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 .
Nefazodone in the treatment of generalized social phobia: a randomized, placebo-controlled trial.
OBJECTIVE Numerous studies have demonstrated the efficacy of serotonergic antidepres-sants , particularly the selective serotonin reuptake inhibitors ( SSRIs ) , in the treatment of social phobia . We evaluated the efficacy , safety , and tolerability of nefazodone , a 5-HT(2 ) antagonist , in patients with generalized social phobia ( GSP ) . METHOD One hundred five patients with GSP ( confirmed using the Structured Clinical Interview for DSM-IV ) from 4 Canadian outpatient anxiety clinics were assigned r and omly to nefazodone ( 300 - 600 mg/day , flexible dose ) or placebo for 14 weeks of double-blind treatment . Data were collected from October 12 , 1999 , through December 8 , 2001 . Primary efficacy outcomes were the Clinical Global Impressions-Improvement scale ( CGI-I ) score and the Liebowitz Social Anxiety Scale score . RESULTS In the intent-to-treat sample , 16 ( 31.4 % ) of 51 subjects taking nefazodone and 12 ( 23.5 % ) of 51 subjects taking placebo were rated as much or very much improved on the CGI-I at endpoint ( chi(2 ) = 0.79 , p = .38 ) . With the exception of the Social Phobia Scale , no significant differences were found in measures of social phobia when comparing the nefazodone and placebo groups . CONCLUSION These findings suggest that nefazodone is not an effective agent in the treatment of GSP . These data parallel some recent findings with the use of the SSRI fluoxetine in GSP . The lack of efficacy of 2 serotonergic antidepressants in GSP suggests that serotonin reuptake inhibition may not be the only mechanism of action required for efficacy to occur in the treatment of GSP
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 .