian network meta-analysis. J Affect Disord; 378: 301-319.
Williams, T. et. Al. (2017) Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database of Systematic Reviews; 10: CD001206.
Canton, J. et. al. (2012) Optimal treatment of social phobia: systematic review and meta-analysis. Neuropsychiatr Dis Treat; 8: 203-215.
Aouizerate, B.; Martin-Guehl, C. & Tignol, J. (2004) Neurobiologie et pharmacothérapie de la phobie sociale. (Neurobiology and pharmacotherapy of social phobia). Encephale; 30(4): 301-313.
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