Social phobia is the most common anxiety disorder of
our time. But the current treatment regimen for
patients with this diagnosis has not proven very
effective. Now NTNU (Norwegian University of Science
and Technology) researchers believe they have found
a cure for social anxiety disorders.
Hans M. Nordahl, a professor of behavioural medicine
at NTNU has led a project with a team of doctors and
psychologists from NTNU and the University of
Manchester in England, who examined the effects of
structured talk therapy and medication on patients
with social anxiety disorders.
Medications, talk therapy or a combination of these
are the most common ways to treat patients with this
NTNU researchers set out to examine which of these
approaches is most effective.
Until now, a combination of cognitive therapy and
medication was thought to be the most effective
treatment for these patients.
The researchers’ results, which have just been
published in the journal Psychotherapy and
Psychosomatics, show that cognitive therapy on its
own has a much better effect in the long term than
just drugs or a combination of the two.
Nearly 85 per cent of the study participants
significantly improved or became completely healthy
using only cognitive therapy.
To clear up some terms: social anxiety is not a
diagnosis, but a symptom that a lot of people
struggle with. For example, talking or being funny
on command in front of a large audience can trigger
On the other hand, social anxiety disorder – or
social phobia – is a diagnosis for individuals who
find it hard to function socially, and anyone with
this diagnosis has high social anxiety.
“A lot of doctors and hospitals combine medications
– like the famous “happy pill” – with talk therapy
when they treat this patient group. It works well in
patients with depressive disorders, but it actually
has the opposite effect in individuals with social
anxiety disorders. Not many health care
professionals are aware of this,” says Nordahl.
“Happy pills,” like selective serotonin re-uptake
inhibitors (SSRIs), may have strong physical side
When patients have been on medications for some time
and want to reduce them, the bodily feelings
associated with social phobia, like shivering,
flushing and dizziness in social situations tend to
Patients often end up in a state of acute social
“Patients often rely more on the medication and
don’t place as much importance on therapy. They
think it’s the drugs that will make them healthier,
and they become dependent on something external
rather than learning to regulate themselves.
So the medication camouflages a very important
patient discovery: that by learning effective
techniques, they have the ability to handle their
anxiety themselves,” says Nordahl.
Well over 100 patients participated in the NTNU
study and were divided into four groups.
The first group received only medication, the second
group received only therapy, the third group
received a combination of the two, and the fourth
received a placebo pill.
The four groups were compared along the way, and
researchers conducted a follow–up assessment with
them a year after treatment ended.
During treatment and right afterwards, the patients
in groups two and three were managing equally well.
But after a year, it was clear that the group two
participants – those who had only received cognitive
therapy – were faring the best.
Only with the help of cognitive therapy have
researchers managed to increase the recovery rate in
patients with social anxiety disorders by 20 to 25
per cent, as compared with the norm for this group.
“This is the most effective treatment ever for this
patient group. Treatment of mental illness often
isn’t as effective as treating a bone fracture, but
here we’ve shown that treatment of psychiatric
disorders can be equally effective,” says Nordahl.
“I can well imagine that the combination of drug
therapy and cognitive therapy isn’t the best
approach, as NTNU researchers have determined in
this study,” said Torkil Berge, a psychologist at
Diakonhjemmet Hospital in Oslo and head of the
Norwegian Association for Cognitive Therapy.
Social anxiety disorder is a public health problem
with major negative consequences for the individual
and for society: nearly twelve per cent of the
population will be affected by this illness during
“This is a hidden disorder, and many patients find
it difficult to communicate their struggle to their
healthcare providers. Thousands upon thousands of
individuals end up not receiving adequate treatment.
Of those who do get treatment, most are probably
offered drug therapy,” Berge says.
Nordahl and the rest of the research team have also
worked to improve standard cognitive therapy. They
have added new processing elements, which have shown
“We’re using what’s called metacognitive therapy,
meaning that we work with patients’ thoughts and
their reactions and beliefs about those thoughts.
We address their rumination and worry about how they
function in social situations.
Learning to regulate their attention processes and
training with mental tasks are new therapeutic
elements with enormous potential for this group of
patients,” says Nordahl.
The researchers now hope to develop standardized
cognitive therapy further for patients who suffer
from social anxiety disorders.
For more information
Psychotherapy and Psychosomatics
Paroxetine, Cognitive Therapy or Their Combination
in the Treatment of Social Anxiety Disorder with and
without Avoidant Personality Disorder: A Randomized