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Social Anxiety

It is common to feel a bit of anxiety around other people from time to time. If the anxiety is more severe than regular shyness, and is interfering with your ability to live your life, you may be suffering from social anxiety: one of the most common anxiety disorders. It is thought that between 2 and 7 people out of every 100 experience social anxiety disorder every year [1,2]. The good news is that Cognitive Behavioral Therapy (CBT) is an effective psychological treatment for social anxiety disorder, and with the right treatment, you can recover.

What is social anxiety?

Do you ever feel anxious when you’re around other people, or if you might have to be the center of attention? Do you worry that other people will notice something about you – or about the way you behave – and judge you for it? Social anxiety is the name for feeling these kinds of fears in social situations. Symptoms of social anxiety disorder include:

Social Anxiety - Symptoms

What is it like to have social anxiety?

Keira struggled with social anxiety. Her story illustrates what it can feel like to be affected in this way.

Keira’s fear of public speaking

I was 20 when I went to the university counseling service. I’d started my course seven months ago, was enjoying living away from home, and had a good group of friends. I’d always been a good student, and tried to do everything as well as I could. I was enjoying some aspects of my course, but was struggling in my group seminars. It was very difficult to contribute to the group, and I found it excruciating to give presentations. My anxiety got so bad that I avoided some of my seminars, to the extent that I might not have been able to progress to the next year.

My therapist asked me to describe a recent time when I felt anxious, and I described a recent seminar. It was my turn to present something to the group, and I’d spent a lot of time preparing exactly what I was going to say. While I was speaking, I felt like I was stumbling over my words. I thought I looked like a fool because I was coming across as nervous, and thought my peers would think I was incompetent. I felt very anxious, hot, sweaty, and shaky. I was worried that other people would hear my voice shaking, so I spoke very quickly to get my presentation over with and quietly to hide my shaky voice. I avoided eye contact and kept my eyes fixed on my presentation because I was so self-conscious. After the presentation I made a swift exit, and spent the rest of the day berating myself for how badly I had performed.

Social Anxiety - Guide advert

Do I have social anxiety?

Social anxiety should only be diagnosed by a mental health professional or a doctor. However, answering the screening questions below can give you an idea of whether you might find it helpful to have a professional assessment.

I avoid situations where I might be the center of attention.
 Never  Occasionally  Sometimes  Often
Fear of embarrassment causes me to avoid doing things or speaking to people.
 Never  Occasionally  Sometimes  Often
When I’m with other people I worry about being embarrassed, looking stupid, or doing something to humiliate myself.
 Never  Occasionally  Sometimes  Often
If I have to endure a social situation it makes me feel very anxious.
 Never  Occasionally  Sometimes  Often
Speaking in front of a group of people makes me feel anxious.
 Never  Occasionally  Sometimes  Often

 

If you answered ‘often’ to most of these questions, and you find that these fears cause hindrance in your life, then you might be suffering from social anxiety. You might find it helpful to speak to your general practitioner, or a mental health professional about how you are feeling.

What causes social anxiety?

There is no single cause for social anxiety. Some things that make you more likely to experience social anxiety include:

  • The way humans have evolved to care about their place in their social group.
  • Your personality.
  • The way that other people have treated you.
  • Your beliefs and assumptions about yourself, how others see you, and how you think you need to behave in public.
  • Having an appearance or condition that draws attention.

Research evidence suggests that there may be genes which make you likely to develop emotional problems in general, but none which make you likely to develop social anxiety.

What triggers social anxiety?

Social anxiety is worse in situations where you fear you might be evaluated or judged by other people. Situations that have been described as triggering by people who suffer from social anxiety include:

Social anxiety - triggers

What keeps social anxiety going?

Research studies have shown that Cognitive Behavior Therapy (CBT) is the most effective treatment for social anxiety [3]. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. In 1995 the psychologists David Clark and Adrian Wells published an influential model of social anxiety which describes some of the ‘parts’ that keep social anxiety going [4]:

Social Anxiety - What Keeps it going?

Treatments for social anxiety disorder

Psychological treatments for social anxiety disorder

The psychological treatment for social anxiety which has the strongest research support is individual (one to one) Cognitive Behavioral Therapy (CBT) specifically designed for social anxiety [3,5]. This is sometimes called cognitive therapy for SAD, or CT-SAD.

CBT is a popular form of talking therapy. CBT therapists understand that what we think and do affects the way we feel. Unlike some other therapies, it is often quite structured. After talking things through so that they can understand your problem, you can expect your therapist to set goals with you so that you both know what you are working towards. You should seek out a therapist who has specialist training and experience in treating social anxiety disorder. At the start of most sessions you will set an agenda together so that you have agreed what that session will concentrate on. ‘Ingredients’ of effective CBT treatment for social anxiety disorder include [3]:

Medical treatments for social anxiety disorder

Medical treatments for social anxiety disorder are typically recommended as a second-line treatment if CBT is refused. The UK National Institute for Health and Care Excellence (NICE) guidelines recommend that the class of medications called Selective Serotonin Reuptake Inhibitors (SSRIs) such as escitalopram or sertraline should be offered [6].

References

  1. Stein, D. J., Lim, C. C., Roest, A. M., De Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., … & De Girolamo, G. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC medicine, 15(1), 143. 
  2. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.
  3. Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., … & Clark, D. M. (2020). Treating social anxiety disorder remotely with cognitive therapy. The Cognitive Behaviour Therapist, 13. 
  4. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guildford Press.
  5. Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.
  6. National Institute for Health and Care Excellence (NICE: 2013). Social; anxiety disorder:recognition, assessment, and treatment. Retrieved from: https://www.nice.org.uk/guidance/cg159/resources/social-anxiety-disorder-recognition-assessment-and-treatment-pdf-35109639699397

About this article

This article was written by Dr Matthew Whalley and Dr Hardeep Kaur, both clinical psychologists. It was last reviewed on 2021/12/07.