Imagine you’re taking a stroll in the park, humming your favorite song, and skipping down the trail. You notice two people walking toward you from a distance, as you begin to wonder “Do I know these people?” “Do I look ‘OK’?” Instinctively you want to turn the other way, but you continue walking, as your heartbeat becomes increasingly louder and louder, until they walk past you, and you let out a deep breath. This is what it’s like to have social anxiety.
Now, researchers at the Norwegian University of Science and Technology (NTNU) have found cognitive behavioral therapy (CBT) is the most effective treatment for treating social anxiety disorder than taking “happy pills”.
“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” said Hans M. Nordahl, a professor of behavioral medicine at NTNU, in a statement.
“Happy pills” like selective serotonin reuptake inhibitors (SSRIs) have strong physical side effects. Patients who’ve been on medications for awhile, and want to reduce their intake, experience bodily feelings associated with social phobia, like shivering, flushing, and dizziness in social situations after withdrawal. Patients tend to end up in a state of acute social anxiety again. NTNU researchers believe “happy pills” only disguise the problem.
“[T]he medication camouflages a very important patient discovery: that by learning effective techniques, they have the ability to handle their anxiety themselves,” said Nordahl.
They’re usually the first choice of medication for treating social anxiety. The way SSRIs work by affecting your brain chemistry by slowing re-absorption to the neurotransmitter serotonin, a chemical researchers believe can help regulate mood and anxiety. However, common side effects include insomnia or sleepiness, sexual dysfunction, and weight gain.
They are considered an effective treatment for all anxiety disorders, although the treatment of obsessive-compulsive disorder, or OCD, typically requires higher doses, according to the Anxiety and Depression Association of America.
In the study, published in Psychotherapy and Psychosomatics, over 100 patients were divided into four groups. The first group received only medication, the second group received only therapy, the third group received a combination of the two, and the fourth received a placebo pill. The four groups were compared along the way, and researchers conducted a follow-up assessment with them a year after treatment ended.
During treatment and right afterward, the patients in groups two and three were managing equally well. After a year, those in group two who only received cognitive therapy, were faring the best. With solely the help of cognitive therapy, the recovery rate of patients with social anxiety disorders went up from 20 to 25 percent, compared with the norm for this group.
“This is the most effective treatment ever for this patient group. Treatment of mental illness often isn’t as effective as treating a bone fracture, but here we’ve shown that treatment of psychiatric disorders can be equally effective,” said Nordahl.
Cognitive therapy is a combination of two different treatments: cognitive restructuring (changing how you think) and exposure therapy (doing the things you fear). Typically, the first treatment will involve writing down your thoughts in your journal, and then comparing it to common cognitive distortion to see where you are being too negative or irrational. Meanwhile, the second treatment involves taking small steps and working towards facing harder and more high pressure situations.
The researchers are trying to improve standard cognitive therapy by adding new processing elements, known as “metacognitive therapy”, which have shown greater effectiveness. Doctors work with patients’ thoughts and their reactions and beliefs about these thoughts to address their rumination and worry about how they function in social situations.
The researchers now hope to develop standardized cognitive therapy further for patients who suffer from social anxiety disorders.
Cognitive therapy is just one of the few drug-free options effective in treating social anxiety. Healthy eating and adequate exercise can help alleviate symptoms linked to the disorder. This creates a lesser dependency of medication, and allows patients to work on overcoming their fear, rather than “numbing” it with drugs.
Eat Fermented Foods
Fermented foods that contain probiotics — a good bacteria — could be beneficial to combat social anxiety. A 2015 study published in Psychiatry Research found among students with high degrees of neurotic feelings, eating more fermented food, like yogurt, Sauerkraut, or even dark chocolate, was linked to fewer symptoms of social anxiety. Probiotics are known to reduce inflammation of the gut, and since anxiety is often accompanied by gastrointestinal symptoms, reducing gut inflammation helps alleviate those symptoms.
Add More Zinc To Your Diet
A 2010 study found a link between zinc intake and depression and anxiety levels. Researchers examined the effects of zinc supplementation on Guatemalan children and measured mental health. When children were examined individually, those with higher zinc levels showed lower levels of depression and anxiety. Enzymes that contain zinc are essential for serotonin production, and since many pharmacological treatments for anxiety act on the serotonergic system, the belief is a severe zinc deficiency could lead to a reduction in serotonin production, and therefore, an increase in anxiety. Zinc stimulates the enzyme,pyridoxal kinase, involved in the synthesis of gaba-aminobutyric acid (GABA) neurotransmitter.
Do Aerobic Exercise
Regular aerobic exercise has been linked to a decrease in overall levels of tension; elevate and stabilize mood; improve sleep; and improve self-esteem. A 2014 study in PLoS ONE found exercise and relaxation activities, such as yoga, can actually change the way people perceive the world. Researchers used a dotted outline of a human — essentially just a series of dots, each one depicting a major joint on the body — for their study. Someone with social anxiety disorder tends to look at the image and believe it’s facing them, which indicates a threat.
Those who either walked or jogged on a treadmill for 10 minutes perceived these ambiguous figures as facing towards them (the observer) less often than those who simply stood on the treadmill. This also occurred when people performed progressive muscle relaxation.
Researchers are just beginning to understand how refining drug-free methods to treat social anxiety are more powerful than taking happy pills.
Source: Nordahl HM, Vogel PA, Morken G 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. Psychotherapy and Psychosomatics. 2016.