Social anxiety disorder - Emerging treatments

Atypical antipsychotics

Atypical antipsychotics (e.g., olanzapine, quetiapine, aripiprazole) require further study. Small randomised controlled trials suggest a possible role in social anxiety disorder.[104][149][150][151] Adverse effects of weight gain and metabolic syndrome may limit usefulness in some patients.

Buspirone

While some authors support the use of buspirone for augmentation of other treatment strategies, efficacy as a monotherapy for social anxiety disorder has not been demonstrated in controlled trials.[108][152]

Cycloserine augmentation

Increasing attention is being invested towards better understanding how to improve exposure-based outcomes for anxiety. Cycloserine is a partial N-methyl-D-asperate agonist. Low doses can be used to enhance the efficacy of exposure-based treatments for social anxiety through memory consolidation.[153][154] An individual participant data meta-analysis on cycloserine augmentation for exposure-based cognitive behavioural therapy found that patients randomised to cycloserine augmentation had a small but significant reduction in symptom severity at post-treatment and follow-up compared with those who received placebo.[155] These findings were not moderated by concurrent antidepressant use or the number of therapy sessions.[155] In one subsequent randomised controlled trial, cycloserine augmentation was equally effective when administered before or after exposure treatment.[156] However, some have questioned the clinical significance of the small effect and highlight the mixed results of individual studies.[64][157][158] Further research is focused on personalisation in an attempt to maximise the efficacy of augmentation strategies.

Interpersonal psychotherapy

This effective treatment for depression has also yielded promise as a psychological intervention for social anxiety disorder, but it may be less effective than cognitive behavioural therapy for social anxiety disorder.[77][159][160]

Interpretation-modification therapy

Attentional bias towards threat is considered to be associated with the maintenance of social anxiety. Training individuals with high level of social anxiety to interpret ambiguous social cues as benign has been found to reduce attentional biases to social threat cues.[161][162]

Transdiagnostic approaches

Transdiagnostic therapy involves taking a cognitive-behavioural approach to managing anxiety, regardless of specific diagnoses. The unified protocol is an example of this approach, with treatment focusing on targeting shared characteristics across disorders, such as negative affect and emotion dysregulation. Research supports the efficacy of transdiagnostic therapy for social anxiety, including comparable findings to disorder-specific protocols and presentations with comorbid depression.[88][163][164][165]

Exercise augmentation

Symptomatic outcomes for cognitive behavioural therapy in social anxiety disorder can be improved with the augmentation of aerobic and anaerobic exercise.[166][167]

Alpha-Stim AID cranial electrotherapy stimulation

An electrotherapy device that aims to reduce symptoms of anxiety by generating alpha brain waves. One small open-label study with no control group showed improvement in Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scores among patients with anxiety symptoms after 6 weeks of treatment.[168] However, the mechanism of action is unclear and there are no studies comparing Alpha-Stim AID with other evidence-based standards of care for anxiety.[169] Further research is needed.