By Mandy Oaklander
September 26, 2014
TIME Health
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For the estimated 7% of people who suffer from social anxiety disorder, antidepressants are often the first line of defense. But a new meta-analysis published in The Lancet Psychiatry found that cognitive behavioral therapy (CBT) is actually more effective—and unlike with antidepressants, the effects last after you stop.

The analysis looked at data from more than 13,000 people with severe social anxiety across 101 clinical trials. CBT came out on top as the most effective therapy overall, as well as the most effective type of talk therapy.

Here’s how it works: “You set up these experiments to test whether people’s beliefs about themselves and the world are really accurate representations,” says study author Evan Mayo-Wilson, research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. In doing that, you’re getting people to experience the anxiety, learn to cope with it, and in a real-world sense, challenge those maladaptive and incorrect beliefs about themselves and the world around them.”

People with social anxiety experience self-consciousness or fear from ordinary situations, like giving a speech or riding the subway, sometimes to a debilitating degree. In CBT sessions, the therapist identifies the beliefs, thoughts and behaviors that are feeding this fear, then find creative ways into them. If a person is afraid of being stared at on the subway, for instance, a therapist might tell them to take a trip and make funny faces to see how passengers react.

Another perk of CBT was that fewer people relapsed after treatment, the study found. And many of those who practiced CBT had sustained benefits without the side effects of medication.

“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs,” Mayo-Wilson said in a press release. “We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated.”

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