BMJ Best Practice Podcast Social anxiety disorder
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Sep 25, 2025 Professor Craig Sawchuk, a leading expert in social anxiety disorder from the Mayo Clinic, dives into the common yet debilitating condition that affects millions. He explains the critical differences between shyness and social anxiety, revealing fascinating insights into diagnosis and treatment approaches. The discussion spans effective cognitive behavioral therapy (CBT) techniques, the role of medication, and the significant delays many face before seeking help. Listeners will also learn about emerging online therapy options and how to navigate the path to improvement.
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Look For Comorbidity And Safety Behaviours
- When assessing, screen for comorbid depression and substance use, and ask about safety behaviours, not just avoidance.
- Explore history to see whether social struggles preceded depression and whether alcohol or nicotine are used to cope.
CBT As First-Line Treatment
- Make cognitive behavioural therapy (CBT) the first-line treatment, emphasising cognitive restructuring and exposure.
- Offer social skills training where developmentally needed and tailor therapy to individual goals.
Expect 8–16 Active CBT Sessions
- Expect meaningful CBT gains within 8–16 sessions and emphasise homework practice between sessions.
- Tell patients therapy is active; in-session work plus repeated real-world exposure produces change.