Treatment of Adult Social Anxiety Disorder: A Treatments-by-Dimensions Review

Although numerous conceptual and meta-analytic reviews have previously established the efficacy of psychosocial treatments for social anxiety disorder (SAD), few have examined whether different treatments produce different effects across the various symptoms experienced by individuals with SAD. In order to address this limitation, this review evaluated the impact of different psychosocial treatments on three specific dimensions of SAD: physiological symptoms and neurological activity, cognitive symptoms and fear of negative evaluation, and overt behavioral performance. The treatments examined included cognitive-only interventions, exposure-only interventions, combined cognitive-behavioral interventions, social skills training, attention/interpretation training, and interpersonal interventions. Overall, we found that most treatments were helpful for most of the dimensions examined, with some notable exceptions. For example, cognitive symptoms and fear of negative evaluation seemed to be quite responsive to most of the active treatments reviewed. However, cognitive-behavioral treatments and exposure-alone appeared more helpful in reducing physiological arousal and improving overt behavioral performance than were treatments without a behavioral intervention. Implications for understanding the mechanisms of change are discussed briefly. It is hoped that practitioners may find this chapter useful in selecting a treatment when a particular dimension of SAD is prominent in an individual client’s presentation.