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  • Q&A with Australian Health Practitioners

    What is best treatment for social anxiety- medication or therapy?

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    Anxiety Mental Health
    Which is the option to go for first to deal with social anxiety and stress. Medication or speaking to a psychologist?
    • 1 answer
    • Dr Paul McQueen
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    Dr Paul McQueen

    Clinical Psychologist, Psychologist

    First and foremost it is important to understand that treatment of anxiety with medication takes different forms: The two most commonly-prescribed medications for anxiety are benzodiazepines (diazepam/valium; oxazepam/serepax/murelax and a long list of others - try googling “benzos”) and SSRIs (effexor/venlafaxine; lovan/fluoxetine; luvox/fluvoxamine and many others). There is a very big difference between the effects of benzos on anxiety and the effects of SSRIs. Benzos seem to work fast and to be very effective. But since their introduction for treatment of anxiety in the 1960s both research and clinical experience have shown these drugs are only safe for SHORT TERM use. Using benzos for more than a week to manage anxiety carries a significant risk of making anxiety significantly worse and creating a dangerous addiction to the medication. Here is just one study, from 1985, detailing the difficulties of withdrawal from benzos: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1415890/

    SSRIs, on the other hand, are primarily antidepressant medications that also seem to have some benefit for anxiety. They take substantially longer to bring about reduction of anxiety symptoms (4+ weeks) and the impact on symptoms is more subtle. SSRIs are not without side effects and recent research cautions that the value of the benefits of medication may be outweighed by the costs of the side effects except in severe cases of anxiety or depression where other treatments are not feasible.

    There is very strong research evidence showing the effectiveness of a variety of psychological treatments for anxiety. Not all psychological treatments have equal evidence. For social anxiety, cognitive behavioural therapy (CBT) has the strongest research evidence, followed by self-help, psychodynamic therapy (with medication), then interpersonal psychotherapy (IPT), then acceptance and commitment therapy (ACT). Please note these rankings are based on the quality of research, not the degree of success of the treatments - so ACT or IPT may be just as effective as CBT, but haven't had as much high-quality research yet to demonstrate this.

    Psychological treatment, however, is not without its challenges or “side effects”. I have written an article about this in relation to therapy generally here: http://www.thrivewellness.com.au/thriving/it-gets-worse-before-it-gets-better/

    You may like to consider the points in that article if considering treatment. Overall, though, I would say that social anxiety is very much treatable if you are ready to give it a shot. Suffering through anxiety is no fun at all. The goal of medication is largely to make the unpleasantness of anxiety go away, whereas therapy is more about teaching you to be able to cope with it (which in turn usually reduces it over time). Generally, as the linked article points out, strategies to make things go away short-term don't work out the best for us in the long-term.

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