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Social Anxiety Disorder: An Update on Evidence-Based Treatment Options

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Educational Objectives

After reading this article, you will be familiar with:

• Strategies used in cognitive behavioral therapy (CBT) for the treatment of severe mental illness
• Treatment approaches
• The benefits and challenges of using CBT

Who will benefit from reading this article?
Psychiatrists, psychologists, primary care physicians, nurse practitioners, and other health care professionals. To determine whether this article meets the continuing education requirements of your specialty, please contact your state licensing and certification boards.

Social anxiety disorder (SAD), also referred to as social phobia, is a chronic and potentially disabling anxiety disorder characterized by the intense and persistent fear of being scrutinized or negatively evaluated by others. At its core, people with this disorder fear and/or avoid the scrutiny of others. Symptoms may occur only in circumscribed situations, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others. More commonly, in the most severe form of SAD, symptoms arise in a variety of social situations.1

A large-scale US epidemiological study, the National Comorbidity Survey, reported a lifetime prevalence for SAD of 13.3%, with a 1-year rate of 7.9% in community samples. These rates make SAD the third most common psychiatric disorder, following substance abuse and depression.2 The more recent National Comorbidity Survey Replication estimated 12-month and lifetime prevalences to be 7.1% and 12.1%, respectively, with higher prevalence in females.3,4

In both clinical and community samples, SAD is commonly associated with other psychiatric disorders. Merikangas and Angst5 reported that an average of 80% of persons with SAD who were identified in community samples also met the diagnostic criteria for another lifetime psychiatric disorder. The lifetime risk of depression is reported to be about 2 to 4 times higher in persons who have SAD.6,7 An earlier study reported that up to 16% of patients with SAD may also have alcohol abuse problems.8

More recently, there has been an increasing realization that alcohol use disorders are commonly comorbid with SAD.9-12 The National Epidemiologic Survey on Alcohol and Related Conditions showed that 48% of those with a lifetime diagnosis of SAD also met diagnostic criteria for an alcohol use disorder.11

Furthermore, the 12-month prevalence of alcohol use disorder among those with SAD was 13.1% compared with 8.5% in the general population.11,12 Kessler and colleagues9 reported that women with SAD appeared to show higher rates of alcohol use disorder than men.

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