The Social Anxiety Evidence Map.
What we know about social anxiety disorder, what we're still figuring out, and what the data can't tell us.
Social anxiety is the most common anxiety disorder by lifetime prevalence and one of the most underdiagnosed. People assume it's shyness, or assume it's something they should have grown out of, and a lot of them never get screened. The treatment evidence is solid. CBT with an exposure component is first-line and effect sizes are large, particularly for the avoidance piece. SSRIs help. Beta-blockers help with performance-only presentations, not with generalized social anxiety, and the literature keeps getting that distinction wrong. The map below shows the evidence by treatment and by use case.
Evidence nodes
What the map shows
The treatment evidence for social anxiety is among the strongest in anxiety care. CBT plus exposure produces large effect sizes for generalized social anxiety. SSRIs add a smaller but reliable benefit. Group CBT and individual CBT both work, with the group format more cost-efficient and the individual format easier to titrate to a specific person. Beta-blockers are useful for performance-only presentations (giving a talk, playing an instrument in front of others) but don't address the disorder when avoidance has generalized. The map separates these by use case so the reader doesn't conflate them.
What the map doesn't show
- ·A lot of the social anxiety literature mixes generalized and performance-only samples, which inflates effect sizes for beta-blockers in some summaries.
- ·Effect sizes for CBT are larger for completers than intent-to-treat samples. Dropout in social anxiety treatment is meaningful and most coverage understates it.
- ·Pediatric onset is more common than the adult literature implies. Most adults with social anxiety can name a childhood version of it.
- ·Long-term outcomes are good for those who complete treatment. The qualifier matters.
Sources
How to cite this map
The Social Anxiety Evidence Map, AnxietyResearch.org. Built from NIMH prevalence data, social anxiety CBT meta-analyses, SSRI trial summaries, and beta-blocker performance-anxiety literature. Accessed [date]. https://anxietyresearch.org/evidence-maps/social-anxiety/
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