Recent Developments in Research and Treatment for Social Phobia
Purpose of Review: This review covers three themes of research that brought fresh data useful for clinical practice in a handicapping anxiety disorder: social phobia. Recent findings deriving from basic biological research, new forms of psychological therapies, and recent psychopharmacology controlled trials are reviewed.
Recent Findings: The basic neuroimaging research suggests that greater activation of the amygdala to novel versus familiar faces may be an underlying trait marker for social phobia. Social phobia may represent a phenotype that expresses a genetically driven trait of social withdrawal, which may be related to infantile inhibited temperament (Kagan's syndrome). The development of virtual reality therapy as therapeutic tool for social phobia appeared promising in one controlled, but not randomized, study. A controlled study suggests that social phobias in children can be effectively treated with cognitive behavioural therapy. This represents an extension of the work done with adults. Venlafaxine appears an effective short-term treatment for social anxiety disorder in two controlled studies. A new compound, pregabalin, appeared clearly effective in a positive controlled study. This trial marks the advent of a new pharmacological lineage for social phobia. Both venlafaxine and pregabalin, however, have been studied in short-term studies. Longer follow-up and relapse prevention studies are warranted.
Summary: Neuroimaging research points to a temperamental basis for social phobia. Virtual reality therapy is an emerging tool to carry out exposure treatment. Group cognitive behavioural therapy can be extended successfully to children. Venlafaxine and pregabalin have a proven short-term effectiveness in social phobia.

Social phobia (or social anxiety disorder) is a chronic condition marked by the fear of negative evaluation by others, anticipatory social anxiety, inhibition, withdrawal, and avoidance of social contacts. Lifetime prevalence ranges from 2.8 to 13% in epidemiological studies. About 70% of social phobic persons are women. Their social and educational level are lower than average. Sixty-six percent of social phobic persons are unwed. There are two peaks of incidence: 11-15 and 18-25 years. Avoidant personality disorder is correlated with generalized social phobia, suggesting the latter is the expression of a temperamental trait, or a disturbance of the personality development. Non-generalized social anxiety disorder is a milder state, in continuity with normal shyness (e.g. fear of speaking in public). The main complication of social anxiety disorder is depression.

Behavioural and cognitive psychotherapies are the most widely studied psychological interventions for generalized and non-generalized social phobia. Controlled evidence and meta-analytic studies lend support to the effectiveness of their combination under the label of cognitive behaviour therapy (CBT). Group CBT has been extensively studied in adults in controlled studies in comparison with credible placebo or antidepressant drugs. Manual interventions have been carefully designed and applied in various settings and compared with medication, and credible placebo. However, basic research is needed to better understand the basic tenets of this chronic condition and the process of the therapeutic change.

Worry about anticipated public performance translates into altered perfusion of brain regions reflecting changes in associated neural activity. Neuroimaging data suggest strongly that anticipatory anxiety in social phobic patients is related to a fear network encompassing the amygdaloid-hippocampal region, prefrontal, and temporal areas.

Moreover, a controlled study by Furmark et al . demonstrated that there were common sites of action for a selective serotonin reuptake inhibitor antidepressant - citalopram - and CBT for social anxiety. Outcome was assessed by subjective and psycho-physiological state anxiety measures and self-report questionnaires. This positron emission tomography-study delineated regions of interest where the cerebral flow decreased in responders to either treatment: the amygdala, hippocampus, and neighbouring cortical areas. The circuitry of these brain regions controls bodily defence reactions to any kind of threat.