Physical Activity as a Treatment for Social Anxiety in Clinical and Non-clinical Populations: A Systematic Review and Three Meta-Analyses for Different Study Designs

Abstract

The fear of being in the focus of attention in social situations can develop into a social anxiety disorder (SAD). The classical treatment for SAD is cognitive behavioral therapy, which is in many cases accompanied by drug treatments. A promising alternative treatment is physical activity (PA) interventions, because regular PA has been shown to be suitable for reducing anxiety in general. We conducted a pre-registered systematic review and meta-analysis (PROSPERO registration no. CRD42020191181) as well as two additional searches. Our aim was to investigate whether PA interventions are a suitable treatment for SAD and whether PA is suitable for reducing social anxiety (SA) in general. For studies with randomized controlled trial designs, a not statistically significant effect of medium size toward lower general SA symptomatology was found in the PA group in comparison with the control group (d = −0.24, p = 0.377). For studies with longitudinal designs, significantly lower SA symptoms were found after PA treatments (d = −0.22, p = 0.001). The effect of PA on SA was stronger for adults than for children and adolescents (p = 0.003). For cross-sectional studies, a small negative association between SA symptoms and the amount of PA was found, i.e., lower SA was found for people who were more physically active (r = −0.12, p = 0.003). We conclude that PA is a promising means for the (additional) treatment of SAD or to reduce SA in general in non-clinical samples, but more research in which high-quality studies with randomized controlled trial designs are used is needed. Furthermore, open questions with respect to moderating variables (e.g., age, sex, BMI, type of intervention, stress, amount of regular PA before the intervention, and comorbidities) remain still open.

Emotional abuse and depressive symptoms among the adolescents: the mediation effect of social anxiety and the moderation effect of physical activity

“…Felipe et al ( 27 ) supported the claim that PA is an evidence-based treatment for depression. Previous research also showed significant associations between a higher level of PA and a lower level of SA symptoms (r = −0.12, p = 0.003) in cross-sectional studies, and PA interventions significantly lower SA symptoms (d = 0–0.22, p = 0.001) in longitudinal studies ( 28 ).…”

Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis

“…For anxiety disorder, direct and indirect comparisons between AE, RE, MBE, and controls did not show significant differences in treatment effects, but a reduction in anxiety-related symptoms could be observed in every case. Previous meta-analyses also demonstrated little to no benefits in exercise interventions for anxiety disorder [ 170 , 171 ]. Based on the ranking probability plot, RE had the highest probability to be the most effective form of exercise, partly because it increases IGF-1 levels [ 172 ] and reduces inflammation [ 173 ] during training.…”

Physical activity and social anxiety symptoms among Chinese college students: a chain mediation model of psychological resilience and sleep problems

“…A study from 17,550 adolescents found that sports participation predicted lower social anxiety symptoms [12]. Moreover, some researchers con rmed that physical activity can treat clinical social anxiety disorder and reduce social anxiety symptoms in non-clinical samples through systematic review and meta-analyse [13]. Conversely, physical inactivity and sedentary behavior were related to limited social participation, limited contact with neighbors, and higher levels of loneliness [14].…”

“…A randomized controlled trial found that the therapeutic effect of high-intensity interval training on social anxiety was twice that of lower intensity training [46] (Plag et al, 2020). In addition, some researchers found that people with more physical activity have lower social anxiety symptoms in crosssectional studies (r = -0.12, P = 0.003), adults after treatment with physical activity were more effective in reducing social anxiety symptoms than children and adolescents in longitudinal studies (d = -0.22, P = 0.001) [13]. What's more, there are some hormone secretion and neurobiological mechanisms that could explain the relationship between physical activity and social anxiety symptoms.…”

“…Li et al indicated that they received material and spiritual support from family, peers and society during the physical activity, which met their growth needs for love and respect, and that prompted them to actively develop good traits, improve psychological resilience and social adaptation, and thus improve the quality of sleep [64]. Previous studies have shown that physical activity has been used as a supplement to cognitive-behavioral therapy to treat social anxiety disorders [13], our ndings suggested that some psychological therapies such as improving psychological resilience or decreasing sleep problems could also be used as a supplement or substitute. Generally, the results of this study complement the internal complex pathways of physical activity, psychological resilience, and sleep problems improving college students' social anxiety symptoms, which provides new strategies for developing more targeted psychological interventions to improve the mental health of college students.…”