Cognitive Therapy ALONE as First Line Treatment for Social Anxiety Disorder
A recent research study has shown cognitive therapy (CT) to be more effective than medication therapy or combination therapy (drug/CT) in the treatment of social anxiety disorder (SAD). This research contradicts the predominant thought that using a combination of cognitive techniques along with pharmaceutical intervention is the most effective treatment for SAD(1).
SAD is the most common anxiety disorder of the modern time. It is estimated that between 3 and 7 percent of adults suffer from social anxiety within a given 12-month period of time, and upwards of 15 percent in adolescents. SAD is a developmentally debilitating condition which impairs individuals from connecting to their peer group, obtaining vital emotional and social support, and enjoying life. It can also be a major influencer of making modifications to diet, exercise, and social habits such as smoking and drinking.
A team of Norwegian and British researchers has spent the last 10 years studying the mistreatment of social anxiety with “happy pills.” Hans M. Nordahl, a professor of behavioural medicine at the Norwegian University of Science and Technology (NTNU) says,”A lot of doctors and hospitals combine medications – like the famous “happy pill” – with talk therapy when they treat this patient group. It works well in patients with depressive disorders, but it actually has the opposite effect in individuals with social anxiety disorders. Not many healthcare professionals are aware of this.”
This study showed that as high as 25% of individuals can achieve recovery from SAD using CT alone, a staggering number for a mental health condition. Cognitive therapy is a method by which a therapist or counselor works to achieve a patient’s acceptance of their fear, going into difficult and challenging situations and learning the ability to shift their attention to what they want to say, do, feel in a situation.
Psychoactive drugs like selective serotonin re-uptake inhibitors (SSRIs) have incredible physical side effects. When individuals have been on them a long time and then try to come off of them they often feel rebound effects of flushing, dizziness in social situations, and shivering. The common impulse is to correlate the drug with feeling good, and discontinue any CT they may have been undergoing. In this way the drugs are camouflaging any positive progress in regulating anxiety themselves when the two are used in combination.
- Nordahl HM, et al. Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial.Psychother Psychosom. 2016;85(6):346-356. Epub 2016 Oct 15.
- Ruscio AM, et al. Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychol Med. 2008;38(1):15.
Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.
