1. What is social anxiety in adults?

Fear of negative evaluation

Social anxiety, also called social phobia, is marked by intense fear in situations where other people may watch, evaluate, or judge you. You may fear looking incompetent, showing signs of nervousness, coming across as unlikeable, or doing something humiliating. Some people avoid these situations. Others endure them in considerable distress. Diagnosis considers how long the fear has lasted, its context, and its impact. It is not simply a matter of counting how often someone blushes. ^[1]

Someone may do well at work and freeze up at lunch with coworkers. Someone else may speak confidently with family and dread a video call. The fact that these difficulties occur in some situations and not others does not make them pretend. Getting through them does not mean the emotional cost is small. An assessment considers what someone manages to do as well as the effort and trade-offs involved. ^[1]

Shyness, introversion, and stage fright are different experiences

These distinctions are for guidance and are not a diagnostic test. The setting matters as much as the person’s internal experience. ^[1,35]

When the problem is limited to speaking or performing in front of an audience, it may be a performance-only presentation. That does not turn ordinary stage fright into an illness or mean that an occasional work presentation and a fear that affects almost every relationship should be treated alike. ^[1]

What can keep the problem going?

One useful model connects anticipation, self-focused attention, perceptions of threat, and protective strategies. Mentally rehearsing every sentence, for example, can make it harder to listen naturally. Avoiding looking around can make it harder to see how the other person actually responds. The relief of canceling plans can reinforce future cancellations. These are possible mechanisms, not a single explanation or a moral failing on the patient’s part. ^[7,8]

A person’s history may involve vulnerability, learning, social experiences, and current circumstances. You do not need to identify a specific trauma before asking for help. Nor is it enough to attribute the problem to a presumed serotonin deficiency. A simple biological explanation cannot, by itself, determine the treatment. ^[1]

What do we know about how common it is?

A World Mental Health Initiative study pooled 28 community surveys with 142,405 participants. Pooled prevalence estimates were 4.0% over a lifetime, 2.4% over 12 months, and 1.3% over 30 days, with differences across countries and settings. The study was published in 2017. It is not a current measurement for Spain or an estimate specific to patients at this practice. ^[3]

Social anxiety often begins before adulthood, but many people seek help later. Living with these difficulties for years does not make them a fixed part of who you are. An assessment should distinguish a personal trait you choose to keep from a limitation you want to change. ^[1]

2. Signs and experiences in adulthood

Before, during, and after an interaction

A tremor or a shaky voice may be the most visible sign. Distress can also begin days before an interaction and continue afterward as you replay what happened. No one else may see how much effort it takes. Asking only whether the person “went to the meeting” leaves out much of the experience. ^[1]

Illustrative examples based on clinical descriptions. Not everyone has every feature. ^[1,7,8]

Avoidance can go unnoticed

Some forms are visible, such as skipping a celebration. Others are more subtle: always letting your partner make a call, responding only in writing, or keeping your attention on your phone to avoid taking part. None of these behaviors is a symptom on its own. What it does for you and what it costs help show whether it is proportionate or keeps a restriction in place. ^[7,11]

Fictional example: a professional spends hours preparing a two-minute contribution. Her first goal may be to prepare what she needs and rest afterward, rather than to “speak more.” Another adult may want to keep a small circle of friends but make a medical appointment without asking someone else to do it. These are different goals, and each deserves its own conversation.

Physical symptoms, appearance, and substance use

Fear that others will notice you blushing can take up more attention than the blushing itself. Even so, new sweating, tremor, or palpitations should not automatically be attributed to anxiety. The circumstances, any treatments, and the medical examination help determine whether further care is needed. ^[1]

When the concern centers on a perceived flaw in appearance, it is worth exploring body dysmorphic disorder too. A cosmetic procedure does not replace that assessment. If alcohol is needed to get through almost every encounter, it makes sense to assess both anxiety and alcohol use without judgment or assuming that one will go away if only the other is treated. ^[1,25]

3. Assessment and diagnosis

Understanding the pattern without testing how likable you are

The interview looks at feared situations, what you expect will happen, physical responses, avoidance, and impact. It also covers mood, sleep, relationships, developmental history, and substance use. You do not have to demonstrate social skills to the clinician. Silence, freezing up, or difficulty making eye contact cannot establish a diagnosis on its own. ^[1,22]

It can help to write down two situations: one you avoid and another you get through at a high cost. For each, briefly explain what you fear, what you do to protect yourself, and what you would like to change. This is a way to organize the conversation, not a validated questionnaire or a request to record every interaction.

The usual duration criterion is that the symptoms persist for at least six months. It should be interpreted alongside clinically significant distress or interference and whether the response is proportionate to the sociocultural context. You do not have to wait six months to seek help, especially if isolation is increasing or other problems arise. ^[1]

Tools that can support the assessment

SPIN and Mini-SPIN come from specific validation studies. Spanish studies have examined the LSAS and measures of disability. They do not validate every translation or automated internet test. Protected items and score cutoffs are not reproduced here for self-diagnosis. ^[4,5,6]

Repeating a measure during treatment can provide information, but it should not turn the appointment into a test. It also matters whether the person can participate more freely, spend less time on exhausting preparation, or stop canceling important activities. These goals are agreed on individually, without comparing how many friends someone has or how often they speak in public with other people.

Differential diagnosis and co-occurring problems

These possibilities are not mutually exclusive. Assessing the context helps avoid attributing all isolation to the same cause. ^{[1,12,22,25,35]}

Testing, privacy, and participation

No blood test can diagnose social phobia. Additional tests should address specific findings, rather than a need to find a biological marker. The assessment also reviews medications, supplements, and substances that may affect symptoms. ^[1]

A partner or family member’s involvement should be agreed on with the adult, subject to applicable safeguarding obligations. It can help clarify everyday situations without taking over the person’s voice. If speaking is difficult, it may help to start with written notes, more specific questions, or an adapted first appointment. The format depends on needs, privacy, and what the service can provide. ^[2,22]

4. Treatment and support

Choosing a goal that matters to you

Treatment aims to ease distress and give you more freedom to act. It does not aim to make you outgoing. A goal might be expressing an opinion, going to a meal you choose, or asking for help without putting it off. It helps to identify what matters, what gets in the way, and how to tell whether things are changing. Preferences, past treatments, access, and co-occurring problems are also considered. ^[1]

NICE recommends individual cognitive behavioral therapy (CBT) developed specifically for social anxietyas the first option, based on the Clark and Wells or Heimberg models. Group therapy can help, but should not be a condition for access or automatically considered preferable. Other options are available if someone does not want individual CBT, and their limitations should be explained. ^[2]

What makes this psychotherapy specific?

It is more than reassurance, positive thinking, or tips for making conversation. Targeted treatments address predictions of rejection, excessive attention to how you appear, protective behaviors, and how you interpret encounters afterward. Behavioral experiments let you compare a prediction with what actually happens, under conditions agreed on together. ^[7,8]

A fictional example: someone predicts that a short pause will make them look incompetent. Therapy can explore what that conclusion means, what evidence supports it, and how to test it without preparing every word. A useful outcome does not have to be a perfect performance. It may be finding that one pause does not determine how the whole conversation goes. The specific exercise depends on the assessment. It is not prescribed on this page.

Some protocols use a recording to compare a mental image with a more balanced observation. This requires an agreed purpose, consent, and privacy safeguards. It does not mean recording other people’s interactions or reviewing videos compulsively. Wild and colleagues report an analysis of participants in the Clark trial and a replication in Hong Kong. The first analysis should not be counted as a separate sample from the trial already cited. ^[8,9]

Exposure is about learning, not enduring humiliation

Exposure involves approaching avoided situations in a planned way and reviewing what you learned. It does not require facing the hardest situation alone or waiting for anxiety to disappear before acting. The plan can gradually adjust strategies that keep you from testing what you can do. You should understand the purpose and be able to say when something is difficult. ^[7,11]

Support needed because of a disability, illness, or language barrier is not automatically a “safety behavior” to remove. Exposure to actual harassment is not therapeutic either. An autistic person may need concrete instructions, advance notice, and sensory accommodations. The goal is not to make the person appear neurotypical. ^[22,35]

What some relevant trials found

^{[7,9,10,11,12,13]}. Trials differ in participant selection, comparison groups, and follow-up. Their figures cannot be added together to predict an individual’s results.

ACT works on how people relate to their thoughts and emotions and how they act in line with personal values. The psychodynamic psychotherapy studied was also structured, not simply any supportive conversation. These approaches can be considered based on preferences and clinical formulation. The level of evidence and priority in guidelines are not identical for every approach. ^[2,11,12]

Online care and digital tools

Digital treatment research distinguishes therapy with targeted material, practice, and follow-up from a generic wellness app. In Clark’s trial, online therapy did not differ significantly from in-person treatment on the primary outcome, although in-person treatment had a small advantage on a behavioral test. That does not establish equivalence for every patient or format. ^[9]

The 2026 trial found a dropout rate of 42.6% without guidance and 15% with support, which included eight video sessions. It was funded by the manufacturer and involved an individual affiliated with the company. It is a relevant update, not a commercial recommendation or confirmation that the app is part of this practice’s services. ^[10]

When considering online care, it is worth reviewing privacy, the ability to practice between sessions, safety, and any need for coordination. The format may make it easier to make first contact, but the goals should still relate to situations that matter in everyday life.

Medication: individual decisions and follow-up

Medication may be considered based on preferences, severity, co-occurring conditions, access, or an insufficient response. It is not required to start therapy and need not be reserved for a complete lack of response. Blomhoff’s trial of 387 primary care participants supports the effectiveness of sertraline. It does not show that any combination with exposure is better than medication alone. ^[2,37]

Information from prescribing documents, not a personal treatment plan. No doses, as-needed instructions, or tapering schedules are provided. ^{[15,16,17,18,19,20]}

Propranolol is not risk-free before a public appearance. Sumial is contraindicated in, among other situations, people with a history of asthma or bronchospasm, a slow heart rate, or low blood pressure. Controlling a tremor also does not show that fear of judgment or avoidance has decreased. Do not try someone else’s medication before a meeting. ^[19]

Benzodiazepines are not recommended as routine treatment for social anxiety. Sedation, dependence, and difficulty stopping them should be considered. Mixing them with alcohol adds risks. Immediate relief is different from a lasting gain in independence. ^[2,21,25]

Reviewing improvement, side effects, and stopping medication

Follow-up should cover agitation, sleep, mood, sexual function, and activities you have resumed. Selective serotonin reuptake inhibitors (SSRIs) can cause sexual dysfunction, and persistent cases after discontinuation have been reported. Suicidal thoughts or major behavior changes require attention, especially when starting treatment or after changes. Discussing these risks helps people make informed decisions. It does not mean everyone will experience them. ^{[15,16,17,18]}

A partial response is a reason to review the diagnosis, consistency of treatment, therapy practice, setting, and side effects before adding treatments. Tapering is planned together and tailored to the person. Symptoms after reducing a medication do not always mean a relapse. Do not stop treatment abruptly on your own. Pregnancy, breastfeeding, and other health conditions require a specific review of benefits and risks rather than automatic discontinuation. ^{[15,16,17,18,21]}

5. An integrative approach: caring for your health without making it another demand

A clear purpose for every intervention

An integrative approach means choosing what helps the individual rather than piling on treatments. Improving general health, correcting a documented problem, and treating social anxiety specifically are different goals. A plausible explanation involving stress or inflammation does not show that a supplement reduces fear of judgment. The following classification is editorial. It is not a GRADE assessment or an independent systematic review. ^[26,30]

Sleep and rest without chasing a perfect night

An assessment can look at anticipation at night, schedules, realistic opportunities for rest, and co-occurring sleep problems. The AASM consensus recommends regularly getting at least seven hours of sleep for adults ages 18 to 60 as general health guidance. It is not a dose of treatment for social phobia or a uniform requirement in every situation. ^[23]

One option is to set aside a way to end the day that does not involve replaying every conversation. If you sleep worse the night before an encounter, you do not need to conclude that taking part the next day will be impossible. Persistent insomnia deserves its own assessment. Adding sleep products without reviewing why you need them can complicate follow-up. The practical goal is enough rest without obsessively monitoring it.

Movement: health, enjoyment, and participation

WHO’s general physical activity recommendations are not a specific protocol for social phobia. Choose an activity you can access, adapt the intensity to your health, and gradually make it more regular. There is no need to start in a crowded gym or turn every walk into a test of courage. ^[24]

A small trial compared MBSR and aerobic exercise in 56 people with social anxiety. Both groups improved, but there was no randomized clinical group receiving no intervention. The additional healthy group does not serve that purpose. The study therefore does not establish equivalence with CBT or allow all changes to be attributed to a particular physiological mechanism. It can inform a complementary choice, but does not replace targeted treatment. ^[14]

Food, caffeine, and nutrition

It is worth reviewing meal regularity, whether you are getting enough to eat, stimulant use, and any difficulty eating in front of others. That last difficulty may call for psychological work rather than a different diet. Extensive restrictions or nutritional problems need their own assessment. A social anxiety diagnosis does not imply a food intolerance.

Caffeine can increase arousal or disrupt sleep for some people. Reviewing how much you use and when symptoms occur is more informative than recommending the same restriction to everyone. The targeted search for this guide does not support routine magnesium, vitamin D, omega-3, or multivitamins as specific treatment for social phobia. Correcting a documented deficiency serves a different purpose. It does not prove that the deficiency explains the disorder. ^[26]

Alcohol: short-term relief can complicate the pattern

It is worth asking about alcohol before meetings, dates, or professional events even when someone does not drink daily. Drinking can become a condition for taking part and coexist with anxiety. An assessment should address both and how they unfold over time, without requiring someone to resolve one before discussing the other. ^[25]

Alcohol is not recommended as an exposure strategy or in combination with sedatives. When someone has been drinking heavily over time or is dependent on alcohol, stopping suddenly can cause dangerous withdrawal. That calls for medical guidance on a safe plan, rather than general advice to stop immediately at home. ^[25,38]

Mindfulness, acceptance, and body-based practices

Mindfulness may help some people relate differently to self-criticism. In Goldin’s trial, a structured MBSR program helped compared with waiting. Group CBT produced a greater reduction in some subtle forms of avoidance. This does not make any meditation practice interchangeable with targeted therapy. NICE does not routinely recommend mindfulness as the main treatment for social anxiety. ^[2,13]

A short practice can be offered as an option without requiring someone to close their eyes or focus on their body if that increases distress. Breathing comfortably should not become a condition for speaking. Yoga, relaxation, and body-based activities can be considered for well-being and according to preference, but the evidence reviewed does not give them the same role as targeted CBT. ACT is also a full psychotherapy, not a meditation app. ^[11,26]

Microbiota, fermented foods, and psychoneuroimmunology

Gut–brain research is of interest, but the specifics of the research matter. Ritz and colleagues transferred microbiota from human donors to mice and observed changes in sensitivity to social fear. It was an animal experiment, not a trial showing that a fecal transplant treats people with social phobia. Nor can a commercial sample identify an individual cause based on this work. ^[29]

Another study of 710 young adults found associations between fermented foods, personality traits, and social symptoms. It was cross-sectional and relied on self-reports. It does not show that adding a food will help or that a particular probiotic strain works. An association with food should not become a recommendation for supplements. ^[31]

Psychoneuroimmunology offers a way to ask about links between stress, immunity, and behavior. Clinical usefulness requires another step: showing that measuring or changing a process improves decisions and outcomes. A consensus statement on microbiome testing notes limits to its routine use. The search for this guide did not identify a validated protocol using cortisol, cytokines, or microbiota to routinely diagnose or treat social anxiety. ^[29,30]

Herbal medicines: formulation, indication, and safety

Spanish prescribing information for Lasea, a standardized oral lavender preparation, covers temporary anxiety symptoms in adults, without a specific indication for social phobia. It also lists contraindications, including liver impairment. That medication is not equivalent to ingesting an aromatherapy essential oil or taking any product that mentions lavender. ^[27]

Research on ashwagandha has examined stress in certain populations, but does not establish it as a validated treatment for social anxiety here. Warnings include liver injury, thyroid changes, pregnancy, and interactions. Kava raises additional concerns about liver toxicity, and St. John’s wort can interact with antidepressants and other medications. “Natural” does not remove the need to check the product, indication, and risks. There is no universal herbal package recommended here. ^[15,26,28]

CBD: an experimental finding is not a clinical recommendation

A study of 24 people with social anxiety tested CBD before a public-speaking task and found favorable results on short-term measures. Its small, one-time design does not establish ongoing treatment of the disorder or make it equivalent to using cannabis. ^[32]

By contrast, a trial of 80 participants with social anxiety or panic disorder with agoraphobia found no benefit on the primary outcome when CBD was added to eight exposure sessions. The studies address different questions. Taken together, they do not establish CBD as a way to make therapy more effective. Product quality, interactions, drowsiness, and liver effects should be considered. Products containing THC add risks of their own. ^[33,34]

Choose measures with a goal and follow-up in mind. Avoid unnecessary restrictions and costs without proven benefit. ^{[23,24,25,26,27,28,29,30,31,32,33,34,38]}

6. Partners, family, work, and social life

Supporting someone without always speaking for them

People close to you can help by asking what support is useful and what you want to regain. Making every call or always answering for you may solve an immediate difficulty without helping you gain the independence you want. Suddenly taking away help to make you “get it together” is not appropriate either. Agree on changes together without making them a test of gratitude or willpower.

For example: “I understand this is hard for you. Would you rather we prepare the first step together, or would you like me to be available afterward?” This is an example of how to communicate, not a separately validated technique. Recognizing the effort does not require promising that no one will judge you or excessively praising every interaction.

Work: participation and real working conditions

Workplace plans should distinguish individual difficulties from problems in the work environment. If there is harassment, discrimination, or a demand incompatible with someone’s health, asking them to do more exposure is not enough. WHO includes organizational risks and workplace support in its guidance on mental health at work. ^[35]

These are adaptable suggestions, not workplace obligations or a universal protocol. They should fit the clinical situation and setting. ^[22,25,35]

Relationships, intimacy, and digital life

Treatment can include goals such as stating a preference, disagreeing respectfully, or meeting someone without imposing dating or a particular kind of social life. The relationships you choose matter more than increasing their number. A partner can take part by agreement without becoming your therapist.

Digital communication can make contact and support easier. It can also become a way to keep putting off conversations you want to have or to review messages until you are exhausted. There is no blanket recommendation to quit social media. It can help to explore what each use does for you and whether it expands or reduces your options. In a video appointment, privacy and constantly seeing your own image are worth discussing and adapting to the therapy. ^[8,9]

7. When to seek help and how to prepare for an appointment

Asking for help before giving up more of what matters

Consider an assessment when fear of judgment affects work, school, relationships, practical tasks, or access to health care. It is also worth seeking help when you keep up your activities at the cost of significant distress. You do not have to be isolated or have every symptom. Relying on alcohol or medication not prescribed to you to get through interactions also deserves attention. ^[1,25]

One useful way to prepare is to note a recent situation, what you feared, what happened, and what you would like to change. You can bring information about treatments and supplements, medical history, and past therapy. You do not need a perfect explanation before your first visit or to rehearse how to “do it right.”

Signs that need faster attention

What should be clear by the end of the appointment?

An assessment should give you a clear explanation of what may be happening, what needs more investigation, and what plan fits the situation. Agree on goals, options, follow-up, and what to do if symptoms get worse. Progress may include less avoidance, more freedom to choose, or less time spent anticipating and replaying interactions. It does not require never feeling embarrassed again. ^[1]

8. Frequently asked questions about social anxiety in adults

9. Sources and clinical reading

The citations correspond to the references below. Guidelines, trials, observational studies, animal experiments, and prescribing documents are distinguished. The accompanying editorial record documents which sources could be accessed. A link does not mean that every publication was reviewed in full.

1. National Institute of Mental Health. Social Anxiety Disorder: What You Need to Know. Reviewed in 2025. View source.
2. NICE. Social anxiety disorder: recognition, assessment and treatment. CG159. Recommendations. View source.
3. Stein DJ, et al. The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine. 2017;15:143. View source. DOI: 10.1186/s12916-017-0889-2.
4. Connor KM, et al. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. British Journal of Psychiatry. 2000;176:379–386. View source. DOI: 10.1192/bjp.176.4.379.
5. Bobes J, et al. Validación de las versiones en español de los cuestionarios Liebowitz Social Anxiety Scale, Social Anxiety and Distress Scale y Sheehan Disability Inventory para la evaluación de la fobia social [Validation of the Spanish versions of the LSAS, Social Anxiety and Distress Scale, and Sheehan Disability Inventory for assessing social phobia]. Medicina Clínica (Barcelona). 1999;112:530–538. View source.
6. Connor KM, et al. Mini-SPIN: A brief screening assessment for generalized social anxiety disorder. Depression and Anxiety. 2001;14:137–140. View source. DOI: 10.1002/da.1055.
7. Clark DM, et al. Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology. 2006;74:568–578. View source. DOI: 10.1037/0022-006X.74.3.568.
8. Wild J, et al. Video feedback to update negative self-perceptions in social anxiety disorder: A comparison of internet-delivered vs face-to-face cognitive therapy formats. Journal of Affective Disorders. 2023;331:139–144. View source. DOI: 10.1016/j.jad.2023.03.017.
9. Clark DM, et al. More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder. Psychological Medicine. 2023;53:5022–5032. Published online in 2022. View source. DOI: 10.1017/S0033291722002008.
10. Schittenhelm J, et al. App-based cognitive therapy for social anxiety disorder: A randomized-controlled comparison of guided and unguided app-based treatment versus waitlist. Behaviour Research and Therapy. 2026;198:104983. View source. DOI: 10.1016/j.brat.2026.104983.
11. Craske MG, et al. Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. Journal of Consulting and Clinical Psychology. 2014;82:1034–1048. View source. DOI: 10.1037/a0037212.
12. Leichsenring F, et al. Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. American Journal of Psychiatry. 2013;170:759–767. View source. DOI: 10.1176/appi.ajp.2013.12081125.
13. Goldin PR, et al. Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology. 2016;84:427–437. View source. DOI: 10.1037/ccp0000092.
14. Jazaieri H, et al. A randomized trial of MBSR versus aerobic exercise for social anxiety disorder. Journal of Clinical Psychology. 2012;68:715–731. View source. DOI: 10.1002/jclp.21863.
15. AEMPS-CIMA. Summary of product characteristics for Besitran film-coated tablets. Sections 4.1–4.8 (in Spanish). View source.
16. AEMPS-CIMA. Summary of product characteristics for Escitalopram HEC Pharm (in Spanish). View source.
17. AEMPS-CIMA. Summary of product characteristics for paroxetine, registration 65781 (in Spanish). View source.
18. AEMPS-CIMA. Summary of product characteristics for extended-release venlafaxine, registration 69590 (in Spanish). View source.
19. AEMPS-CIMA. Summary of product characteristics for Sumial (in Spanish). View source.
20. AEMPS-CIMA. Summary of product characteristics for pregabalin, registration 90011 (in Spanish). View source.
21. NICE. Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. NG215. Recommendations. View source.
22. NICE. Autism spectrum disorder in adults: diagnosis and management. CG142. Recommendations. View source.
23. Watson NF, et al. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Recommendation of the American Academy of Sleep Medicine and Sleep Research Society. 2015. View source.
24. World Health Organization, Regional Office for Europe. Physical activity. View source.
25. NIAAA. Mental Health Issues: Alcohol Use Disorder and Common Co-occurring Conditions. View source.
26. NCCIH. Anxiety and Complementary Health Approaches. Clinical Digest. 2020. View source.
27. AEMPS-CIMA. Summary of product characteristics for Lasea (in Spanish). View source.
28. NCCIH. Ashwagandha: Usefulness and Safety. View source.
29. Ritz NL, et al. Social anxiety disorder-associated gut microbiota increases social fear. Proceedings of the National Academy of Sciences. 2024;121:e2308706120. Published online in 2023. View source. DOI: 10.1073/pnas.2308706120.
30. International consensus statement on microbiome testing in clinical practice. The Lancet Gastroenterology & Hepatology. 2025;10:154–167. View source. DOI: 10.1016/S2468-1253(24)00311-X.
31. Hilimire MR, DeVylder JE, Forestell CA. Fermented foods, neuroticism, and social anxiety: An interaction model. Psychiatry Research. 2015;228:203–208. View source. DOI: 10.1016/j.psychres.2015.04.023.
32. Bergamaschi MM, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36:1219–1226. View source. DOI: 10.1038/npp.2011.6.
33. Kwee CM, et al. Cannabidiol enhancement of exposure therapy in treatment refractory patients with social anxiety disorder and panic disorder with agoraphobia: A randomised controlled trial. European Neuropsychopharmacology. 2022;59:58–67. View source. DOI: 10.1016/j.euroneuro.2022.04.003.
34. NCCIH. Cannabis (Marijuana) and Cannabinoids: What You Need To Know. View source.
35. World Health Organization. Mental health at work. September 15, 2026. View source.
36. Emergency Medical Services, Government of Catalonia. 112 or 061? (in Catalan). View source.
37. Blomhoff S, et al. Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. British Journal of Psychiatry. 2001;179:23–30. View source. DOI: 10.1192/bjp.179.1.23.
38. NIAAA. Rethinking Drinking: To Cut Down or to Quit? View source.

10. Review and maintenance

Document date: November 8, 2026. Version: 1.0 of this edition.

Clinical review of the Spanish original: Dr. Marc Agraz · November 9, 2026 · Clinically approved for publication in Spanish.

Future revisions should consider new treatment trials, changes to prescribing information, the safety of complementary approaches, and whether support resources remain current. A lack of sufficient evidence in this search is not a final conclusion.