Social Anxiety Disorder — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersSocial Anxiety DisorderMRCPsych Paper B

A 45-year-old man has newly diagnosed social anxiety disorder, with marked avoidance of social situations and significant social isolation. He has received no previous treatment and would accept either psychological or pharmacological treatment. According to NICE CG159, which intervention should be offered first?

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Correct answer: B — Individual CBT using a disorder-specific model

NICE recommends offering adults with social anxiety disorder individual CBT specifically developed for the condition, using either the Clark and Wells or Heimberg model. This is therefore the preferred initial intervention when the patient is willing to receive psychological treatment. Sertraline or escitalopram is offered when the person declines cognitive behavioural interventions and prefers medication. Combined CBT and an SSRI is not routinely the initial treatment; it may be considered after a partial response to an adequate course of CBT, or CBT may be added after a partial response to an SSRI. Propranolol may reduce peripheral autonomic symptoms in specific performance situations but is not recommended as treatment for generalised social anxiety disorder. EMDR is primarily used for trauma-related disorders and is not a recommended treatment for social anxiety disorder.

Reference: National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. NICE guideline CG159, recommendations 1.3.2–1.3.12, 2013. https://www.nice.org.uk/guidance/cg159/resources/social-anxietydisorder-recognition-assessment-and-treatmentpdf-35109639699397