Objective: Social anxiety disorder (SAD) is a marked and persistent fear of social situations characterized by pervasive social inhibition and timidity. The average age of onset is early to middle adolescence (11.3 – 12.7 years-old). It was estimated that about % 1 – 2 of the general child population suffered from SAD. Children with SAD report distress in a broad range of interpersonal encounters including joining in on and starting a conversation, writing, reading and speaking in front of the class, and musical or athletically performances. Also they frequently report physical symptoms such as heart palpitations, shakiness, sweating, and nausea. Furthermore, a substantial proportion of individuals have comorbid psychiatric conditions such as generalized anxiety disorder, selective mutism, separation anxiety disorder and depression. Children and adolescents with SAD exhibit deficient social skills. Several retrospective studies showed that the majority of those with a history of SAD recovered from the disorder. The strongest predictor of recovery was later age of onset of social fears. The aim of this review is to discuss the treatment approaches for SAD in adolescents. Recommendations and suggestions for future research will also be presented.
Materials and Methods: Studies were collected through searching PubMed using the search words social phobia or social anxiety, treatment, pharmacotherapy, psychotherapy, children, adolescents, social skills training, group therapy and antidepressants. The article included published after 1995 with adolescent participants (age < 18 years) with SAD.
Results: Few studies have focused specifically to the treatment of SAD in adolescence. There are mainly three treatment approaches that this review will focus on: 1- Cognitive behavioral treatment (CBT), 2- Pharmacotherapy and 3- Family treatment. Several studies reported that adolescents treated with individually CBT had significantly lower general anxiety and enhanced coping abilities and improved on parents’ ratings of anxiety, depression, and social competence. The Group Cognitive-Behavioral Treatment for Adolescents (GCBT-A), a 12-week group therapy that consists of psychoeducation, skill building, cognitive restructuring and behavioral exposure to social distressing situations, was also reported to be an effective treatment program for adolescents with SAD. Similarly Social Effectiveness Therapy for Children (SET-C), a multifaceted behavioral treatment that includes group social skill training, peer-generalization experiences, and individual in vivo exposure, was found that children were less anxious, less avoidant, more skillful and engaged in more social discourse at post-treatment. Selective serotonin reuptake inhibitors (SSRIs) are usually considered as the first-line pharmacological agent with the advantages of minimal side effects and high tolerance levels. Several studies showed that children with only one anxiety disorder responded to lower doses of SSRIs than did children with comorbid disorders. The addition of family component to the CBT, either individually or in groups, was superior to CBT alone, especially in preadolescents.
Concussions: As SAD has been found to be an early-onset, comorbid, and chronic disorder, early detection and intervention could help avert a lifetime of personal distress and social maladjustment. Psychopharmacological and psychotherapeutic interventions are found to be effective in the treatment of adolescents with SAD.