Talk, not medication, say researchers from Johns Hopkins University in Baltimore, appears the best treatment for those suffering social anxiety disorder, characterized by intense fear and avoidance of social situations.

Antidepressants have become the most common used treatment for social anxiety disorder, a psychiatric condition that affects up to 13 percent of Americans and Europeans, but the latest study found cognitive behavioral therapy is more effective and, unlike medication, can have lasting effects long after treatment has stopped.

"Social anxiety is more than just shyness," study leader Evan Mayo-Wilson, a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, said in a news release. "People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering."

Findings of the new research -- published online in The Lancet Psychiatry and was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College London, where Mayo-Wilson formerly worked -- explain most people receive treatment for the disorder and, for those who do, medication is much more accessible than trained psychotherapists.

For the study, Mayo-Wilson and his colleagues analyzed data from 13,164 participants in 101 clinical trials.

The participants, the study explained, all suffered severe and longstanding social anxiety; an estimated 9,000 received medication or a placebo pill and more than 4,000 received a psychological intervention.

Very few of the previous studies looked at combining medication with talk therapy and there was no evidence that any of the previous research had compared the effectiveness of a combined therapy approach to talk therapy alone.

When Mayo-Wilson and his team compared several different types of talk therapy, they revealed individual CBT, which focuses on relationships between thoughts, feelings and behaviors in an effort to help people challenge irrational fears and overcome their avoidance tendencies, was the most effective overall treatment.

The researchers noted that medication remains important, but should be considered as a second-line therapy for people who do not respond to or do not want psychological therapy. The group's analysis has already led to new treatment guidelines guidance in the United Kingdom and could have a significant impact on policy-making in the United States, Mayo-Wilson said.

"Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce health care costs," Mayo-Wilson said. "The health care system does not treat mental health equitably, but meeting demand isn't simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff."