Studies Point to the Most Effective Ways to Treat Social Anxiety Disorder

There are many different treatments for social anxiety disorder (SAD). So what should you look for?

Psychotherapy

Both meta-analysis and expert opinion about psychotherapy methods for SAD found that cognitive behavioral therapy (CBT) "was generally the most effective psychotherapy" (Sun, 2025; Baldacara, 2025). CBT can also reduce comorbid depression and general anxiety and improve the quality of life in patients with SAD (Kindred, 2022).

In addition to face-to-face CBT, remote CBT can be effectively delivered via the internet. Remote CBT is "at least as effective, or slightly more effective, than face-to-face treatments" (Winter, 2023).

SAD is often comorbid with other mental disorders, especially depression. Internet therapy for comorbid SAD and depression showed that internet-delivered CBT was "effective in treating individuals with SAD regardless of comorbid depression, and focusing internet CBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD" (Shalom, 2024).

Patients with both SAD and alcohol use disorder (AUD) "have a higher prevalence of psychiatric comorbidities, mainly major depressive disorder and depressive symptoms" (Oliveira, 2018). Also, there were "higher rates of suicidal thoughts, suicide plans, and attempts in patients with AUD and SAD" (Oliveira, 2018). These patients were less compliant with treatment. This is an example of the need to carefully look for comorbid disorders in patients seeking treatment for SAD.

A meta-analysis showed that psychodynamic therapy (PDT) is "the most effective non-CBT treatment" (Sun, 2025). A different meta-analysis showed "no difference between PDT and CBT for social anxiety disorder" (Zhang, 2022).

Several other psychotherapy methods are used to treat SAD. They include exposure and social skills therapy, self-help therapy, cognitive bias modification, and mindfulness. All of them can be effective for some patients but are generally less effective than CBT and PDT (Baldacara, 2025).

According to Horenstein (2019), "Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcomes." Research has shown that mindfulness-based stress reduction was more effective at improving sleep quality than cognitive behavioral group therapy (Horenstein, 2019).

Social skills development is an important component of the treatment of SAD. One method is using in-person exposure, for example, group therapy. According to Caponnetto (2021), "Virtual reality therapies have proven to be a valid alternative." Virtual reality therapy is neither more nor less effective than in-person exposure but can be less expensive (Emmelkamp, 2020).

Medication Treatment

According to recently published research, "Currently, selective serotonin reuptake inhibitors (e.g., escitalopram) and serotonin and norepinephrine reuptake inhibitors (e.g., venlafaxine) are first-line treatments, but side effects are common (affects about 50% of patients)" (Caldiroli, 2023; Baldacara, 2025).

Some experts say that serotonin and norepinephrine reuptake inhibitors (SNRIs) are less desirable than selective serotonin reuptake inhibitors (SSRIs) because "divergent results have been found for the serotonin-norepinephrine reuptake inhibitor venlafaxine (Effexor)" (Baldacara, 2025).

A meta-analysis revealed that "paroxetine (Paxil) was the most effective medication in reducing symptom severity as compared to placebo" (Williams, 2020). The next most effective were escitalopram (Lexapro), sertraline, fluvoxamine, phenelzine, and clonazepam (Williams, 2020).

It should be noted that "differences between drugs and placebo were small, apart from a significant reduction in symptom severity and response for paroxetine (Paxil)" (Williams, 2020).

Caldiroli reported that "pregabalin at high doses (450-600 mg/day) appears to be a reliable alternative strategy for SAD treatment" (Caldiroli, 2023). This is not standard treatment and should be prescribed only by experts.

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There are several other medications such as quetiapine, fluoxetine, duloxetine, mirtazapine, atomoxetine, and buspirone that "present negative, limited, or contrasting results" (Caldiroli, 2023). These should be considered second-line therapy.

When a patient comes for treatment of SAD, what is usually the best treatment to start with? In general, "psychological interventions are better tolerated, and there is evidence that they provide better long-term benefits than pharmacological agents" (Baldacara, 2025). While psychotherapy is the preferred first treatment option, specific circumstances or co-morbidities may alter the choice of treatment.

The Gut Microbiome and Social Anxiety Disorder

Research has shown that "the gut microbiome of patients with SAD differs in composition and function to that of healthy controls" (Butler, 2023). Eating fermented foods that naturally contain probiotics is "associated with fewer symptoms of social anxiety" (Hilimere, 2025)

Good examples of helpful fermented foods include yogurt, cottage cheese, kefir, and sauerkraut.

The Bottom Line

• First-line treatment is CBT, and, if medication is indicated, paroxetine (Paxil) is the best choice in most cases.
• Psychotherapy generally has a better long-term outcome than medication treatment alone.
• Comorbidities are common and must be evaluated at the onset of treatment. Depression is the most common.
• Patients with severe sleep disturbance may benefit from mindfulness-based therapy.
• Social skills treatment is an important part of treatment and can be provided in person or by virtual reality. Group therapy is a good venue for in-person treatment because patients can practice social skills with one another.
• SAD is associated with an abnormal gut microbiome, and eating fermented foods with natural probiotics may be helpful.