Ruy Miranda
Social Anxiety Shyness Info

The treatment of Social Phobia / Social Anxiety is made with psychotherapy or medication or both. However, the psychotherapeutic approaches and the use of medication are an object of disagreement among professionals. The reason is simple: neither one or the association of the two solve the problem of all patients.

In this article I will deal with two generic questions:
– What is necessary (in my opinion) for the treatment to yield good results.
– More frequently used types of medication.

The first issue to be highlighted refers to how the sufferer of Social Phobia / Social Anxiety must be seen: as a person in crisis, in need of immediate help to lessen her suffering. My own conduct follows these criteria:

– Make available to the client all the arsenal of knowledge and experience for him to understand the phobia mechanism he bears.

– Remove from the client the conception created or introduced by third parties that the problem can be solved by sheer willpower.

– Use very active action to rid the client of the attacks.

The second issue to be highlighted: once the crises are overcome or reduced to levels that make life more comfortable, let the person decide whether to climb to another level of the knowledge of "self" and its possible enlargement of the changes already made, that is, if the client wants to engage in psychotherapy.

Thus, the treatment unfolds on two successive fronts:

* to eliminate or relieve the intensity of the crises ,

* to work on reformulating the self or its enlargement.

The whole treatment can be through psychotherapy alone. In any psychotherapeutic approach , from Cognitive Therapy to orthodox Psychoanalysis, the reduction or overcoming of symptoms may be the function of changes in self-concept. The way to work such changes is different from one approach to another. In a future article, I will examine such differences.

Many professionals add medication to the treatment, myself included. I resort to medication at the first stage, when the crises are intensive. It may be necessary to maintain the drug(s) in lower doses for months. For many years, at the start of my professional life, I used only psychotherapy. Nowadays, I am convinced that I offer my clients relief that is quicker than that found in psychotherapy alone. Besides, today there are a greater number and more effective drugs than there were almost forty years ago.

The medications most frequently used are :

– Antidepressants.

– Anxiolytics, particularly benzodiazepines.

– Beta-blockers.

They are used in isolation or in association.

As I see it, the most important are the antidepressants, inasmuch as they cause more impact in the elimination or relief of the crises . I must add that obsessive thinking and compulsions associated with social anxieties seem also to respond to these medications.

In another article I will deal with the probable action mechanisms of these medications and why the associations are justified.

For now, I will mention the following items, which, as I see it, should guide the use of these substances:
– A given medication may be ineffective for one person and effective for another.
– Sub-therapeutic dosages usually bring about no relief.
– Therapeutic dosages in the phobias are equivalent to dosages used in the depressions.
– If a medication (or association) shows no significant results in, at the most, two weeks, then I try another. (In this particular , there is a difference vis à vis the depressions, when the wait must be up to one month).


May, 2004

Updated May, 2005

Updated December, 2005

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