Resources

• Triumph Over Shyness
  By Murray B. Stein, MD & John R. Walker, PhD
  2002 New York: McGraw-Hill
• The Hidden Face of Shyness
  By Franklin Schneier, MD & Lawrence Welkowitz, PhD
  1996 New York: Avon Books
• The Wiley Blackwell Handbook of Social Anxiety Disorder
  By Justin W. Weeks
  2014 West Sussex, UK, John Wiley & Sons

Recent findings at our research center here at the Columbia University Medical Center have demonstrated promising steps forward in the development of psychotherapy and medication treatments which help people with social anxiety disorder.

In 2003, researchers in our clinic systematically reviewed all existing reports on medication for social anxiety. They found several classes of drugs to be helpful. Serotonin reuptake inhibitors (SSRI's), along with venlafaxine, a drug from a similar class, are good "first-line treatments," in that they can treat social anxiety as well as other problems which often occur at the same time, such as depression. Some medications originally developed for other problems, such as Nardil (phenelzine), Klonopin (clonazepam), and Neurontin (gabapentin), were found in his review to be effective for social anxiety as a "second-line drug," for use when patients do not respond to SSRI's.

The efforts of our research team have resulted in reports showing that medications belonging to the class known as the selective serotonin reuptake inhibitors, or SSRI's, are effective in the treatment of social anxiety disorder. In articles published in 1998 and 2005, Dr. Michael Liebowitz (then Director of the Social Anxiety Research Clinic) and his collaborators found Paxil (paroxetine) and Effexor (venlafaxine) to be effective in reducing social anxiety symptoms, with few side effects for most people.

A series of studies comparing and combining cognitive-behavioral therapy and medication for social anxiety disorder has helped establish that cognitive-behavioral therapy can be equally effective as medication for many patients. Our most recent publication in this series, in 2010, found that the combination of medication and therapy may be particularly effective.

Another focus of the Social Anxiety Research Clinic has been to improve understanding of biological factors that may be related to social anxiety and its treatment. In the late 1990s, Dr. Schneier and collaborators began to use PET imaging of the brain to measure chemical receptors in the brain. A series of studies identified difference in receptors for the neurotransmitter dopamine in persons with generalized social anxiety disorder. More recently, Dr. Schneier has used functional magnetic resonance imaging (fMRI) to demonstrate differences in the way the brains of persons with social anxiety disorder process the experience of making direct eye contact.

More research is planned to continue to develop these and other findings, and to apply them to improving the diagnosis and treatment of social anxiety disorder.

• Schneier FR. Clinical Practice: Social anxiety disorder: New England Journal of Medicine 2006;355:1029-1036.
• Schneier FR, Pomplun M, Sy M, Hirsch J. Neural response to eye contact and paroxetine treatment in generalized social anxiety disorder. Psychiatry Research Neuroimaging. 2011;194(3):271-8. PMCID: PMC2745296
• Blanco C, Xu Y, Schneier F, Okuda M, Liu S-M, Heimberg RG. Predictors of persistence of Social Anxiety Disorder: A National Study. Journal of Psychiatry Research. 2011;45(12):1557-63.
• Talati A, Pantazatos SP, Schneier FR, Weissman MM, Hirsch J. Grey matter abnormalities in social anxiety disorder: Primary, replication, and specificity studies. Biol Psychiatry 2013;73:75-84. PMCID: PMC3465490
• Pantazatos SP, Talati A, Schneier FR, Hirsch J. Reduced Anterior Temporal and Hippocampal Functional Connectivity During Face Processing Discriminates Individuals with Social Anxiety Disorder from Healthy Controls and Panic Disorder, and Increases Following Treatment. Neuropsychopharmacology. 2014 Jan;39(2):425-34. PMID: 24084831: PMC3870777

• Andrew Kukes Foundation For Social Anxiety
• Anxiety and Depression Association of America