Social phobia, also called social anxiety disorder, is the third most common mental health disorder after depression and substance abuse, affecting as many as 10 million Americans. Social phobia is an anxiety disorder involving intense distress in response to public situations. [1, 2] Individuals with social phobia typically experience symptoms resembling panic during a social encounter. These situations may include speaking in public, using public restrooms, eating with other people, or engaging in social contact in general.
Persons with this disorder fear being humiliated or embarrassed in social and/or performance situations by their actions and may become intensely anxious, with an increased heart rate, diaphoresis, and other signs of autonomic arousal. These physical symptoms may cause additional anxiety, often leading to a conditioned fear response that reinforces their anxiety in public situations. 
The onset of social phobia may or may not be abrupt, often manifesting after a stressor or humiliating social experience in an individual with a childhood history of excessive shyness or social inhibition. Social phobia is considered a disorder if it is severe enough to adversely affect social or occupational functioning.  Individuals with true social phobia go to great lengths to avoid social situations, usually to their own detriment. The fear of embarrassment is egodystonic, thus persons with social phobia are distressed by their symptoms. 
The pathophysiology of social phobia is evolving as a result of research into brain connectivity and function and recent hypotheses regarding cognition.
A functional connectivity study of 174 subjects, 78 of whom had social anxiety disorder, examined whether emotion regulation can be a transdiagnostic measure. Results showed that effectual regulation in the context of negative stimuli consisted of engagement of the Prefrontal Cortex (PFC) along with reduced amygdala reactivity, and greater symptom severity correlated with less engagement of the Dorsal Anterior Cingulate Cortex (DACC) and less functional connectivity between the amygdala and ventrolateral prefrontal cortex. 
Cognitive theories helpful in the understanding of the etiology of social phobia include the “Clark and Wells cognitive model of social phobia,” which hypothesizes that self-focused attention, negative observer-perspective images of oneself, and safety behaviors maintain anxiety in subjects with social phobia and that this anxiety associates with observer-perspective imagery and safety-seeking behavior in adolescence; however, even though adolescents with clinical social phobia may report frequent negative self-focused thoughts, this may not be a clear associated symptom. However, such negative cognitions focused on self do not associate to self-reported social anxiety. 
Theories have also arisen looking at the efficacy of pharmacologic agents used to treat social phobia. Thus, serotonergic functioning might be involved, as serotonergic reuptake inhibitors help alleviate symptoms. Similarly, some researchers believe in an adrenergic etiology because of the success of propranolol therapy. Neurocircuitry involving the amygdala, a structure involved in fear, may be involved, as studies have found an exaggerated reactivity of the amygdala to aversive social stimuli in social anxiety. [7, 8]
Implications for treatment include the importance of not advancing treatment too quickly and triggering severe anxiety and early cessation of treatment; to enhance the ability to tolerate low levels of anxiety, the presence of a caregivier who is able to model adaptive functioning is desirable as an initial approach. 
Very low weight (600–1250 g) premature babies may also be at higher risk for later development of social anxiety disorder, possibly owing to abnormalities in the uncinate fasciculus, the major white matter tract connecting the frontal cortex to the amygdala, and other limbic temporal regions. 
One multisite study looked at whether treatment response was associated with specific genetic loci. Although treatment response was not assoicated with specific genetic loci, FKBP5, GR polymorphisms, or pretreatment percentage DNA methylation, the change in FKBP5 DNA methylation was nominally associated with treatment response as persons who demonstrated the greatest reduction in severity decreased in percentage DNA methylation during treatment compared with persons with one or more FKBP5 risk alleles who had little or no decrease or an increase in percentage of DNA methylation and did not show robust treatment response. 
In the United States, 9% of youth experience social phobia at some point in their lifetime—a slightly lower rate than the 12.1% rate observed among US adults in the National Comorbidity Survey (NCS)-Replication study. This social phobia was associated with marked levels of impairment and persistence. However, adolescents did not have significant associations, when compared with adults, between social phobia and mood or alcohol use disorders, after controlling for comorbid disorders; this suggests these relationships may be due, in part, to other psychopathology.
The US NCS-Adolescent Supplement is the first study of social phobia in adolescents with a large community-based sample and was done from 2001–2004.  This study of 10,123 adolescents aged 13–18 years in the continental United States had a very good overall response rate of 83.3% of parents/parental surrogates, who responded to a self-administered questionnaire. Additional scales of excellent quality were used, such as the modified version of the World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0 and the Sheehan Disability Scale, to determine the impact of the disorder on the adolescents’ general functioning.
The study used the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5) criteria for social phobia and found no sex differences in incidence; data were statistically very reliable (P = .001-.01) that 4.8% of all adolescents, representing more than half (55.8%) of all adolescents with social phobia, had fear of most social situations — generalized social phobia (7 or more of the 12 types of social fears)—as follows:
Meeting new people their own age
Talking to people in authority (eg, coaches, other adults they do not know very well)
Being with a group of people their own age (eg, at a party, in the lunchroom at school)
Going into a room that already has people in it
Talking with people they do not know very well
Going out with/dating someone they are interested in
Any other situation in which they could be the center of attention or something embarrassing might happen (eg, working/doing homework while someone watches; writing/eating/drinking while someone watches; speaking in class when a teacher asks a question/when a teacher calls on them; acting/performing/giving a talk in front of a group of people; taking an important test/examination or interviewing for a job, although they are well prepared)
A smaller percentage (3.8%) of all adolescents, representing 44.2% of all those adolescents with social phobia, had nongeneralized type of social phobia—fewer than 7 types of fears.
A very much smaller percentage of all adolescents (0.7%) had performance social phobia, representing only 0.8% of all adolescents with social phobia. This is perhaps due to the fact that public speaking and performance fears may only become clinically significant with the greater opportunity for avoidance that characterizes adulthood, as youth are required, because of school, to participate in such situations. Thus, they have more occasions for exposure resulting in performance anxiety, habituation, and lower prevalence rates than occur in adults, who are able to avoid such situations.
Disability from social phobia of the generalized type was moderate to severe and highly persistent; 87.03% of adolescents experienced at least 7 fears for 4 days of the previous calendar year, and there was a high comorbidity with social phobia. About one third to one fifth of adolescents with generalized social phobia had another disorder, most often anxiety due to agoraphobia (27%), followed by panic disorder (20.5%), separation anxiety disorder (18.1%), posttraumatic stress disorder (17.1%), and specific phobia (12.8%).
Lifetime incidence of comorbid oppositional defiant disorder occurred in a significant number of adolescents, more so in those with generalized social phobia (12.5% compared with adolescents who had the nongeneralized type of social phobia). That group had lower rates of comorbid disorders, and there was a statistically significant rate (P = .05) of significant comorbid drug-use disorders in 13% of those with generalized social phobia, as compared with only 7.2% of those with nongeneralized social phobia.
A unique pattern was found — an association between generalized social phobia with agoraphobia and panic disorder. Nongeneralized social phobia had an association with posttraumatic stress disorder and a unique negative association with alcohol use disorders. Although overall 18.6% of adolescents with social phobia presented with a lifetime mood disorder, adjusted odds ratios indicated that these associations were primarily due to other anxiety or behavior disorder.
Social phobia often goes undiagnosed in patients with other coexisting acute psychiatric conditions such as depression or suicidality but should not be overlooked, as it can contribute to a lack of symptom remission. In some situations, social phobia may be the root cause of depressive or suicidal symptoms. [4, 13]
Social phobia is often comorbid with other anxiety disorders; in one study, 60% of children with social phobia had another disorder (generally an anxiety disorder); 10% had generalized anxiety disorder, attention deficit/hyperactivity disorder (ADHD), or specific phobia. In other studies, children with social phobia were found to have comorbid separation anxiety disorder (in younger children), as well as selective mutism. Social phobia often leads to extreme social isolation in children and can be accompanied by selective mutism and/or can be a precursor to depression.
Intermitten explosive disorder (IED) can co-occur with social phobia. Data from the National Comorbidity Survey Replication and Adolescent Supplement Study indicated lifetime presence of an anxiety disorder increased the rate of IED by almost 3-fold (7.8% in adolescents without anxiety compared with 22.9% in adolescents with anxiety). 
In adults with social phobia, academic and occupational functioning may be affected; often, people with social phobia have significant trouble forming relationships with others. 
Social phobia can also be comorbid with autistic spectrum disorder. Longstanding social phobia increases the lifetime risk of depression later in adulthood, potentially leading to an increased risk of substance abuse, including alcoholism. This thereby confers a higher risk for cardiovascular morbidity and mortality. [15, 3, 16, 17]
A severe form of social phobia and avoidant personality disorder, Hikikomori has been associated with adverse cardiovascular consequences including hypertension and has been found in many cultures, not exclusively in Japan but also found in Hong Kong, China, India, South Korea, Spain and the United States. 
Social phobia occurs in many cultures. Persons of Asian descent in North America may not receive treatment as early in the course of the disorder as persons of European descent. In addition, persons of Asian descent have significant cultural differences involving emotional responses in social interactions compared with persons of other cultures. [19, 20]
In the general population, more females than males develop social phobia, with a female-to-male ratio of 1.5–2:1; however, in clinical samples, cases involving males are more prevalent. The reasons for this prevalence are unknown. 
Social phobia typically manifests in middle childhood, at approximately age 10 years. Adolescents (aged 11–12 y) with social phobia may avoid age-appropriate social activities, such as attending parties and dating. Symptoms of social phobia in younger children include crying, temper tantrums, fidgeting, somatic complaints, and avoidance and withdrawal from social situations. Untreated childhood social phobia typically continues into adulthood. [1, 15]
A recent study suggests that interpersonal stressors, including the particularly detrimental stressors of peer victimization and familial emotional maltreatment, may predict the later development of social anxiety symptoms in adolescents who have more immediate depressogenic reactions after stress. 
Mild social phobia is associated with a good prognosis and may have a benign course. Severe avoidance behavior and substance abuse are often associated witha guarded prognosis.
Symptoms of social phobia in younger children include crying, temper tantrums, fidgeting, somatic complaints, and avoidance and withdrawal from social situations.  The median delay from onset to seeking treatment can be as long as 28 years.  Untreated childhood social phobia typically continues into adulthood and thus can potentially cause significant duration of impairment and interfere with normal development. 
A severe form of social phobia and avoidant personality disorder, Hikikomori has been associated with adverse cardiovascular consequences including hypertension and has been found in many cultures, not exclusively in Japan but also found in Hong Kong, China, India, South Korea, Spain, and the United States. 
Recent naturalistic research looked at functional MRI activity in anxious children and adolescents who requested that their caregiver accompany them in the scanner room compared with those without their caregiver present. Results indicate that activity in the hypothalamus, ventromedial, and ventrolateral prefrontal cortex were significantly reduced in anxious children and adolescents who requested that their caregiver accompany them in the scanner room compared to those without their caregiver present. Mean activity in these regions in anxious children and adolescents with their caregiver in the scanner room was comparable to that of healthy controls. This suggests links between social contact and neural mechanisms of emotional reactivity, and that the presence of caregivers may lessen the increase in anxiety associated with stressful stimuli. 
Approaches to prevention of social phobia in school children include universal emotional health interventions using computer programs such as FRIENDS or Coping Cat to decrease anxiety symptoms and to improve self-eseteem, which may be helpful as long as the interventions specifically target social phobia. [23, 24, 25, 26, 27, 28]
The folllowing organizations may prove beneficial to patients and their families:
Patient and family education are important for helping resolve symptoms and preventing relapses. Family support may be helpful in behavioral desensitization techniques and in decreasing the social isolation of the patient. Patients and families should be educated regarding the nature, prognosis, and treatment of the disorder.
Beidel DC. Social anxiety disorder: etiology and early clinical presentation. J Clin Psychiatry. 1998. 59 Suppl 17:27-32. [Medline].
Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan. 51(1):8-19. [Medline].
Heimberg RG, Stein MB, Hiripi E, Kessler RC. Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades. Eur Psychiatry. 2000 Feb. 15(1):29-37. [Medline].
Wiltink J, Haselbacher A, Knebel A, Tschan R, Zwerenz R, Michal M, et al. Social Phobia – An Anxiety Disorder Underdiagnosed in Outpatient and Consultation-Liaison Service?. Psychother Psychosom Med Psychol. 2009 May 18. [Medline].
Fitzgerald JM, Klumpp H, Langenecker S, Phan KL. Transdiagnostic neural correlates of volitional emotion regulation in anxiety and depression. Depress Anxiety. 2018 Nov 8. [Medline].
Ranta K, Tuomisto MT, Kaltiala-Heino R, Rantanen P, Marttunen M. Cognition, Imagery and Coping among Adolescents with Social Anxiety and Phobia: Testing the Clark and Wells Model in the Population. Clin Psychol Psychother. 2013 Jan 24. [Medline].
Phan KL, Orlichenko A, Boyd E, Angstadt M, Coccaro EF, Liberzon I, et al. Preliminary evidence of white matter abnormality in the uncinate fasciculus in generalized social anxiety disorder. Biol Psychiatry. 2009 Oct 1. 66(7):691-4. [Medline]. [Full Text].
Stein MB. Neurobiological perspectives on social phobia: from affiliation to zoology. Biol Psychiatry. 1998 Dec 15. 44(12):1277-85. [Medline].
Conner OL, Siegle GJ, McFarland AM, et al. Mom-it helps when you’re right here! Attenuation of neural stress markers in anxious youths whose caregivers are present during fMRI. PLoS One. 2012. 7(12):e50680. [Medline]. [Full Text].
Constable RT, Ment LR, Vohr BR, Kesler SR, Fulbright RK, Lacadie C, et al. Prematurely born children demonstrate white matter microstructural differences at 12 years of age, relative to term control subjects: an investigation of group and gender effects. Pediatrics. 2008 Feb. 121(2):306-16. [Medline].
Roberts S, Keers R, Lester KJ, Coleman JR, Breen G,et al. HPA AXIS RELATED GENES AND RESPONSE TO PSYCHOLOGICAL THERAPIES: GENETICS AND EPIGENETICS. Depress Anxiety. 2015 Dec. 32 (12):861-70. [Medline].
Burstein M, He JP, Kattan G, Albano AM, Avenevoli S, Merikangas KR. Social phobia and subtypes in the national comorbidity survey-adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry. 2011 Sep. 50(9):870-80. [Medline]. [Full Text].
Pöhlmann K, Döbbel S, Löffler S, Israel M, Joraschky P. [Social phobia – the blind spot: infrequently diagnosed, highly complex, and a predictor for unfavourable therapy outcomes?]. Z Psychosom Med Psychother. 2009. 55(2):180-8. [Medline].
Keyes KM, McLaughlin KA, Vo T, Galbraith T, Heimberg RG. ANXIOUS AND AGGRESSIVE: THE CO-OCCURRENCE OF IED WITH ANXIETY DISORDERS. Depress Anxiety. 2015 Sep 30. [Medline].
Fichter MM, Kohlboeck G, Quadflieg N, Wyschkon A, Esser G. From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community. Soc Psychiatry Psychiatr Epidemiol. 2009 Sep. 44(9):792-803. [Medline].
Kuusikko S, Pollock-Wurman R, Jussila K, Carter AS, Mattila ML, Ebeling H, et al. Social anxiety in high-functioning children and adolescents with Autism and Asperger syndrome. J Autism Dev Disord. 2008 Oct. 38(9):1697-709. [Medline].
Weinstock LS. Gender differences in the presentation and management of social anxiety disorder. J Clin Psychiatry. 1999. 60 Suppl 9:9-13. [Medline].
Yuen JWM, Yan YKY, Wong VCW, Tam WWS, So KW, Chien WT. A Physical Health Profile of Youths Living with a “Hikikomori” Lifestyle. Int J Environ Res Public Health. 2018 Feb 11. 15 (2):[Medline].
Lau AS, Fung J, Wang SW, Kang SM. Explaining elevated social anxiety among Asian Americans: emotional attunement and a cultural double bind. Cultur Divers Ethnic Minor Psychol. 2009 Jan. 15(1):77-85. [Medline].
Hsu L, Alden LE. Cultural influences on willingness to seek treatment for social anxiety in Chinese- and European-heritage students. Cultur Divers Ethnic Minor Psychol. 2008 Jul. 14(3):215-23. [Medline].
Guntheroth W. Link among mitral valve prolapse, anxiety disorders, and inheritance. Am J Cardiol. 2007 May 1. 99(9):1350. [Medline].
Hamilton JL, Potter CM, Olino TM, Abramson LY, Heimberg RG, Alloy LB. The Temporal Sequence of Social Anxiety and Depressive Symptoms Following Interpersonal Stressors During Adolescence. J Abnorm Child Psychol. 2015 Jul 5. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Text Revision. 4th ed. Washington, DC: American Psychiatric Association; 2000.
Amir N, Beard C, Burns M, Bomyea J. Attention modification program in individuals with generalized anxiety disorder. J Abnorm Psychol. 2009 Feb. 118(1):28-33. [Medline].
Suveg C, Hudson JL, Brewer G, Flannery-Schroeder E, Gosch E, Kendall PC. Cognitive-behavioral therapy for anxiety-disordered youth: secondary outcomes from a randomized clinical trial evaluating child and family modalities. J Anxiety Disord. 2009 Apr. 23(3):341-9. [Medline].
Titov N, Andrews G, Johnston L, Schwencke G, Choi I. Shyness programme: longer term benefits, cost-effectiveness, and acceptability. Aust N Z J Psychiatry. 2009 Jan. 43(1):36-44. [Medline].
Suveg C, Sood E, Comer JS, Kendall PC. Changes in emotion regulation following cognitive-behavioral therapy for anxious youth. J Clin Child Adolesc Psychol. 2009 May. 38(3):390-401. [Medline].
Berger T, Hohl E, Caspar F. Internet-based treatment for social phobia: a randomized controlled trial. J Clin Psychol. 2009 Oct. 65(10):1021-35. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.
Letamendi AM, Chavira DA, Hitchcock CA, Roesch SC, Shipon-Blum E, Stein MB. Selective Mutism Questionnaire: Measurement Structure and Validity. J Am Acad Child Adolesc Psychiatry. 2008 Aug 8. [Medline].
Mazeh D, Bodner E, Weizman R, Delayahu Y, Cholostoy A, Martin T, et al. Co-morbid social phobia in schizophrenia. Int J Soc Psychiatry. 2009 May. 55(3):198-202. [Medline].
Pisano S, Catone G, Pascotto A, Iuliano R, Tiano C, Milone A, et al. Paranoid Thoughts in Adolescents with Social Anxiety Disorder. Child Psychiatry Hum Dev. 2015 Dec 10. [Medline].
Evans KC, Wright CI, Wedig MM, Gold AL, Pollack MH, Rauch SL. A functional MRI study of amygdala responses to angry schematic faces in social anxiety disorder. Depress Anxiety. 2008. 25(6):496-505. [Medline].
Stein MB, Goldin PR, Sareen J, Zorrilla LT, Brown GG. Increased amygdala activation to angry and contemptuous faces in generalized social phobia. Arch Gen Psychiatry. 2002 Nov. 59(11):1027-34. [Medline].
Maeda F, Nathan JH. Understanding taijin kyofusho through its treatment, Morita therapy. J Psychosom Res. 1999 Jun. 46(6):525-30. [Medline].
Wong QJJ, Chen J, Gregory B, Baillie AJ, Nagata T, Furukawa TA, et al. Measurement equivalence of the Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) across individuals with social anxiety disorder from Japanese and Australian sociocultural contexts. J Affect Disord. 2019 Jan 15. 243:165-174. [Medline].
Hayakawa K, Kato TA, Watabe M, Teo AR, Horikawa H, Kuwano N, et al. Blood biomarkers of Hikikomori, a severe social withdrawal syndrome. Sci Rep. 2018 Feb 13. 8 (1):2884. [Medline].
van Peer JM, Spinhoven P, van Dijk JG, Roelofs K. Cortisol-induced enhancement of emotional face processing in social phobia depends on symptom severity and motivational context. Biol Psychol. 2009 May. 81(2):123-30. [Medline].
Walter D, Hautmann C, Rizk S, et al. Short term effects of inpatient cognitive behavioral treatment of adolescents with anxious-depressed school absenteeism: an observational study. Eur Child Adolesc Psychiatry. 2010 Nov. 19(11):835-44. [Medline].
Farrell LJ, Waters AM, Oar EL, Tiralongo E, Garbharran V, Alston-Knox C, et al. D-cycloserine-augmented one-session treatment of specific phobias in children and adolescents. Brain Behav. 2018 Jun. 8 (6):e00984. [Medline].
Blair K, Shaywitz J, Smith BW, Rhodes R, Geraci M, Jones M, et al. Response to emotional expressions in generalized social phobia and generalized anxiety disorder: evidence for separate disorders. Am J Psychiatry. 2008 Sep. 165(9):1193-202. [Medline].
Duval ER, Javanbakht A, Liberzon I. Neural circuits in anxiety and stress disorders: a focused review. Ther Clin Risk Manag. 2015. 11:115-26. [Medline].
Hauser TU, Iannaccone R, Walitza S, Brandeis D, Brem S. Cognitive flexibility in adolescence: neural and behavioral mechanisms of reward prediction error processing in adaptive decision making during development. Neuroimage. 2015 Jan 1. 104:347-54. [Medline].
Wright BD, Cooper C, Scott AJ, Tindall L, Ali S, Bee P, et al. Clinical and cost-effectiveness of one-session treatment (OST) versus multisession cognitive-behavioural therapy (CBT) for specific phobias in children: protocol for a non-inferiority randomised controlled trial. BMJ Open. 2018 Aug 17. 8 (8):e025031. [Medline].
Miller G. Society for Neuroscience meeting. Pills and games help conquer fear. Science. 2003 Nov 21. 302(5649):1321. [Medline].
Victor AM, Bernstein GA. Anxiety disorders and posttraumatic stress disorder update. Psychiatr Clin North Am. 2009 Mar. 32(1):57-69. [Medline].
Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us?. J Clin Psychiatry. 2006. 67 Suppl 12:20-6. [Medline].
Katzelnick DJ, Kobak KA, Greist JH, et al. Sertraline for social phobia: a double-blind, placebo-controlled crossover study. Am J Psychiatry. 1995 Sep. 152(9):1368-71. [Medline].
Pande AC, Davidson JR, Jefferson JW, et al. Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol. 1999 Aug. 19(4):341-8. [Medline].
Guastella AJ, Richardson R, Lovibond PF, Rapee RM, Gaston JE, Mitchell P, et al. A randomized controlled trial of D-cycloserine enhancement of exposure therapy for social anxiety disorder. Biol Psychiatry. 2008 Mar 15. 63(6):544-9. [Medline].
Rapee RM, Gaston JE, Abbott MJ. Testing the efficacy of theoretically derived improvements in the treatment of social phobia. J Consult Clin Psychol. 2009 Apr. 77(2):317-27. [Medline].
Stangier U, Schramm E, Heidenreich T, Berger M, Clark DM. Cognitive Therapy vs Interpersonal Psychotherapy in Social Anxiety Disorder: A Randomized Controlled Trial. Arch Gen Psychiatry. 2011 Jul. 68(7):692-700. [Medline].
James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2015 Feb 18. 2:CD004690. [Medline].
Maric M, Heyne DA, de Heus P, van Widenfelt BM, Westenberg PM. The Role of Cognition in School Refusal: An Investigation of Automatic Thoughts and Cognitive Errors. Behav Cogn Psychother. 2011 Jun 29. 1-15. [Medline].
Heyne D, Sauter FM, Van Widenfelt BM, Vermeiren R, Westenberg PM. School refusal and anxiety in adolescence: Non-randomized trial of a developmentally sensitive cognitive behavioral therapy. J Anxiety Disord. 2011 Apr 28. [Medline].
Knijnik DZ, Salum GA Jr, Blanco C, Moraes C, Hauck S, Mombach CK, et al. Defense style changes with the addition of psychodynamic group therapy to clonazepam in social anxiety disorder. J Nerv Ment Dis. 2009 Jul. 197(7):547-51. [Medline].
Midgley N. Re-reading “Little Hans”: Freud’s case study and the question of competing paradigms in psychoanalysis. J Am Psychoanal Assoc. 2006 Spring. 54(2):537-59. [Medline].
Mörtberg E, Andersson G. Predictors of response to individual and group cognitive behaviour therapy of social phobia. Psychol Psychother. 2013 Jan 18. [Medline].
Hudson JL, Keers R, Roberts S, Coleman JR, Breen G, et al. Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study. J Am Acad Child Adolesc Psychiatry. 2015 Jun. 54 (6):454-63. [Medline].
Bechor M, Pettit JW, Silverman WK, Bar-Haim Y, Abend R, Pine DS, et al. Attention Bias Modification Treatment for children with anxiety disorders who do not respond to cognitive behavioral therapy: a case series. J Anxiety Disord. 2014 Mar. 28 (2):154-9. [Medline].
Shechner T, Rimon-Chakir A, Britton JC, Lotan D, Apter A, Bliese PD, et al. Attention bias modification treatment augmenting effects on cognitive behavioral therapy in children with anxiety: randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2014 Jan. 53 (1):61-71. [Medline].
Klein AM, Rapee RM, Hudson JL, Schniering CA, Wuthrich VM, Kangas M, et al. Interpretation modification training reduces social anxiety in clinically anxious children. Behav Res Ther. 2015 Dec. 75:78-84. [Medline].
Fu X, Du Y, Au S, Lau JY. Reducing negative interpretations in adolescents with anxiety disorders: a preliminary study investigating the effects of a single session of cognitive bias modification training. Dev Cogn Neurosci. 2013 Apr. 4:29-37. [Medline].
Reuland MM, Teachman BA. Interpretation bias modification for youth and their parents: a novel treatment for early adolescent social anxiety. J Anxiety Disord. 2014 Dec. 28 (8):851-64. [Medline].
Costa VA, Haimowitz R, Cheng YI, Wang J, Silverman RA, Bauman NM. Social Impact of Facial Infantile Hemangiomas in Preteen Children. JAMA Otolaryngol Head Neck Surg. 2015 Nov 19. 1-7. [Medline].
Bögels SM, Alden L, Beidel DC, et al. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety. 2010 Feb. 27(2):168-89. [Medline].
Altamura AC, Pioli R, Vitto M, Mannu P. Venlafaxine in social phobia: a study in selective serotonin reuptake inhibitor non-responders. Int Clin Psychopharmacol. 1999 Jul. 14(4):239-45. [Medline].
Bailey JE, Papadopoulos A, Lingford-Hughes A, Nutt DJ. D-Cycloserine and performance under different states of anxiety in healthy volunteers. Psychopharmacology (Berl). 2007 Sep. 193(4):579-85. [Medline].
Connor KM, Davidson JR, Potts NL, et al. Discontinuation of clonazepam in the treatment of social phobia. J Clin Psychopharmacol. 1998 Oct. 18(5):373-8. [Medline].
Hofmann SG, Pollack MH, Otto MW. Augmentation treatment of psychotherapy for anxiety disorders with D-cycloserine. CNS Drug Rev. 2006 Fall-Winter. 12(3-4):208-17. [Medline].
Nutt DJ, Bell CJ, Malizia AL. Brain mechanisms of social anxiety disorder. J Clin Psychiatry. 1998. 59 Suppl 17:4-11. [Medline].
Schmidt NB, Richey JA, Buckner JD, Timpano KR. Attention training for generalized social anxiety disorder. J Abnorm Psychol. 2009 Feb. 118(1):5-14. [Medline].
Stallard P, Simpson N, Anderson S, Goddard M. The FRIENDS emotional health prevention programme: 12 month follow-up of a universal UK school based trial. Eur Child Adolesc Psychiatry. 2008 Aug. 17(5):283-9. [Medline].
Stein DJ, Westenberg HG, Yang H, et al. Fluvoxamine CR in the long-term treatment of social anxiety disorder: the 12- to 24-week extension phase of a multicentre, randomized, placebo-controlled trial. Int J Neuropsychopharmacol. 2003 Dec. 6(4):317-23. [Medline].
Stein MB, Chavira DA. Subtypes of social phobia and comorbidity with depression and other anxiety disorders. J Affect Disord. 1998 Sep. 50 Suppl 1:S11-6. [Medline].
Stein MB, Liebowitz MR, Lydiard RB, et al. Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. JAMA. 1998 Aug 26. 280(8):708-13. [Medline].
Velosa JF, Riddle MA. Pharmacologic treatment of anxiety disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2000 Jan. 9(1):119-33. [Medline].
Weeks JW, Heimberg RG, Fresco DM, Hart TA, Turk CL, Schneier FR, et al. Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychol Assess. 2005 Jun. 17(2):179-90. [Medline].
Westenberg HG. The nature of social anxiety disorder. J Clin Psychiatry. 1998. 59 Suppl 17:20-6. [Medline].
White M, Dorman SM. Receiving social support online: implications for health education. Health Educ Res. 2001 Dec. 16(6):693-707. [Medline].
Zaider TI, Heimberg RG. Non-pharmacologic treatments for social anxiety disorder. Acta Psychiatr Scand Suppl. 2003. 72-84. [Medline].
Nagata T, Nakajima T, Teo AR, Yamada H, Yoshimura C. Psychometric properties of the Japanese version of the Social Phobia Inventory. Psychiatry Clin Neurosci. 2013 Apr. 67 (3):160-6. [Medline].
Bettina E Bernstein, DO Distinguished Fellow, American Academy of Child and Adolescent Psychiatry; Distinguished Fellow, American Psychiatric Association; Clinical Assistant Professor of Neurosciences and Psychiatry, Philadelphia College of Osteopathic Medicine; Clinical Affiliate Medical Staff, Department of Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia; Consultant to theVillage, Private Practice; Consultant PMHCC/CBH at Family Court, Philadelphia
Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility
Disclosure: Nothing to disclose.
Mohammed A Memon, MD Psychiatrist/Geriatric Psychiatrist, Carolina Center for Behavioral Health; Assistant Professor of Psychiatry, Virginia Commonwealth University School of Medicine
Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association
Disclosure: Nothing to disclose.
The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Kiki D Chang, MD, to the development and writing of this article.