What to know about social anxiety?

Social Anxiety: Why Therapy Leaves a Lasting Mark

Description: A landmark randomized controlled trial, published in the New England Journal of Medicine, compared the effectiveness of CBT (Cognitive Behavioral Therapy) and fluoxetine (Prozac) — alone and in combination — for generalized social anxiety disorder. The study found that while medication can bring fast relief, therapy delivers the most lasting change, helping people retrain how they respond to fear in social situations.

The Takeaway

Both medication and therapy help, but CBT creates long-term transformation.
Here’s how patients improved across treatments:

• Fluoxetine (SSRI): 51% improved
• CBT: 54% improved
• Combination (CBT + fluoxetine): 54% improved
• Placebo: 32% improved

Fluoxetine worked faster — with many patients feeling better by week 4. But CBT helped people rewire their reactions, gain confidence, and sustain progress after treatment ended.

Key message: Meds can reduce fear. Therapy teaches you how to face it — and win.

Why Should You Care

Because social anxiety shrinks your life — avoiding meetings, turning down invitations, fearing judgment. This study shows that CBT doesn’t just treat symptoms — it rewires the brain, offering freedom that lasts.
One number to remember: 54% of patients improved with CBT — the same as with medication, but with more lasting effects.

The Article

This trial was published in the New England Journal of Medicine, one of the most trusted medical journals worldwide. The study was a randomized controlled trial — the gold standard in research — and included patients from multiple top academic centers. Its methods and conclusions are considered highly reliable and practice-changing.

The Clinical Data

Takeaway: CBT works as well as meds — and its benefits stick even after therapy ends.

Study Design: How They Figured It Out

• Type: Randomized controlled trial (RCT)
• Location: Multiple top U.S. academic centers
• Participants: Adults with generalized social phobia (the type that affects many areas of life)
• Interventions:
  • Fluoxetine
  • CBT (computer-assisted)
  • Combination treatment
  • Placebo
• Follow-up: Tracked both short-term and longer-term results
• Published in: New England Journal of Medicine

This study offered a rigorous, head-to-head comparison of the most common real-world treatment options for social anxiety.

Why This Study Changed My Practice

When patients tell me, “I just want to stop panicking in social situations,” I used to reach for medication first. But this study shifted my priorities.
Now I tell them:
“Medication turns the volume down — but therapy helps you rewrite the script.”

Here’s what I changed:

• I now offer CBT as a first-line treatment, especially when patients want lasting change
• I explain that SSRIs like fluoxetine help, but don’t teach skills to face fear
• I frame treatment as not just symptom relief, but a path to regaining confidence
• I support combining therapy and medication, but emphasize that CBT alone is often enough

What Patients Should Know

• Social anxiety is treatable — and very common
• Fluoxetine (Prozac) can ease anxiety quickly
• CBT helps you learn to face and unlearn fear
• You don’t have to choose just one — but therapy gives lifelong tools
• The real goal? Not just fewer anxious moments, but more freedom and connection

Final Thought

This study showed that therapy doesn’t just reduce anxiety — it changes how your brain responds to fear. Medication can help open the door, but CBT is what helps you walk through it.

If social anxiety has been keeping you silent, stuck, or small — there’s a way out, and CBT can guide you there. With the right support, you can not only feel better — you can start showing up in your life again.

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🔗 Link to the study: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482074

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