Social anxiety disorder (SAD) or social phobia is characterized by excessive fear of social situations and marked by an intense fear of being watched, judged, or humiliated by others in social settings. There may be physical reactions like blushing, sweating, trembling, and a racing heartbeat. Often the person with SAD avoids public places, stays silent in groups, and skips school or work out of fear. The lifetime prevalence of SAD is 4%, but this may be an underestimate. Well-established interventions for SAD are cognitive-behavioural therapy (CBT) and pharmacological treatments with selective serotonin reuptake inhibitors (SSRIs). CBT tends to focus on cognitive restructuring of distorted thoughts or standards and graded exposure to systematically confront feared social situations. However, the response rate for treatment is about 45.3%, and 19.6% drop out of CBT, indicating that a significant proportion of patients do not respond to these interventions. Patients may respond to other interventions if they were offered. Short-term psychodynamic psychotherapy (STPP) seeks to address the underlying mechanisms of the disorder by focusing on unconscious conflicts (clash between desire for praise and fear of rejection or punishment), early relational experiences (past interactions with attachment figures shaping current expectations of oneself and others), and defense mechanisms (displacing distress onto a safe external social situation). STPP helps the patient gain insight into their current social fears linked to past relational wounds and replace avoidant defences by using the therapeutic relationship to model, face, and work through fears. In this meta-analysis, Noren and colleagues provide a comprehensive review of STPP for SAD and assess its effects against control groups and other active treatments. They found 11 studies that met their inclusion criteria. When compared with passive control groups (k = 6), STPP interventions were superior to waitlist conditions on measures of social anxiety, yielding a large effect at treatment termination (g = -0.89; 95% CI: -1.18 to -0.60, p < .001). Comparing STPP with CBT (k = 5) yielded a pooled effect size of g = 0.00 (95% CI: . 0.23 to 0.23, p = .974), indicating no significant differences. Similar findings were reported for other outcomes like depression and treatment dropouts.
Practice Implications
Social anxiety disorder or social phobia is a common problem that has an early onset and affects school and work performance. Some people respond to common treatments like CBT and medications like SSRIs, but many do not respond or drop out. STPPP may offer another option to patients who want relief, and to clinicians and patients who want to focus not only on symptoms (distorted thoughts and avoidance behaviours) but also on understanding the underlying mechanisms that make one vulnerable to these problems (internal conflicts and the effects of early attachment relationships on current fears).
Noren, M., Lindqvist, K., Lilliengren, P., & Mechler, J. (2026). Short-term psychodynamic psychotherapy for social anxiety disorder: A meta-analysis of randomized controlled trials. BMC Psychology, 14, 484. https://doi.org/10.1186/s40359-026-04306-x