Each option has a rating from Strong evidence to Not tested. A high rating means good trials show it helps on average. It does not promise it will help you, and a low rating does not mean it cannot.
Guides
- Virtual reality
Everything about VR for social anxiety: therapy with a headset, home apps, 360° video, social VR and AI avatars. What each has behind it, costs, and how to judge an app.
On your own
Things you can start this week, without a referral.
- Self-help books
You work through a book based on CBT, doing the exercises in real life. Books helped in trials, and they help more when someone checks in with you along the way.
- Internet CBT
You work through online lessons and exercises, usually with a therapist checking in by message. Guided programmes work about as well as face-to-face therapy in several trials.
- Exposure on your own
You face the situations you fear, in small planned steps, without a therapist. Exposure is part of every proven treatment, but doing it alone has been tested mostly as part of a book or online programme.
- Apps for social anxiety
Phone apps that teach CBT skills or guide exposure. A few trials suggest some benefit, but most were small and weak, and the most careful larger trial found no clear effect. Most apps in stores are untested.
Talking therapy
Therapy with a trained therapist, alone, in a group or online.
- Cognitive therapy for social anxiety (CT-SAD)
A form of CBT made for social anxiety. You and a therapist test your fears with experiments, drop safety behaviours and practise focusing outward. It has the strongest evidence of any treatment for social anxiety.
- Group CBT
You meet weekly with a small group of people who also have social anxiety, and practise feared situations together. It helps clearly, but individual therapy made for social anxiety has done better in comparisons.
- Acceptance and commitment therapy (ACT)
Instead of fighting anxious feelings, you learn to notice them and still do what matters to you. One good trial found it helped about as much as CBT, but few trials have tested it for social anxiety.
- Mindfulness-based therapy
You practise paying attention to the present moment without judging it, usually in a weekly group course. It helps more than no treatment, but a little less than CBT.
- Psychodynamic therapy
A talking therapy that explores where your fears come from and the patterns they create in relationships. It helps clearly, but CBT did a little better in the short term.
Medication
Medicines a doctor can prescribe, and what trials show next to what people report.
- SSRIs and SNRIs
Daily antidepressant medicines, such as sertraline, escitalopram, paroxetine or venlafaxine. They are the best-tested medicines for social anxiety and clearly beat placebo, but symptoms often return after stopping.
- Propranolol and other beta-blockers
A heart medicine that blocks some physical signs of adrenaline, like shaking and a pounding heart. Many people use it before talks or performances. For social anxiety disorder itself, it has almost no trial evidence.
- Benzodiazepines
Fast-acting calming medicines, such as clonazepam, alprazolam or diazepam. A few trials show they reduce social anxiety, but they can cause dependence and withdrawal, so guidelines do not make them a first choice.
- Pregabalin and gabapentin
Medicines first made for epilepsy and nerve pain. A few placebo-controlled trials show they reduce social anxiety, often only at high doses. Misuse and withdrawal are real concerns.
- MAOIs (phenelzine)
An older type of antidepressant. Phenelzine worked well for social anxiety in several trials. Because of food and drug interactions, doctors usually keep it for when other options have not helped.
Virtual reality and technology
VR exposure, apps, chatbots and other tools.
- Virtual reality exposure therapy
You wear a headset and practise feared situations, such as a meeting or a talk, with a therapist guiding you. Inside a course of therapy, it works about as well as practising in real life.
- VR exposure at home
You use a headset and an app to practise feared situations on your own, at home, step by step. Small trials found it helps more than waiting. It has not yet been compared fairly with other self-help.
- Social VR (VRChat and similar)
Social VR means meeting real people as avatars in apps like VRChat. Many socially anxious people feel calmer there. No trial has tested whether it reduces social anxiety offline.
- AI chatbots for social anxiety
Some people practise conversations with AI chatbots like ChatGPT. No trial has tested this for social anxiety. It may work as rehearsal, or it may become a way to avoid people.
Not proven or did not work
New treatments still in trials, and ideas that were tested and did not help.
- Fasedienol nasal spray
Fasedienol (PH94B) is an experimental nasal spray meant to calm anxiety within minutes, before a social situation. It is not approved anywhere. One large trial found it helped, three did not.
- CBD (cannabidiol)
CBD is a substance from the cannabis plant that does not make you high. Two small trials looked hopeful for social anxiety. Two bigger trials have finished, but their full results are not public.
- MDMA, ketamine and psychedelics
Researchers have tested MDMA-assisted therapy and ketamine for social anxiety in very small trials. None is approved for it. No psilocybin trial for social anxiety is registered.
- Attention training (brain-training apps)
Attention training is a computer task meant to stop your attention jumping to signs of threat, such as frowning faces. Early lab trials looked exciting. Done at home or online, it did not beat a fake version.
- D-cycloserine with exposure therapy
D-cycloserine is an old antibiotic that researchers hoped would help the brain learn faster during exposure therapy. In the largest trial for social anxiety, people got better a bit sooner, but not more by the end.
- Oxytocin nasal spray
Oxytocin is a hormone linked to bonding and trust. In a trial for social anxiety, a nasal spray of it alongside exposure therapy did not lead to better results than a dummy spray.