Psychoanalysis for Social Anxiety Disorder

Overview of Psychoanalysis for Social Anxiety Disorder

Psychoanalysis is sometimes used to treat SAD.
SAD can sometimes be treated through psychoanalysis. Bruce Ayres / Getty Images

Psychoanalysis for social anxiety disorder (SAD) is based on psychodynamic theory, which was originally attributed to Sigmund Freud.

From a psychodynamic perspective, social anxiety disorder is believed to be part of a larger problem that develops during childhood. Scientists with this perspective view anxiety as a disorder of childhood origin. Therefore, they see your social anxiety as resulting from your early experiences and attachments to your caregivers and other important people in your life.

Psychodynamic Theory of Social Anxiety Disorder

Although there is no comprehensive psychoanalytic theory of SAD, there are several beliefs about the origins of social anxiety from this perspective.

According to psychodynamic theory, your social anxiety may be the result of the following:

  • an expectation of shame and humiliation elicited by critical or harsh parents
  • a conflict between your need to achieve and succeed, and your fear of success
  • a conflict between your need for independence and your fear of rejection or abandonment by your parents
  • your narcissistic fear of being unable to make a perfect impression

Each of these conflicts is believed to result in shame, social withdrawal, insecurity and low self-esteem.

Psychoanalytic Therapy for Social Anxiety Disorder

The goal of psychoanalytic therapy for SAD is to uncover underlying conflicts believed to cause the disorder and work through these issues.

Your psychoanalyst will work with you to determine the unique conflicts and childhood issues that may be linked to your social anxiety.

In addition, your therapist will discuss potential issues that may affect therapy that are unique to social anxiety disorder. For example, you may find yourself expecting that your therapist will judge you negatively.

Or, you may have trouble trusting your therapist.

Relevant Research Findings

In a 2013 multicenter randomized controlled trial, 495 patients with social anxiety disorder were randomly assigned to receive either cognitive-behavioral therapy (CBT), psychodynamic therapy or a wait-list condition. Assessments were conducted at baseline and at the end of treatment using the Liebowitz Social Anxiety Scale among other tests. Response rates for CBT, psychodynamic therapy and the wait-list control were 60%, 52% and 15%, respectively. Remission rates were 36%, 26% and 9%, respectively.

These findings show that CBT and psychodynamic therapy are better than being on a wait list to receive treatment both in terms of response and remission. However, cognitive-behavioral therapy was superior to psychodynamic therapy when it came to remission.

However, in a 2014 study of CBT verus psychodynamic psychotherapy for SAD, both treatments were found to be highly efficacious. In another 2014 study of the long-term outcomes of CBT and psychodynamic therapy for social anxiety disorder, participants were followed for 24 months. Response rates were about 70% for both treatments at 2-year follow-up and remission rates were nearly 40% for both.

In a 2016 multicenter trial of patient characteristics that predict outcomes of psychodynamic psychotherapy for social anxiety disorder, it was found that the most important predictor of treatment outcomes was the level of severity of social anxiety prior to treatment.

These conflicting results indicate the need for further research on the effectiveness of psychodynamic psychotherapy for social anxiety disorder over the long-term.

A Word From Verywell

Based on current research evidence, psychodynamic therapy is likely as good as CBT when it comes to immediate response to treatment. However, over the long-term, cognitive-behavioral therapy may be more effective.

Sources:

Bögels SM, Wijts P, Oort FJ, Sallaerts SJM. Psychodynamic psychotherapy versus cognitive behavior therapy for social anxiety disorder: an efficacy and partial effectiveness trial. Depress Anxiety. 2014;31(5):363-373. doi:10.1002/da.22246.

Leichsenring F, Salzer S, Beutel ME, Herpertz S, Hiller W, Hoyer J et al. Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. American Journal of Psychiatry 2013;170(7):759–767. doi: 10.1176/appi.ajp.2013.12081125.

Leichsenring F, Salzer S, Beutel ME, et al. Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. Am J Psychiatry. 2014;171(10):1074-1082. doi:10.1176/appi.ajp.2014.13111514.

Shedler G. The efficacy of psychodynamic psychotherapyAmerican Psychologist. 2010; 65(2): 98-109.

Wiltink J, Hoyer J, Beutel ME, et al. Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder? PLoS ONE. 2016;11(1):e0147165. doi:10.1371/journal.pone.0147165.

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