Intended for healthcare professionals

Practice Guidelines

Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance

BMJ 2013; 346 doi: (Published 22 May 2013) Cite this as: BMJ 2013;346:f2541
  1. Stephen Pilling, director, professor123,
  2. Evan Mayo-Wilson, senior research associate123,
  3. Ifigeneia Mavranezouli, senior research fellow in health economics123,
  4. Kayleigh Kew, systematic reviewer4,
  5. Clare Taylor, senior editor5,
  6. David M Clark, professor6
  7. On behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Mental Health, University College London, London WC1E 7HB, UK
  2. 2Centre for Outcomes Research and Effectiveness, University College London, London WC1E 7HB, UK
  3. 3Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, UK
  4. 4Cochrane Airways Group, Population Health Sciences and Education, St George’s, University of London, London SW17 0RE, UK
  5. 5National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA, UK
  6. 6Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK
  1. Correspondence to: S Pilling s.pilling{at}
  • Accepted 16 April 2013

Social anxiety disorder is one of the most persistent and common of the anxiety disorders, with lifetime prevalence rates in Europe of 6.7% (range 3.9-13.7%).1 It often coexists with depression, substance use disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder.2 It can severely impair a person’s daily functioning by impeding the formation of relationships, reducing quality of life, and negatively affecting performance at work or school. Despite this, and the fact that effective treatments exist, only about half of people with this condition seek treatment, many after waiting 10-15 years.3 Although about 40% of those who develop the condition in childhood or adolescence recover before adulthood,4 for many the disorder persists into adulthood, with the chance of spontaneous recovery then limited compared with other mental health problems.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on recognising, assessing, and treating social anxiety disorder in children, young people, and adults.5


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Principles for working with all people with social anxiety disorder

  • When a person is first offered an appointment, provide clear information in a letter about:

    • -Where to go on arrival and where they can wait (offer the use of a private waiting area or the option to wait elsewhere—for example, outside the service’s premises)

    • -Location of facilities available at the service (for example, the car park and toilets)

    • -What will happen and what will not happen during assessment and treatment.

When the person arrives for the appointment, offer to meet them or alert them …

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