Prompt diagnosis of social anxiety disorder leads to effective treatment

A prompt diagnosis of social anxiety disorder is crucial in ensuring people access the most clinical and cost effective treatment, according to NICE.

A prompt diagnosis of social anxiety disorder is crucial in ensuring people access the most clinically and cost effective treatment, according to NICE.

Social anxiety disorder, which has been called 'social phobia' in the past, is one of the most common of the anxiety disorders, affecting around one in ten people.

It involves the persistent fear of certain social situations, such as meeting new people, talking in meetings, eating or drinking while being observed, and public performances such as public speaking.

Worries about such situations are common, yet people with social anxiety disorder worry about them excessively, and so try to avoid them. This can have a large impact on their personal lives, their experience in the workplace, and their education.

While a range of effective psychological and pharmacological treatments exist for the disorder, many may not access them, and only half seek treatment. This is partly because the disorder is under-recognised and inadequately assessed, especially in primary care.

In the first clinical guideline on social anxiety disorder, NICE has developed recommendations to help healthcare professionals with diagnosis and the provision of follow-up care.

Due to the nature of the social anxiety disorder, visiting services for treatment can cause dificulties for people with the condition, as one service user describes in an interview with NICE.

As a result, NICE recommends that services should provide clear information to a person with social anxiety disorder on where they should go on arrival and where they can wait, when first getting in contact with them.

Information should include the location of facilities at the service, such as the car park and toilets, and what will not happen during assessment and treatment.

To identify adults with possible social anxiety disorder, healthcare professionals should ask questions in line with the NICE clinical guideline on Common mental health disorders.

If social anxiety is then expected, the 3-item Mini Social Phobia Inventory (Mini-SPIN) should be used, and the person should be asked two questions, namely: 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, a comprehensive assessment social anxiety disorder should be carried out, or the person should be referred for one.

NICE also recommends a range of treatment options for adults with social anxiety disorder.

Cognitive behavioural therapy (CBT) should be offered that has been specifically developed to treat social anxiety disorder. This should be based on the Clark and Wells or the Heimberg model.

Adults who decline CBT and wish to consider another psychological intervention should be offered CBT-based supported help.

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

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Social anxiety disorder isn't about being shy at parties or feeling anxious about a job interview, it's about experiencing a level of anxiety that can disrupt normal life, interfering with social relationships and affecting performance at work or school. In these cases, it is really important that the individual is able to get the right help.

"This guideline includes a number of recommendations to support healthcare professionals to accurately diagnose and manage social anxiety disorder. We hope that the development of NICE guidance in this area will help ensure that those affected by this disorder receive the best possible support."

Nicky Lidbetter, Chief Executive Officer of Anxiety UK, said: "We welcome the development of these guidelines for social anxiety and the recognition that the condition of social anxiety can be extremely disabling for those who experience it.

"The recommendations for the treatment of social anxiety disorder will provide GPs and other health professionals with a clear pathway to provide the help and support needed."

A range of implementation tools have been produced to help put this guideline into practice. These include a costing report and template, a baseline assessment tool and a list of treatment manuals for CBT.