A meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators

ABSTRACT

Introduction: Social anxiety disorder (SAD) is among the most prevalent mental disorders, associated with impaired functioning and poor quality of life. Pharmacotherapy is the most widely utilized treatment option. The current study provides an updated meta-analytic review of the efficacy of pharmacotherapy and examines moderators and mediators of treatment efficacy.

Areas Covered: A comprehensive search of the current literature yielded 52 randomized, pill placebo-controlled trials of pharmacotherapy for adults diagnosed with SAD. Data on potential mediators of treatment outcome were collected, as well as data necessary to calculate pooled correlation matrices to compute indirect effects.

Expert Opinion: The overall effect size of pharmacotherapy for SAD is small to medium (Hedges’ g = 0.41). Effect sizes were not moderated by age, sex, length of treatment, initial severity, risk of study bias, or publication year. Furthermore, reductions in symptoms mediated pharmacotherapy’s effect on quality of life. Support was found for reverse mediation. Future directions may include sustained efforts to examine treatment mechanisms of pharmacotherapy using rigorous longitudinal methodology to better establish temporal precedence.

KEYWORDS:

• Pharmacotherapy
• social anxiety disorder
• quality of life
• meta-analysis

Article highlights

• This updated meta-analysis provides support that pharmacotherapy is efficacious for SAD (Hedges’ g = 0.45).

• The two classes of pharmacotherapy with the largest numbers of studies supporting their efficacy were SSRIs (Hedge’s g = 1.00) and MAOIs (Hedge’s g = 0.36).

• Pharmacotherapy may enhance quality of life in individuals with SAD (Hedge’s g = 0.28).

• Pharmacotherapy’s effect on quality of life may be mediated through reductions in anxiety symptoms.

This box summarizes key points contained in the article.

Declaration of interest

S G Hofmann receives support from the National Center for Complementary and Integrative Health, National Institute of Mental Health, the James S. McDonnell Fundation 21st Century Science Initiative in Understanding Human Cognition – Special Initiative, and the Department of the Army for work unrelated to the studies reported in this article. He receives compensation for his work as an advisor from the Palo Alto Health Sciences and Otsuka Digital Health, Inc., and for his work as a Subject Matter Expert from John Wiley & Sons, Inc. and SilverCloud Health, Inc. He also receives royalties and payments for his editorial work from various publishers. J Smits reported receiving royalties from various book publishers unrelated to this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. The sponsor (NIH) had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review or approval of the manuscript.

Additional information

Funding

S G Hofmann receives support from NIH/NCCIH (R01AT007257), NIH/NIMH (R01MH099021, R34MH099311, R34MH086668, R21MH102646, R21MH101567, K23MH100259).