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 .
Duloxetine for the treatment of generalized social anxiety disorder: a preliminary randomized trial of increased dose to optimize response.
OBJECTIVE This is the first trial examining duloxetine for  generalized social anxiety disorder ( GSAD ) and the effect of increased dose for those without early remission . METHODS Individuals ( n=39 ) with GSAD received 6 weeks of open-label duloxetine 60 mg/day ; those with a Liebowitz Social Anxiety Disorder Scale ( LSAS ) score > 30 at week 6 were r and omized in double-blind fashion to an additional 18 weeks of continued duloxetine 60 mg/day or to duloxetine 120 mg/day . RESULTS Duloxetine was associated with a significant LSAS reduction at week 6 ( 91.3 [ 17.7 ] to 69.8 [ 28.5 ] , paired t [df]=5.2 [ 38 ] , P<.0001 ) , and r and omized participants overall continued to improve at week 24 ( 74.6 [ 23.9 ] to 60.3 [ 29.7 ] ; paired t [df]=3.3 [ 27 ] , P=.0026 ) . Though the increased dose strategy was associated with a moderate effect size ( Cohen 's d=.57 ) , there was no significant difference at week 24 endpoint in LSAS reduction ( 20.5 [ 26.0 ] versus 7.3 [ 17.2 ] , t [df]=1.6 [ 26 ] , P=.13 ) nor remission ( 33 % versus 8 % ) for duloxetine with dose increased to 120 mg/day compared to duloxetine continued at 60 mg/day . Overall , 44 % ( 17/39 ) discontinued prior to week 24 . CONCLUSIONS Though with limited power , these data provide preliminary support for the efficacy of duloxetine for GSAD , and suggest continued improvement but limited remission overall at 24 weeks for individuals remaining symptomatic at week 6 . These observations warrant further controlled study
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 .