How should I approach the initial management of a patient with Social Anxiety Disorder in primary care?

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 ¹.

If the patient does not return after initial assessment, contact them using their preferred method to discuss barriers and facilitate further assessment or treatment ¹.

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 ¹.

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 ¹.

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 ¹.

If the patient declines CBT, supported self-help or pharmacological options such as SSRIs (escitalopram or sertraline) can be discussed, with careful monitoring ¹.