Zaburzenie lękowe społeczne (fobia społeczna) – Rokowania, prognozy i postęp choroby

Zaburzenie lękowe społeczne (fobia społeczna)
Rokowania, prognozy i postęp choroby

Zaburzenie lękowe społeczne (fobia społeczna) charakteryzuje się uporczywym lękiem przed oceną społeczną, prowadzącym do istotnego upośledzenia funkcjonowania, które często utrzymuje się od okresu dojrzewania do dorosłości bez odpowiedniego leczenia. Mediana opóźnienia w poszukiwaniu terapii wynosi nawet 28 lat, co pogarsza rokowanie. Czynniki predykcyjne słabszej odpowiedzi na leczenie obejmują wczesny początek choroby, większą ciężkość objawów, współwystępowanie innych zaburzeń lękowych, dłuższy czas trwania choroby, podtyp uogólniony, dodatni wywiad rodzinny oraz płeć męską. Zaburzenie to wiąże się z ryzykiem rozwoju ciężkiej depresji, nadużywania substancji psychoaktywnych oraz obniżenia jakości życia, a także pogorszenia funkcjonowania edukacyjnego i zawodowego. Terapia poznawczo-behawioralna (CBT) oraz farmakoterapia, zwłaszcza SSRI i wenlafaksyna, wykazują wysoką skuteczność, z wskaźnikami odpowiedzi na poziomie 65,8% dla terapii poznawczej i znaczącą poprawą jakości życia (efekt d=0,8–1,2). Nowoczesne metody, takie jak internetowa CBT i terapia ekspozycyjna w wirtualnej rzeczywistości, są obiecujące nawet w ciężkich przypadkach.

Prognozy leczenia zaburzenia lękowego społecznego (fobii społecznej)

Zaburzenie lękowe społeczne (fobia społeczna) jest stanem medycznym charakteryzującym się wyraźnym i uporczywym lękiem przed upokorzeniem lub oceną ze strony innych osób. Schorzenie to może powodować znaczne upośledzenie funkcjonowania, które często utrzymuje się od okresu dojrzewania aż do dorosłości, jeśli nie zostanie właściwie leczone. Prognoza leczenia zaburzenia lękowego społecznego zależy od wielu czynników, które mogą wpływać na skuteczność interwencji terapeutycznych.¹²

Naturalne prognozy bez leczenia

Nieleczone zaburzenie lękowe społeczne zwykle utrzymuje się przez długi czas, a prognozy bez interwencji terapeutycznej są często niekorzystne. Mediana opóźnienia od wystąpienia objawów do poszukiwania leczenia może wynosić nawet 28 lat, co znacząco wydłuża czas trwania upośledzenia i negatywnie wpływa na normalne funkcjonowanie. Istotne jest, że nieleczona fobia społeczna u dzieci zazwyczaj utrzymuje się w wieku dorosłym, co może potencjalnie powodować znaczące upośledzenie i zakłócać prawidłowy rozwój.³⁴

Łagodna fobia społeczna wiąże się z dobrą prognozą i może mieć łagodny przebieg. Jednak ciężkie zachowania unikające i nadużywanie substancji psychoaktywnych często wiążą się z ostrożnym rokowaniem. Nieleczone zaburzenie lękowe społeczne może prowadzić do:⁵⁶

Pogorszenia wyników edukacyjnych
Spadku wydajności pracy
Niższej jakości relacji interpersonalnych
Ogólnego obniżenia jakości życia

⁷

Co więcej, duży odsetek osób z nieleczonym zaburzeniem lękowym społecznym może rozwinąć ciężką depresję i/lub zaburzenia związane z używaniem alkoholu. Bez odpowiedniego leczenia, osoba z fobią społeczną może zmagać się z tym schorzeniem przez całe życie.⁸

Czynniki prognostyczne wpływające na wyniki leczenia

Na podstawie badań zidentyfikowano szereg czynników, które mogą przewidywać słabszą odpowiedź na leczenie zaburzenia lękowego społecznego. Wiedza na temat tych czynników może pomóc specjalistom w przewidywaniu możliwych odpowiedzi na interwencje terapeutyczne.⁹

Do najważniejszych czynników predykcyjnych słabszej odpowiedzi na leczenie należą:¹⁰¹¹

Wczesny początek choroby – jest to jeden z najbardziej powtarzalnych wyników badań
Większa ciężkość choroby – wyższa wyjściowa ciężkość objawów
Współwystępowanie innych zaburzeń lękowych (szczególnie uogólnione zaburzenie lękowe i prosta fobia)
Wysokie oczekiwania odnośnie roli terapeuty w procesie leczenia
Dłuższy czas trwania choroby
Podtyp uogólniony fobii społecznej
Dodatni wywiad rodzinny w kierunku zaburzenia lękowego społecznego
Płeć męska w niektórych badaniach

¹²

Badanie z 2013 roku wykazało, że predyktorami mniej korzystnej odpowiedzi na leczenie są również: martwienie się z wyprzedzeniem, ruminacje i cechy osobowości charakteryzujące się unikaniem szkody. Ponadto zaburzenie lękowe społeczne, w porównaniu z innymi zaburzeniami lękowymi, przewidywało gorszą odpowiedź i remisję na terapię poznawczo-behawioralną (CBT), niezależnie od współistniejących zaburzeń nastroju.¹³

Jeśli zaburzenie lękowe społeczne występuje u osoby z autyzmem, może mieć gorsze rokowanie, szczególnie jeśli w wieku dorosłym rozwinie się ciężka depresja.¹⁴

Skuteczność różnych metod terapeutycznych

Osoby z zaburzeniem lękowym społecznym bardzo dobrze reagują na leczenie, czy to w formie terapii poznawczo-behawioralnej (CBT), farmakoterapii, czy też połączenia obu metod. Dowody wykazały, że CBT i leki przeciwdepresyjne są bardzo skuteczne w leczeniu i kontrolowaniu zaburzenia lękowego społecznego.¹⁵¹⁶

W badaniu porównującym różne metody terapeutyczne u dorosłych z zaburzeniem lękowym społecznym, 117 osób otrzymało 16 indywidualnych sesji terapii poznawczej (CT) lub terapii interpersonalnej (IPT) oraz jedną sesję wzmacniającą. Wyniki po zakończeniu leczenia wykazały wskaźniki odpowiedzi na poziomie:¹⁷¹⁸

65,8% dla terapii poznawczej (CT)
42,1% dla terapii interpersonalnej (IPT)
7,3% dla grupy kontrolnej oczekującej na leczenie (WLC)

¹⁹

Badanie skuteczności internetowej terapii poznawczo-behawioralnej (ICBT) dla zaburzenia lękowego społecznego w rutynowej praktyce psychiatrycznej wykazało duży efekt leczenia po jego zakończeniu (d=0,8; 95% CI 0,7 do 0,9), z ciągłą długoterminową poprawą (d=1,2; 95% CI 1,0 do 1,3). Długoterminowa poprawa obserwowana była również w przypadku współistniejących objawów depresyjnych (d=0,7; 95% CI 0,5 do 0,8) i jakości życia związanej ze zdrowiem (d=0,3; 95% CI 0,4 do 0,1).²⁰

Co ważne, badanie to wykazało, że ICBT jest również skuteczna dla pacjentów z ciężkim przebiegiem choroby, co może być sprzeczne z powszechnymi przekonaniami dotyczącymi terapii internetowych. Zidentyfikowano również rodzinne występowanie lęku społecznego jako predyktor gorszego wyniku leczenia.²¹

Prognozy dla dzieci i młodzieży

Zaburzenie lękowe społeczne u dzieci i młodzieży wymaga szczególnej uwagi ze względu na potencjalny wpływ na rozwój i funkcjonowanie w późniejszym życiu. Fobia społeczna często prowadzi do skrajnej izolacji społecznej u dzieci i może współwystępować z mutyzmem wybiórczym i/lub być prekursorem depresji.²²

Badanie dotyczące roli umiejętności społecznych i ich interakcji z lękiem społecznym jako czynników predykcyjnych wyników leczenia u dzieci z zaburzeniem lękowym wykazało, że:²³

Rodzice dzieci z zaburzeniem lękowym społecznym (SoAD) zgłaszali znacznie mniej korzystne stosowanie asertywnych i odpowiedzialnych zachowań społecznych u swoich dzieci przed leczeniem niż rodzice dzieci bez SoAD
Dzieci z wyższymi umiejętnościami społecznymi miały lepszą reakcję na leczenie
Dzieci z lękiem i wyższym odpowiedzialnym zachowaniem przed leczeniem bez SoAD miały lepszą reakcję na leczenie, ale efekt ten nie występował u dzieci z SoAD

²⁴

Ogólnie, wyższy poziom umiejętności społecznych przewidywał lepsze wyniki leczenia, a zaburzenie lękowe społeczne odgrywało jedynie niewielką rolę w tej relacji. Badanie to sugeruje, że wyższe umiejętności społeczne zgłaszane przez rodziców u ich dzieci przewidywały wyższy wskaźnik powrotu do zdrowia po leczeniu.²⁵

Prognozy dla osób z autyzmem i fobią społeczną

Zaburzenie lękowe społeczne często współwystępuje z zaburzeniami ze spektrum autyzmu (ASD). Badanie oceniające potencjalne korzyści, tolerancję i akceptowalność interwencji grupowej opartej na terapii poznawczo-behawioralnej (CBT) u młodych dorosłych z ASD wykazało statystycznie istotną poprawę we wszystkich mierzonych wynikach.²⁶

Konkretnie, objawy lęku społecznego zmniejszyły się (p<.001), a określone subdomeny funkcjonowania społecznego poprawiły się po interwencji, szczególnie w zakresie motywacji społecznej (p=.032) oraz ograniczonych zainteresowań i powtarzalnych zachowań (p=.025). Zgłaszane przez uczestników poprawy objawów uogólniły się również na nastrój (depresja, lęk i stres; p<.05).²⁷

Badanie to jako pierwsze wykazało statystycznie istotną poprawę zarówno w objawach lęku społecznego, jak i w domenach funkcjonowania społecznego u młodych dorosłych z ASD po ukończeniu interwencji CBT dostosowanej do tej populacji klinicznej. Wyniki te dostarczają obiecujących wstępnych dowodów wspierających połączoną grupę CBT skupioną na lęku społecznym i umiejętnościach społecznych dla młodych dorosłych z ASD, z silną akceptacją uczestników i potencjalną użytecznością kliniczną.²⁸

Długoterminowe prognozy i ryzyko nawrotu

Dla niektórych osób objawy zaburzenia lękowego społecznego mogą z czasem zanikać, a leki można odstawić. Inni mogą wymagać przyjmowania leków przez lata, aby zapobiec nawrotowi. Regularne mierzenie się z sytuacjami wywołującymi lęk społeczny może pomóc w budowaniu i wzmacnianiu umiejętności radzenia sobie. Z czasem te metody radzenia sobie mogą pomóc w kontrolowaniu objawów i zapobieganiu nawrotowi.²⁹³⁰

Ważne jest, aby nie rezygnować, jeśli leczenie nie działa szybko. Pacjenci mogą nadal robić postępy w psychoterapii przez kilka tygodni lub miesięcy. Nauka nowych umiejętności pomagających radzić sobie z lękiem wymaga czasu, a znalezienie odpowiedniego leku dla danej sytuacji może wymagać prób i błędów.³¹

Wykorzystanie nowych technologii w przewidywaniu wyniku leczenia

Możliwość przewidywania wyników na wczesnym etapie terapii może być cenna, ponieważ może pozwolić terapeutom na dostosowanie terapii tak szybko, jak to możliwe, aby zwiększyć szanse na szybki powrót do zdrowia.³²

Badanie wykorzystujące pisma pacjentów poddawanych leczeniu zaburzenia lękowego społecznego wykazało, że można przewidzieć wynik terapii z obszarem pod krzywą (AUC) wynoszącym 0,83 w połowie terapii i z precyzją 0,78 przy wykorzystaniu pełnych danych (tj. całego okresu leczenia). W badaniu wykorzystano algorytmy uczenia maszynowego do generowania modeli predykcyjnych na podstawie danych od 69 pacjentów.³³

Wyniki pokazują, że przewidywanie wyniku terapeutycznego na podstawie danych socjodemograficznych działa zasadniczo tak samo jak losowe zgadywanie. Jednak przy uwzględnieniu zachowań związanych z pisaniem e-maili, uzyskano AUC do 0,78 przy wykorzystaniu wszystkich dostępnych danych: średnich i trendów atrybutów e-maili w połączeniu z danymi socjodemograficznymi przy użyciu podejścia random forest.³⁴

Teksty pomagają w przewidywaniu wyniku terapeutycznego. Użycie słów wydaje się być głównym czynnikiem przyczyniającym się, a trendy są ważne w obu najlepiej punktujących modelach.³⁵

Podsumowanie rokowania w zaburzeniu lękowym społecznym

Zaburzenie lękowe społeczne (fobia społeczna) ma zróżnicowane rokowanie w zależności od kilku kluczowych czynników. Ogólnie rzecz biorąc, osoby z tym zaburzeniem dobrze reagują na leczenie, zwłaszcza gdy stosuje się kombinację farmakoterapii i psychoterapii. Dowody wskazują, że terapia poznawczo-behawioralna (CBT) i leki przeciwdepresyjne, szczególnie selektywne inhibitory wychwytu zwrotnego serotoniny (SSRI) takie jak citalopram (Celexa), escitalopram (Lexapro), fluwoksamina (Luvox), paroksetyna (Paxil), fluoksetyna (Prozac), sertralina (Zoloft) oraz wenlafaksyna (Effexor), są bardzo skuteczne w leczeniu i kontrolowaniu objawów.³⁶³⁷

Czynniki prognostyczne, które mogą przewidywać mniej korzystne wyniki leczenia, obejmują wczesny początek choroby, większą ciężkość objawów, współwystępowanie innych zaburzeń lękowych, wysokie oczekiwania odnośnie roli terapeuty oraz pozytywny wywiad rodzinny w kierunku zaburzenia lękowego społecznego. Identyfikacja tych czynników może pomóc w dostosowaniu interwencji terapeutycznych, aby zwiększyć szanse na powodzenie leczenia.³⁸³⁹

Długoterminowe rokowanie jest zazwyczaj korzystne dla osób, które otrzymują odpowiednie leczenie, z utrzymującą się poprawą objawów lęku społecznego, współistniejących objawów depresyjnych i jakości życia związanej ze zdrowiem. Jednak nieleczone zaburzenie lękowe społeczne często utrzymuje się i może prowadzić do poważnych konsekwencji, w tym depresji, nadużywania substancji psychoaktywnych oraz ogólnego obniżenia jakości życia.⁴⁰⁴¹

Nowe podejścia, takie jak terapia ekspozycyjna w wirtualnej rzeczywistości i internetowa terapia poznawczo-behawioralna, pokazują obiecujące wyniki w leczeniu zaburzenia lękowego społecznego, nawet w przypadkach ciężkiego przebiegu choroby. Trwające badania mające na celu identyfikację czynników predykcyjnych odpowiedzi na leczenie powinny przyczynić się do rozwoju bardziej skutecznych interwencji dla tej populacji pacjentów.⁴²⁴³

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Materiały źródłowe

#1 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
Social anxiety disorder (social phobia) is a medical condition that causes fear and anxiety when you’re around people in social situations. This disorder is treatable with talk therapy and medications such as antidepressants. […] Social anxiety disorder is a common anxiety disorder. […] Social anxiety disorder is a common mental health condition that can affect anyone. […] Approximately 5% to 10% of people across the world have social anxiety disorder. […] People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. […] If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life.
#2
https://link.springer.com/article/10.1007/s10567-018-0258-5
Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. […] Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. […] Social anxiety disorder persists in the absence of treatment. […] Remarkably similar findings have been reported in adolescent samples. […] Social anxiety disorder is associated with profound negative consequences and high levels of impairment even when compared to other psychiatric disorders. […] Social anxiety makes day-to-day life difficult, for example, shopping and using the telephone can be a challenge. […] The increased incidence of social anxiety disorder during adolescence is perhaps unsurprising. […] It seems plausible that the acute self-consciousness experienced during early adolescence renders this a developmentally sensitive period for the emergence of social anxiety.
#3 Social Phobia: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/290854-overview
Mild social phobia is associated with a good prognosis and may have a benign course. Severe avoidance behavior and substance abuse are often associated with a guarded prognosis. […] The median delay from onset to seeking treatment can be as long as 28 years. […] Untreated childhood social phobia typically continues into adulthood and thus can potentially cause significant duration of impairment and interfere with normal development. […] Social anxiety can occur in the presence of autism and can have a poorer prognosis, especially if major depression develops in adulthood.
#4 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
Social anxiety disorder (social phobia) is a medical condition that causes fear and anxiety when you’re around people in social situations. This disorder is treatable with talk therapy and medications such as antidepressants. […] Social anxiety disorder is a common anxiety disorder. […] Social anxiety disorder is a common mental health condition that can affect anyone. […] Approximately 5% to 10% of people across the world have social anxiety disorder. […] People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. […] If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life.
#5 Social Phobia: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/290854-overview
Mild social phobia is associated with a good prognosis and may have a benign course. Severe avoidance behavior and substance abuse are often associated with a guarded prognosis. […] The median delay from onset to seeking treatment can be as long as 28 years. […] Untreated childhood social phobia typically continues into adulthood and thus can potentially cause significant duration of impairment and interfere with normal development. […] Social anxiety can occur in the presence of autism and can have a poorer prognosis, especially if major depression develops in adulthood.
#6 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
Social anxiety disorder (social phobia) is a medical condition that causes fear and anxiety when you’re around people in social situations. This disorder is treatable with talk therapy and medications such as antidepressants. […] Social anxiety disorder is a common anxiety disorder. […] Social anxiety disorder is a common mental health condition that can affect anyone. […] Approximately 5% to 10% of people across the world have social anxiety disorder. […] People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. […] If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life.
#7 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
Social anxiety disorder (social phobia) is a medical condition that causes fear and anxiety when you’re around people in social situations. This disorder is treatable with talk therapy and medications such as antidepressants. […] Social anxiety disorder is a common anxiety disorder. […] Social anxiety disorder is a common mental health condition that can affect anyone. […] Approximately 5% to 10% of people across the world have social anxiety disorder. […] People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. […] If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life.
#8 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
A large percentage of people who have social anxiety disorder and don’t get treatment can develop major depression and/or alcohol use disorder. […] If left untreated, a person with social anxiety disorder could have it for the rest of their life. […] Evidence has shown that cognitive behavioral therapy (CBT) and medications like antidepressants are very successful in treating and managing social anxiety disorder.
#9 SciELO Brazil – A review on predictors of treatment outcome in social anxiety disorder A review on predictors of treatment outcome in social anxiety disorder
https://www.scielo.br/j/rbp/a/XXBFrtxnsLF6dV6ZmWjyxcs/
OBJECTIVE: This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD). […] RESULTS: Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD. […] CONCLUSIONS: Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.
#10 A review on predictors of treatment outcome in social anxiety disorder – PubMed
https://pubmed.ncbi.nlm.nih.gov/22392395/
Objective: This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD). […] Results: Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD. […] Conclusions: Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.
#11 SciELO Brazil – A review on predictors of treatment outcome in social anxiety disorder A review on predictors of treatment outcome in social anxiety disorder
https://www.scielo.br/j/rbp/a/XXBFrtxnsLF6dV6ZmWjyxcs/
The present work aimed at reviewing the overall profile of individuals with SAD who respond and not respond to standard treatment, with the ultimate purpose of contributing to future research on the development of more effective interventions. […] We found that early onset, increased duration and severity of illness, presence of generalized subtype, positive family history of SAD, and male gender were all predictors of worse response to treatment in at least one study. […] Among these, early onset and severity of illness were the most replicated findings. […] To date, early onset, severity of illness, comorbid anxiety disorders (particularly generalized anxiety disorder and simple phobia), and low expectancy regarding treatment efficacy emerged as potential correlates and/or predictors of low therapeutic response.
#12 SciELO Brazil – A review on predictors of treatment outcome in social anxiety disorder A review on predictors of treatment outcome in social anxiety disorder
https://www.scielo.br/j/rbp/a/XXBFrtxnsLF6dV6ZmWjyxcs/
The present work aimed at reviewing the overall profile of individuals with SAD who respond and not respond to standard treatment, with the ultimate purpose of contributing to future research on the development of more effective interventions. […] We found that early onset, increased duration and severity of illness, presence of generalized subtype, positive family history of SAD, and male gender were all predictors of worse response to treatment in at least one study. […] Among these, early onset and severity of illness were the most replicated findings. […] To date, early onset, severity of illness, comorbid anxiety disorders (particularly generalized anxiety disorder and simple phobia), and low expectancy regarding treatment efficacy emerged as potential correlates and/or predictors of low therapeutic response.
#13 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC (Wait List Control). […] A 2013 randomized control trial found that predictors of a less favorable treatment response include anticipatory worry, rumination, and harm-avoidant personality traits. […] Data showed that social anxiety disorder, compared with other anxiety disorders, predicted poorer response and remission to CBT over and above comorbid mood disorders. […] Social phobia often leads to extreme social isolation in children and can be accompanied by selective mutism and/or can be a precursor to depression.
#14 Social Phobia: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/290854-overview
Mild social phobia is associated with a good prognosis and may have a benign course. Severe avoidance behavior and substance abuse are often associated with a guarded prognosis. […] The median delay from onset to seeking treatment can be as long as 28 years. […] Untreated childhood social phobia typically continues into adulthood and thus can potentially cause significant duration of impairment and interfere with normal development. […] Social anxiety can occur in the presence of autism and can have a poorer prognosis, especially if major depression develops in adulthood.
#15 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
Social anxiety disorder (social phobia) is a medical condition that causes fear and anxiety when you’re around people in social situations. This disorder is treatable with talk therapy and medications such as antidepressants. […] Social anxiety disorder is a common anxiety disorder. […] Social anxiety disorder is a common mental health condition that can affect anyone. […] Approximately 5% to 10% of people across the world have social anxiety disorder. […] People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. […] If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life.
#16 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
A large percentage of people who have social anxiety disorder and don’t get treatment can develop major depression and/or alcohol use disorder. […] If left untreated, a person with social anxiety disorder could have it for the rest of their life. […] Evidence has shown that cognitive behavioral therapy (CBT) and medications like antidepressants are very successful in treating and managing social anxiety disorder.
#17 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
A combination of pharmacotherapy and psychotherapy is usually indicated for persons with social phobia. […] Virtual reality exposure therapy is an effective approach, especially when done using head-mounted displays in a manner that mimics in vivo exposure therapy. […] Antidepressants including selective serotonin reuptake inhibitors (SSRIs; citalopram [Celexa], escitalopram [Lexapro], fluvoxamine [Luvox], paroxetine [Paxil], fluoxetine [Prozac], sertraline [Zoloft]) and venlafaxine (Effexor)) are commonly prescribed to treat the symptoms of social phobia and generally result in remission of symptoms after 4 weeks of treatment. […] A study of adults was a randomized controlled trial of 117 persons undergoing social anxiety disorder (SAD) treatment who received 16 individual sessions of either cognitive therapy (CT) or interpersonal therapy (IPT) and 1 booster session.
#18 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC (Wait List Control). […] A 2013 randomized control trial found that predictors of a less favorable treatment response include anticipatory worry, rumination, and harm-avoidant personality traits. […] Data showed that social anxiety disorder, compared with other anxiety disorders, predicted poorer response and remission to CBT over and above comorbid mood disorders. […] Social phobia often leads to extreme social isolation in children and can be accompanied by selective mutism and/or can be a precursor to depression.
#19 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC (Wait List Control). […] A 2013 randomized control trial found that predictors of a less favorable treatment response include anticipatory worry, rumination, and harm-avoidant personality traits. […] Data showed that social anxiety disorder, compared with other anxiety disorders, predicted poorer response and remission to CBT over and above comorbid mood disorders. […] Social phobia often leads to extreme social isolation in children and can be accompanied by selective mutism and/or can be a precursor to depression.
#20 Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitiveâbehavioural therapy for social anxiety disorder in routine psychiatric care | BMJ Open
https://bmjopen.bmj.com/content/5/6/e007902
A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). […] Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=0.3 (95% CI 0.4 to 0.1)). […] These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases. […] Identifying factors that can predict non-responders or explain individual differences in long-term improvement is an important addition to the knowledge of how ICBT works in the treatment of SAD within a routine clinical context. […] The main objective of this study was to evaluate the long-term effectiveness of ICBT for SAD in a cohort of consecutively recruited patients treated within routine psychiatric care.
#21 Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitiveâbehavioural therapy for social anxiety disorder in routine psychiatric care | BMJ Open
https://bmjopen.bmj.com/content/5/6/e007902
A secondary aim was to test the prognostic value of illness severity, adherence, treatment credibility and the influence of having a family history of social anxiety. […] We have found that these factors lack predictive value over longer follow-up time frames when severity of illness is controlled for. […] Nonetheless, this observation is a strong indicator that ICBT is also effective for patients who are severely ill, which may be contrary to common beliefs regarding internet-delivered therapies. […] We also identified family history of social anxiety as a predictor of poorer outcome. […] In sum, this study demonstrates that ICBT for the treatment of SAD in regular clinical practice is effective not only in the short term but also in the long term.
#22 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
At the posttreatment assessment, response rates were 65.8% for CT, 42.1% for IPT, and 7.3% for WLC (Wait List Control). […] A 2013 randomized control trial found that predictors of a less favorable treatment response include anticipatory worry, rumination, and harm-avoidant personality traits. […] Data showed that social anxiety disorder, compared with other anxiety disorders, predicted poorer response and remission to CBT over and above comorbid mood disorders. […] Social phobia often leads to extreme social isolation in children and can be accompanied by selective mutism and/or can be a precursor to depression.
#23
https://link.springer.com/article/10.1007/s10802-021-00824-x
The current study investigated the role of social skills and its interaction with social anxiety as predictors of treatment outcome in children with an anxiety disorder either with or without a social anxiety disorder (SoAD). […] Results showed that 1) parents of children with a SoAD reported significantly less favorable use of assertive and responsible social behavior in their children pre-treatment than parents of children without SoAD, 2) children with higher social skills had a better treatment recovery, and 3) children with anxiety and higher responsible behavior pre-treatment and without a SoAD had a better treatment recovery, but this effect did not show for children with SoAD. […] In conclusion, better use of social behavior increased the likelihood of treatment recovery but not of reliable change.
#24
https://link.springer.com/article/10.1007/s10802-021-00824-x
The current study investigated the role of social skills and its interaction with social anxiety as predictors of treatment outcome in children with an anxiety disorder either with or without a social anxiety disorder (SoAD). […] Results showed that 1) parents of children with a SoAD reported significantly less favorable use of assertive and responsible social behavior in their children pre-treatment than parents of children without SoAD, 2) children with higher social skills had a better treatment recovery, and 3) children with anxiety and higher responsible behavior pre-treatment and without a SoAD had a better treatment recovery, but this effect did not show for children with SoAD. […] In conclusion, better use of social behavior increased the likelihood of treatment recovery but not of reliable change.
#25
https://link.springer.com/article/10.1007/s10802-021-00824-x
The overall aim of the current study was to investigate the role of parent-reported social skills performance on treatment outcome and the possible interaction with social anxiety. […] We found that parents of children with SoAD reported significantly lower levels of assertive and responsible social behavior prior to treatment in their children compared to parents of children with an anxiety disorder without SoAD. […] The results of the present study showed that higher levels of assertion, self-control and responsibility predicted a higher likelihood of Treatment-Recovery. […] Children with no SoAD who had higher levels of responsibility had a more favorable outcome as measured with the ADIS-TR than children with lower social skills, but this effect did not show for children with SoAD. […] In sum, it appears that higher social skills in general predicted Treatment-Recovery, and that SoAD only played a minor role in this relation. […] The findings in the present study indicate that higher parent reported social skills in their children predicted higher treatment-recovery.
#26 Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder | Molecular Autism | Full Text
https://molecularautism.biomedcentral.com/articles/10.1186/s13229-021-00418-w
There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. […] The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress. […] Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p<.001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p=.032) and restricted interests and repetitive behaviours (p=.025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p<.05).
#27 Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder | Molecular Autism | Full Text
https://molecularautism.biomedcentral.com/articles/10.1186/s13229-021-00418-w
There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. […] The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress. […] Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p<.001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p=.032) and restricted interests and repetitive behaviours (p=.025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p<.05).
#28 Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder | Molecular Autism | Full Text
https://molecularautism.biomedcentral.com/articles/10.1186/s13229-021-00418-w
These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. […] A bidirectional link between social anxiety and the key symptoms of ASD, particularly difficulties in social functioning and reciprocal social interactions, has been suggested as a primary contributor to the high co-occurrence of social anxiety in people with ASD. […] Despite the bidirectional relationship that has been demonstrated to exist between social anxiety and social functioning, anxiety interventions and social skills groups for ASD have predominantly been examined separately. […] Our study is the first to show statistically significant improvements across both social anxiety symptoms and social functioning domains in young adults with ASD upon completion of a group-delivered CBT intervention specifically adapted for use with this clinical population. […] Overall, these results provide promising preliminary evidence supportive of a combined social anxiety and social skills CBT group for young adults with ASD, with strong participant acceptability and potential clinical utility.
#29 Social anxiety disorder (social phobia) – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/diagnosis-treatment/drc-20353567
Your health care provider will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder. […] Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The most common treatment for social anxiety disorder includes psychotherapy (also called psychological counseling or talk therapy) or medications or both. […] For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse. […] Don’t give up if treatment doesn’t work quickly. You can continue to make strides in psychotherapy over several weeks or months. Learning new skills to help manage your anxiety takes time. And finding the right medication for your situation can take some trial and error.
#30 Social anxiety disorder (social phobia) – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/diagnosis-treatment/drc-20353567
By regularly facing these kinds of situations, you’ll continue to build and reinforce your coping skills. […] Over time, these coping methods can help control your symptoms and prevent a relapse. Remind yourself that you can get through anxious moments, that your anxiety is short-lived and that the negative consequences you worry about so much rarely come to pass.
#31 Social anxiety disorder (social phobia) – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/diagnosis-treatment/drc-20353567
Your health care provider will want to determine whether other conditions may be causing your anxiety or if you have social anxiety disorder along with another physical or mental health disorder. […] Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The most common treatment for social anxiety disorder includes psychotherapy (also called psychological counseling or talk therapy) or medications or both. […] For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse. […] Don’t give up if treatment doesn’t work quickly. You can continue to make strides in psychotherapy over several weeks or months. Learning new skills to help manage your anxiety takes time. And finding the right medication for your situation can take some trial and error.
#32 Predicting Social Anxiety Treatment Outcome based on Therapeutic Email Conversations
https://pmc.ncbi.nlm.nih.gov/articles/PMC5613669/
As an outcome measure the Social Phobia Measure is taken. […] Reliable change was determined according to the Reliable Change Index by using the retest reliability reported for the German version of the Social Phobia Measure. […] The ability to predict outcomes early in the course of therapy can be valuable because it can allow therapists to adjust therapy as soon as possible to improve the chances of a speedy recovery. […] The results show that predicting therapeutic outcome based on socio-demographic data performs essentially equally to random guessing. […] When considering the email behavior however, an AUC of up to 0.78 is obtained when exploiting all data available: the averages and trends of the email attributes combined with the socio-demographic data using the random forest approach.
#33 Predicting Social Anxiety Treatment Outcome based on Therapeutic Email Conversations
https://pmc.ncbi.nlm.nih.gov/articles/PMC5613669/
Predicting therapeutic outcome in the mental health domain is of utmost importance to enable therapists to provide the most effective treatment to a patient. […] In this paper, we study predictive modeling using writings of patients under treatment for a social anxiety disorder. […] We then apply machine learning algorithms to generate the predictive models. Based on a dataset of 69 patients we are able to show that we can predict therapy outcome with an Area Under the Curve (AUC) of 0.83 halfway through the therapy and with a precision of 0.78 when using the full data (i.e., the entire treatment period). […] We try to predict a successful therapeutic outcome (according to a significant improvement in the Social Phobia Measure from the start to the end of therapy) at three points in time: (1) at the start of the therapy by means of socio-demographic data; (2) halfway through the therapy (6 weeks) by using the socio-demographic data and the emails sent by the patient up to that time point, and (3) at the end of the therapy by using the socio-demographic data and all email data originating from the patient.
#34 Predicting Social Anxiety Treatment Outcome based on Therapeutic Email Conversations
https://pmc.ncbi.nlm.nih.gov/articles/PMC5613669/
As an outcome measure the Social Phobia Measure is taken. […] Reliable change was determined according to the Reliable Change Index by using the retest reliability reported for the German version of the Social Phobia Measure. […] The ability to predict outcomes early in the course of therapy can be valuable because it can allow therapists to adjust therapy as soon as possible to improve the chances of a speedy recovery. […] The results show that predicting therapeutic outcome based on socio-demographic data performs essentially equally to random guessing. […] When considering the email behavior however, an AUC of up to 0.78 is obtained when exploiting all data available: the averages and trends of the email attributes combined with the socio-demographic data using the random forest approach.
#35 Predicting Social Anxiety Treatment Outcome based on Therapeutic Email Conversations
https://pmc.ncbi.nlm.nih.gov/articles/PMC5613669/
Although these results are interesting, in a therapeutic setting it is important to know early in treatment whether it is best to continue, or whether it is best to change strategy to improve the chances for recovery. […] The texts help in predicting therapeutic outcome. Word usage seems to be the main contributing factor, and trends are important in both top scoring models.
#36 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
A large percentage of people who have social anxiety disorder and don’t get treatment can develop major depression and/or alcohol use disorder. […] If left untreated, a person with social anxiety disorder could have it for the rest of their life. […] Evidence has shown that cognitive behavioral therapy (CBT) and medications like antidepressants are very successful in treating and managing social anxiety disorder.
#37 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
A combination of pharmacotherapy and psychotherapy is usually indicated for persons with social phobia. […] Virtual reality exposure therapy is an effective approach, especially when done using head-mounted displays in a manner that mimics in vivo exposure therapy. […] Antidepressants including selective serotonin reuptake inhibitors (SSRIs; citalopram [Celexa], escitalopram [Lexapro], fluvoxamine [Luvox], paroxetine [Paxil], fluoxetine [Prozac], sertraline [Zoloft]) and venlafaxine (Effexor)) are commonly prescribed to treat the symptoms of social phobia and generally result in remission of symptoms after 4 weeks of treatment. […] A study of adults was a randomized controlled trial of 117 persons undergoing social anxiety disorder (SAD) treatment who received 16 individual sessions of either cognitive therapy (CT) or interpersonal therapy (IPT) and 1 booster session.
#38 SciELO Brazil – A review on predictors of treatment outcome in social anxiety disorder A review on predictors of treatment outcome in social anxiety disorder
https://www.scielo.br/j/rbp/a/XXBFrtxnsLF6dV6ZmWjyxcs/
OBJECTIVE: This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD). […] RESULTS: Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD. […] CONCLUSIONS: Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.
#39 SciELO Brazil – A review on predictors of treatment outcome in social anxiety disorder A review on predictors of treatment outcome in social anxiety disorder
https://www.scielo.br/j/rbp/a/XXBFrtxnsLF6dV6ZmWjyxcs/
The present work aimed at reviewing the overall profile of individuals with SAD who respond and not respond to standard treatment, with the ultimate purpose of contributing to future research on the development of more effective interventions. […] We found that early onset, increased duration and severity of illness, presence of generalized subtype, positive family history of SAD, and male gender were all predictors of worse response to treatment in at least one study. […] Among these, early onset and severity of illness were the most replicated findings. […] To date, early onset, severity of illness, comorbid anxiety disorders (particularly generalized anxiety disorder and simple phobia), and low expectancy regarding treatment efficacy emerged as potential correlates and/or predictors of low therapeutic response.
#40 Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitiveâbehavioural therapy for social anxiety disorder in routine psychiatric care | BMJ Open
https://bmjopen.bmj.com/content/5/6/e007902
A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). […] Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=0.3 (95% CI 0.4 to 0.1)). […] These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases. […] Identifying factors that can predict non-responders or explain individual differences in long-term improvement is an important addition to the knowledge of how ICBT works in the treatment of SAD within a routine clinical context. […] The main objective of this study was to evaluate the long-term effectiveness of ICBT for SAD in a cohort of consecutively recruited patients treated within routine psychiatric care.
#41 Social Anxiety Disorder: Symptoms, Tests, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/22709-social-anxiety
Social anxiety disorder (social phobia) is a medical condition that causes fear and anxiety when you’re around people in social situations. This disorder is treatable with talk therapy and medications such as antidepressants. […] Social anxiety disorder is a common anxiety disorder. […] Social anxiety disorder is a common mental health condition that can affect anyone. […] Approximately 5% to 10% of people across the world have social anxiety disorder. […] People with social anxiety disorder respond very well to treatment, whether that’s in the form of cognitive behavioral therapy (CBT), medication or both. […] If left untreated, social anxiety disorder can be debilitating and can result in poor education outcomes, declining job performance, lower-quality relationships and an overall decreased quality of life.
#42 Social Phobia Treatment & Management: Approach Considerations, Medical Care, Surgical Care
https://emedicine.medscape.com/article/290854-treatment
A combination of pharmacotherapy and psychotherapy is usually indicated for persons with social phobia. […] Virtual reality exposure therapy is an effective approach, especially when done using head-mounted displays in a manner that mimics in vivo exposure therapy. […] Antidepressants including selective serotonin reuptake inhibitors (SSRIs; citalopram [Celexa], escitalopram [Lexapro], fluvoxamine [Luvox], paroxetine [Paxil], fluoxetine [Prozac], sertraline [Zoloft]) and venlafaxine (Effexor)) are commonly prescribed to treat the symptoms of social phobia and generally result in remission of symptoms after 4 weeks of treatment. […] A study of adults was a randomized controlled trial of 117 persons undergoing social anxiety disorder (SAD) treatment who received 16 individual sessions of either cognitive therapy (CT) or interpersonal therapy (IPT) and 1 booster session.
#43 Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitiveâbehavioural therapy for social anxiety disorder in routine psychiatric care | BMJ Open
https://bmjopen.bmj.com/content/5/6/e007902
A secondary aim was to test the prognostic value of illness severity, adherence, treatment credibility and the influence of having a family history of social anxiety. […] We have found that these factors lack predictive value over longer follow-up time frames when severity of illness is controlled for. […] Nonetheless, this observation is a strong indicator that ICBT is also effective for patients who are severely ill, which may be contrary to common beliefs regarding internet-delivered therapies. […] We also identified family history of social anxiety as a predictor of poorer outcome. […] In sum, this study demonstrates that ICBT for the treatment of SAD in regular clinical practice is effective not only in the short term but also in the long term.