Social anxiety disorder—a chronic and naturally unremitting disease that causes substantial impairment—can be treated with pharmacological , psychological , and self-help interventions . We aimed to compare these interventions and to identify which are most effective for the acute treatment of social anxiety disorder in adults .
We did a systematic review and network meta-analysis of interventions for adults with social anxiety disorder, identified from published and unpublished sources between 1988 and Sept 13 , 2013 . We analysed interventions by class and individually . Outcomes were validated measures of social anxiety , reported as standardised mean differences (SMDs) compared with a waitlist reference . This study is registered with PROSPERO, number CRD42012003146 .
We included 101 trials (13 164 participants) of 41 interventions or control conditions (17 classes) in the analyses . Classes of pharmacological interventions that had greater effects on outcomes compared with waitlist were monoamine oxidase inhibitors (SMD −1·01, 95% credible interval [CrI] −1·56 to −0·45), benzodiazepines (−0·96, −1·56 to −0·36) , selective serotonin-reuptake inhibitors and serotonin—norepinephrine reuptake inhibitors (SSRIs and SNRIs ; −0·91 , −1·23 to −0·60) , and anticonvulsants (−0·81, −1·36 to −0·28) .
Compared with waitlist , efficacious classes of psychological interventions were individual cognitive—behavioural therapy (CBT; SMD −1·19 , 95% CrI −1·56 to −0·81) , group CBT (−0·92, −1·33 to −0·51), exposure and social skills (−0·86, −1·42 to −0·29) , self-help with support (−0·86, −1·36 to −0·36), self-help without support (−0·75 , −1·25 to −0·26) , and psychodynamic psychotherapy (−0·62, −0·93 to −0·31) . Individual CBT compared with psychological placebo (SMD −0·56, 95% CrI −1·00 to −0·11) , and SSRIs and SNRIs compared with pill placebo (−0·44, −0·67 to −0·22) were the only classes of interventions that had greater effects on outcomes than appropriate placebo . Individual CBT also had a greater effect than psychodynamic psychotherapy (SMD −0·56, 95% CrI −1·03 to −0·11) and interpersonal psychotherapy , mindfulness, and supportive therapy (−0·82, −1·41 to −0·24) .
Individual CBT (which other studies have shown to have a lower risk of side-effects than pharmacotherapy) is associated with large effect sizes . Thus , it should be regarded as the best intervention for the initial treatment of social anxiety disorder . For individuals who decline psychological intervention, SSRIs show the most consistent evidence of benefit .
National Institute for Health and Care Excellence .