In primary care, the initial management of a patient with social anxiety disorder involves obtaining a detailed description of their current social anxiety, including feared and avoided situations, associated fears, anxiety symptoms, self-view, safety-seeking behaviours, and social focus, as well as their occupational, educational, and social circumstances, and substance use NICE CG159.
If the patient does not return after initial assessment, contact them using their preferred method to discuss barriers and facilitate further assessment or treatment NICE CG159.
It is important to provide information about the disorder, its course, impact, and available evidence-based treatments, and to involve the patient in decision-making about their care NICE CG159.
Assess for comorbid depression and substance misuse, and treat depression if it preceded social anxiety, or consider treating both if they coexist, taking patient preferences into account NICE CG159.
Consider offering psychological interventions such as individual cognitive behavioural therapy (CBT) specifically developed for social anxiety disorder, delivered by competent practitioners, with regular outcome monitoring NICE CG159.
If the patient declines CBT, supported self-help or pharmacological options such as SSRIs (escitalopram or sertraline) can be discussed, with careful monitoring NICE CG159.