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 .
A randomized controlled trial of venlafaxine extended release in generalized social anxiety disorder.
BACKGROUND Generalized social anxiety disorder is a debilitating psychiatric illness characterized by maladaptive thoughts about social situations . This double-blind study evaluated the anxiolytic efficacy , safety , and tolerability of venlafaxine extended release ( ER ) in adult out- patients with generalized social anxiety disorder . METHOD Patients were r and omly assigned to receive 12 weeks of treatment with a flexible dose of venlafaxine ER ( 75 to 225 mg/day ) or placebo . The Liebowitz Social Anxiety Scale ( LSAS ) total score was the primary efficacy variable . Secondary efficacy variables included scores on the Clinical Global Impressions-Severity of Illness ( CGI-S ) and -Improvement ( CGI-I ) scales , Social Phobia Inventory ( SPIN ) , and LSAS subscales . Response was defined as a CGI-I score of 1 or 2 . Two definitions of remission were used : LSAS total score < or = 30 and CGI-I score of 1 . RESULTS Data from 271 patients ( intent-to-treat population ) were analyzed for efficacy ; 279 patients were analyzed for safety . Overall , 173 patients completed the study . Improvement on the LSAS was significantly greater with venlafaxine ER treatment than with placebo at weeks 6 through 12 ( p < .05 , weeks 6 and 8 ; p < .01 , week 10 ; and p < .001 , week 12 ) and at weeks 8 through 12 based on CGI-S and SPIN scores . Week 12 response and remission ( LSAS score < or = 30 ) rates were significantly greater in the venlafaxine ER group than in the placebo group ( response : 44 % vs. 30 % , respectively , p = .018 ; remission : 20 % vs. 7 % , respectively , p < .01 ) . Patients experienced no unexpected or serious adverse events . CONCLUSION Venlafaxine ER is safe , well tolerated , and efficacious in the short-term treatment of generalized social anxiety disorder
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 .