Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .
Prevention of relapse in generalized social phobia: results of a 24-week study in responders to 20 weeks of sertraline treatment.
The aim of this study was to evaluate the efficacy , tolerability , and effects on quality of life of sertraline , a selective serotonin reuptake inhibitor , in the prevention of relapse of generalized social phobia .  Fifty adult out patients with generalized social phobia who were rated much or very much improved on the Clinical Global Impression Scale of Improvement ( CGI-I ) after 20 weeks of sertraline treatment ( 50 - 200 mg/day ) were r and omly assigned in a one-to-one ratio to either continue double-blind treatment with sertraline or immediately switch to placebo for another 24 weeks . The initial 20-week study was placebo-controlled , and 15 responders to placebo also continued to receive double-blind placebo treatment in the continuation study . Eighty-eight percent of patients in the sertraline-continuation group and only 40 % of patients in the placebo-switch and placebo-responder groups completed the study . In intent-to-treat endpoint analyses , 1 ( 4 % ) of 25 patients in the sertraline-continuation group and 9 ( 36 % ) of 25 patients in the placebo-switch group had relapsed at study endpoint ( chi2 = 8.0 , Fisher exact test , p = 0.01 ) . The relative risk ( hazards ratio ) for relapse associated with placebo-switch relative to sertraline-continuation treatment was 10.2 ( 95 % confidence interval , 1.3 - 80.7 ) . Mean CGI-Severity , Marks Fear Question naire ( MFQ ) Social Phobia subscale , and Duke Brief Social Phobia Scale ( BSPS ) total scores were reduced by 0.07 , 0.34 , and 1.86 in the Sertraline-Continuation group and increased by 0.88 , 4.09 , and 5.99 in the Placebo-Switch group ( all F > 5.3 , p < 0.03 ) , respectively . CGI-Severity , MFQ Social Phobia subscale , and BSPS scores also increased in the Placebo-Responder group . Discontinuations because of lack of efficacy were 4 % in the sertraline-continuation group , 28 % in the placebo-switch group ( chi2 = 5.36 , Fisher exact test , p = 0.049 ) , relative to sertraline , and 27 % in the placebo-responder group . Sertraline was effective in preventing relapse of generalized social phobia . Future research should assess whether improvements may be maintained or further increased by longer periods of treatment or through the addition of cognitive-behavioral techniques
Cognitive behavior therapy  appears to be more effective than other evidence -based psychological techniques , and its effects appear to be more enduring than those of pharmacotherapy .
There is some evidence , albeit limited to certain drug classes , that the combination of  medication and cognitive behavior therapy may be more effective than either strategy used alone .
This article proposes a number of recommendations for the treatment of  generalized social phobia  , based on a systematic literature review and meta- analysis .
For medications , selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles .
There are other medication classes with demonstrated efficacy in social phobia ( benzodiazepines , antipsychotics , alpha-2-delta lig and s ) , but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines , it is unclear how best to incorporate these drugs into treatment regimens .