The Diagnosis and Treatment of Social Anxiety Disorder by Ilyse Dobrow DiMarco, Ph.D

According to the Anxiety and Depression Association of America (, Social Anxiety Disorder (SAD) affects about 15 million American adults, and 36% of people report symptoms for 10+ years before seeking help. SAD is an extremely heterogeneous condition, and no two people with Social Anxiety Disorder look alike. For example, both an outgoing businesswoman who becomes paralyzed when speaking at work meetings and a “painfully shy” man who avoids nearly all social functions could be diagnosed with SAD.

A recent meta-analysis (Mayo-Wilson et al., 2014)[1] declared cognitive-behavioral therapy (CBT) to be the initial treatment of choice for individuals suffering from SAD. CBT involves a number of components. The first step in effective CBT treatment is completing a thorough assessment of the patient’s symptoms, working to understand the cognitive, behavioral, physiological, and emotional processes that trigger and maintain social anxiety. Once all of these processes are understood, the therapist creates a case formulation for the patient, incorporating all those factors that appear to be maintaining the problem. An example of a formulation template can be found in Hofmann & Otto (2008, p. 34)[2]

This formulation is then used to create a personalized treatment plan. CBT treatment of SAD often includes several components:

Cognitive work: patients learn to identify and challenge problematic thinking patterns that tend to maintain anxiety.

Behavioral work: patients are tasked with exposing themselves, either in reality or in their imaginations, to feared/avoided situations and experiences. With consistent, repeated exposure to these situations and experiences, patients learn that they are able to tolerate these situations and manage their anxiety, and that the outcomes they fear often do not come to pass and/or are not as catastrophic as expected.

Mindfulness/acceptance work: patients learn to accept that they may be anxious at times, but that this anxiety need not limit them. Acceptance work is often accompanied by mindfulness training. Mindfulness training consists of exercises that help patients learn to fully accept their thoughts, feelings, and experiences in the present moment, without judging them.

For additional information about CBT for Social Anxiety Disorder and other anxiety disorders, please see Dr. Dobrow DiMarco’s website:

Dr. Dobrow DiMarco is a licensed clinical psychologist and a Diplomate of the Academy of Cognitive Therapy specializing in cognitive-behavioral therapy for anxiety. In addition to maintaining a private practice in Summit, NJ, she is the Assistant Director of the Rutgers Anxiety Disorders Clinic.

[1] Mayo-Wilson, Dias, Mavranezouli, Kew, Clark, Ades, & Pilling (2014). Lancet Psychiatry, 1, 368-76.

[2] Cognitive Behavioral Therapy for Social Anxiety Disorder (2008). New York: Routledge.