Brazilian Psychiatric Association guidelines for the treatment of social anxiety disorder

Abstract

Social anxiety disorder (SAD), one of the most prevalent anxiety disorders, is not well recognized. In most cases, SAD follows an unremitted and chronic course, affecting individual functioning in relationships, education, and work. Due to the disorder’s relevance in Brazil, guideline-based treatments adapted to the Brazilian social and economic context are needed. We conducted a systematic review assessing several treatment modalities for SAD. PubMed, Cochrane, SciELO, and ClinicalTrials.gov were searched using the Medical Subject Headings social anxiety disorder and social phobia. Of the 438 selected articles, 20 were selected. Selective serotonin reuptake inhibitors are considered a first-line treatment for SAD due to their large effect size and database of evidence. Monoamine oxidase inhibitors, benzodiazepines, and the anticonvulsants pregabalin and gabapentin are also effective. Divergent results have been found for the serotonin-norepinephrine reuptake inhibitor venlafaxine. Among psychological interventions, robust data support cognitive behavioral therapy (whether individual, group, or remote) as a first-line option. Psychodynamic psychotherapy, exposure and social skills therapy, self-help therapies (with or without support), cognitive bias modification, virtual reality exposure therapy, and mindfulness-based therapy are also effective techniques. Psychological interventions are better tolerated and there is evidence that they provide better long-term benefits than pharmacological agents. Access to treatment (considering the Brazilian socioeconomic context), treatment adherence, short and long-term response rates, and side effects must be considered when choosing the best treatment strategy.