Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

General principles of care in mental health and general medical settings

Improving access to services

  • When a person with social anxiety disorder is first offered an appointment, in particular in specialist services, provide clear information in a letter about:

    • where to go on arrival and where they can wait (offer the use of a private waiting area or the option to wait elsewhere, for example outside the service's premises)

    • location of facilities available at the service (for example, the car park and toilets)

    • what will happen and what will not happen during assessment and treatment.

      When the person arrives for the appointment, offer to meet or alert them (for example, by text message) when their appointment is about to begin.

Identification and assessment of adults

Identification of adults with possible social anxiety disorder

  • Ask the identification questions for anxiety disorders in line with recommendation 1.3.1.2 in Common mental health disorders (NICE clinical guideline 123), and if social anxiety disorder is suspected:

    • use the 3-item Mini-Social Phobia Inventory (Mini-SPIN) or

    • consider asking the following 2 questions:

      • Do you find yourself avoiding social situations or activities?

      • Are you fearful or embarrassed in social situations?

        If the person scores 6 or more on the Mini-SPIN, or answers yes to either of the 2 questions above, refer for or conduct a comprehensive assessment for social anxiety disorder (see recommendations 1.2.5–1.2.9).

Interventions for adults with social anxiety disorder

Treatment principles

  • All interventions for adults with social anxiety disorder should be delivered by competent practitioners. Psychological interventions should be based on the relevant treatment manual(s), which should guide the structure and duration of the intervention. Practitioners should consider using competence frameworks developed from the relevant treatment manual(s) and for all interventions should:

    • receive regular, high-quality outcome-informed supervision

    • use routine sessional outcome measures (for example, the Social Phobia Inventory or the Liebowitz Social Anxiety Scale) and ensure that the person with social anxiety is involved in reviewing the efficacy of the treatment

    • engage in monitoring and evaluation of treatment adherence and practitioner competence – for example, by using video and audio tapes, and external audit and scrutiny if appropriate.

Initial treatment options for adults with social anxiety disorder

  • Offer adults with social anxiety disorder individual cognitive behavioural therapy (CBT) that has been specifically developed to treat social anxiety disorder (based on the Clark and Wells model or the Heimberg model; see recommendations 1.3.13 and 1.3.14).

  • For adults who decline CBT and wish to consider another psychological intervention, offer CBT-based supported self-help (see recommendation 1.3.15).

  • For adults who decline cognitive behavioural interventions and express a preference for a pharmacological intervention, discuss their reasons for declining cognitive behavioural interventions and address any concerns.

  • If the person wishes to proceed with a pharmacological intervention, offer a selective serotonin reuptake inhibitor (SSRI) (escitalopram or sertraline). Monitor the person carefully for adverse reactions (see recommendations 1.3.17–1.3.23).

Interventions for children and young people with social anxiety disorder

Treatment for children and young people with social anxiety disorder

  • Offer individual or group CBT focused on social anxiety (see recommendations 1.5.4 and 1.5.5) to children and young people with social anxiety disorder. Consider involving parents or carers to ensure the effective delivery of the intervention, particularly in young children.

  • National Institute for Health and Care Excellence (NICE)