If you are alone day in and day out, you may be one of the 15 million Americans who has social anxiety disorder. Everyone gets socially nervous from time to time, but when it’s truly difficult to get “out there” because you feel too shy or awkward to deal with other people face-to-face, you need help to live the life you deserve. The norm in our modern world is to “fix” this problem by throwing drugs at it—psychiatric drugs. There is a better way…a way that’s completely drug-free—and the best news is, a wonderful new research study from Britain proves that this way really works.


When a team of researchers from the University College of London took a close look at treatments typically offered to people with social anxiety disorder, they found that cognitive behavioral therapy was the most effective. This is a kind of “talk therapy” in which a person learns how to catch him- or herself in negative, self-sabotaging thinking and change his or her perspective.

The researchers came to their conclusion after looking at all the published and unpublished literature available for review between 1988 and 2013 and, from that, identifying 101 high-quality clinical trials that studied a whole bunch of different kinds of treatments for social anxiety. This comprehensiveness is what makes the study so exciting.

The treatments included various types of drugs…exposure therapy (in which a person is exposed to the situation or memory that he or she otherwise avoids and taught to accept it and react to it in an empowered way), social-skills training (which is, as the name suggests, learning how to gracefully maneuver social situations), individual and group behavioral and cognitive therapies, other psychological therapies, exercise, self-help (with and without support) and mixtures of these treatments. Because the studies that were analyzed measured their findings in many different ways, the researchers rated each therapy by comparing its effect against nontreatment or placebo, and that allowed the researchers to then compare the effect size of each treatment. And this is what they learned…

  • Cognitive behavioral therapy, particularly individual, one-on-one therapy, was the most effective strategy to beat social anxiety disorder. The effect size was about 60% greater than placebo.
  • Even self-help (use of books and tapes) with support from a cognitive behavioral therapist was useful for people who shy away from one-on-one therapy.
  • Psychiatric drugs called selective serotonin reuptake inhibitors, or “SSRIs” (such as Paxil, Lexapro and Zoloft), were the most reliably effective medications given to people to treat social anxiety disorder. No one SSRI was shown to be better than another on average, although individuals can certainly have varied results from various drugs.
  • Exercise and treatments such as interpersonal psychotherapy (which analyzes emotional conflicts a person has with others) and mindfulness training (which trains a person to observe thoughts and emotions) were not effective. The study did not interpret why but only showed that the effect sizes for these treatments were lower than that of placebo.


People with social anxiety disorder who do not get help typically worsen over time. If you have social anxiety disorder and want to break out of your shell and get on with having a fuller life but are afraid that a doctor will tell you to take psychiatric drugs, you can opt for cognitive behavioral therapy. On the other hand, if the thought of talk therapy makes you too uncomfortable, SSRIs may be your next best bet. SSRIs come with the drawback of side effects, though. Weight gain and reduced sexual function, for instance, are common complaints. SSRIs are not a permanent solution unless you keep taking them—because symptoms of social anxiety disorder tend to come back about six months after someone stops taking them (sometimes sooner). In contrast, the benefits of cognitive behavioral therapy continue after therapy is completed, the study researchers said.

The duration of cognitive behavioral therapy typically ranges from 12 to 20 weeks, but it can take longer depending on a person’s individual needs. You can find a certified cognitive behavioral therapist in your area through the National Association of Cognitive-Behavioral Therapists.

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