Short-term psychodynamic psychotherapy for social anxiety disorder: a meta-analysis of randomized controlled trials

Although established treatments for social anxiety disorder (SAD) are effective, a substantial proportion of patients does not respond. This meta-analysis evaluated the efficacy of psychodynamic therapy (PDT) by assessing its short- and long-term effects on social anxiety symptoms, as well as on secondary measures of depressive symptoms. A systematic literature search following PICO criteria identified randomized controlled trials (RCTs) of PDT for SAD published since 1980. Study quality was assessed using the Randomized Controlled Trial Psychotherapy Quality Rating Scale and the Cochrane Risk of Bias tool. At treatment termination, between-group effect sizes were pooled using random effect models. Long-term effects were explored using between- and within-group analyses, depending on available follow-up data. Eleven eligible RCTs (n = 1167), evaluating short-term psychodynamic psychotherapy (STPP) were identified. In SAD symptoms, STPP was superior to waitlist controls (k = 6) with a large pooled effect (g = − 0.97, 95% CI: -1.27 to -0.12). Compared with active treatment conditions (k = 9), no significant differences were observed (g = 0.01, 95% CI: − 0.14 to 0.15). Study quality significantly moderated effects in comparisons with passive controls only, with lower-quality studies reporting larger effects (β = 0.02). No differences in dropout rates were observed. Available follow-up data indicated that gains in social anxiety symptoms were maintained, with some evidence of continued improvement over time. These findings suggest that STPP may be an effective and acceptable treatment for SAD. Future studies should include active treatment comparisons, assess long-term outcomes, and examine mechanisms of change. PROSPERO database with ID CRD420250656024.