Psychoanalysis for Social Anxiety Disorder

Overview of Psychoanalysis for Social Anxiety Disorder

Image of Sigmund Freud
Sigmund Freud was the founder of psychoanalysis. Getty / Imagno

Psychoanalysis for social anxiety disorder (SAD) is based on psychodynamic theory, which was originally attributed to Sigmund Freud. There is no complete psychodynamic model of SAD, because the 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 SAD

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 SAD

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 SAD. 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

Not much research has been conducted on the effectiveness of psychoanalytic therapy for SAD.

However, in one multicenter randomized controlled trial1, 495 patients with SAD were randomly assigned to receive either 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 showed that CBT and psychodynamic therapy were better than being on a wait list to receive treatment both in terms of response and remission. However, CBT was superior to psychodynamic therapy when it came to remission.

Putting It All Together

Based on current research evidence, psychodynamic therapy may be as good as CBT when it comes to immediate response to treatment. However, in the long-term, you are better off receiving CBT.


1. 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.

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

3. Starjevic V. Anxiety disorders in adults: A clinical guide. New York: Oxford University Press;2005.

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