Social Anxiety Disorder and Social Phobia
Symptoms, Self-Help, and Treatment
Many people get nervous or self-conscious on occasion, like when giving a speech or interviewing for a new job. But social anxiety, or social phobia, is more than just shyness or occasional nerves. With social anxiety disorder, your fear of embarrassing yourself is so intense that you avoid situations that can trigger it. But no matter how painfully shy you may be and no matter how bad the butterflies, you can learn to be comfortable in social situations and reclaim your life.
Social anxiety disorder, also known as social phobia, involves intense fear of certain social situations—especially situations that are unfamiliar or in which you feel you’ll be watched or evaluated by others.
These social situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them.
Underlying social anxiety disorder or social phobia is the fear of being scrutinized, judged, or embarrassed in public. You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. And even though you probably realize that your fears of being judged are at least somewhat irrational and overblown, you still can’t help feeling anxious.
While it may seem like there’s nothing you can do about the symptoms of social anxiety disorder or social phobia, in reality, there are many things that can help. It starts with understanding the problem.
Matthew skipped class today. It’s the first day of the new semester, and he’s afraid that the professor will go around the class and have the students introduce themselves. He knows it shouldn’t be a big deal, but it really stresses him out. Whenever he has to speak in front of more than just a few people, his voice starts shaking and his face gets red. He always feels so humiliated afterwards.
Since public speaking is Matthew’s worst nightmare, he’s been avoiding a speech class he has to take in order to graduate. He’s also dreading his brother’s wedding, even though it’s over six months away. As the best man, he’ll have to give a toast at the reception and he’s already nervous about it.
Although it may feel like you’re the only one with this problem, social anxiety or social phobia is actually quite common. Many people struggle with these fears. But the situations that trigger the symptoms of social anxiety disorder can be different.
Some people experience anxiety in most social and performance situations, a condition known as generalized social anxiety disorder. For other people with social phobia, anxiety is connected with specific social situations, such as speaking to strangers, eating at restaurants, or going to parties.
The most common specific social phobia is fear of public speaking or performing in front of an audience.
Triggers for social anxiety disorder (social phobia)
The following situations are often stressful for people with social anxiety disorder:
Just because you occasionally get nervous in social situations doesn’t mean you have social anxiety disorder or social phobia. Many people are shy or self-conscious—at least from time to time—yet it doesn’t get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress.
For example, it’s perfectly normal to get the jitters before giving a speech. But if you have social anxiety disorder or social phobia, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak.
Emotional symptoms of social anxiety disorder / social phobia
- Excessive self-consciousness and anxiety in everyday social situations
- Intense worry for days, weeks, or even months before an upcoming social situation
- Extreme fear of being watched or judged by others, especially people you don’t know
- Fear that you’ll act in ways that that will embarrass or humiliate yourself
- Fear that others will notice that you’re nervous
Physical symptoms of social anxiety disorder / social phobia
- Red face, or blushing
- Shortness of breath
- Upset stomach, nausea (i.e. butterflies)
- Trembling or shaking (including shaky voice)
- Racing heart or tightness in chest
- Sweating or hot flashes
- Feeling dizzy or faint
Behavioral symptoms of social anxiety disorder / social phobia
- Avoiding social situations to a degree that limits your activities or disrupts your life
- Staying quiet or hiding in the background in order to escape notice and embarrassment
- A need to always bring a buddy along with you wherever you go
- Drinking before social situations in order to soothe your nerves
Social anxiety disorder / social phobia in children
There’s nothing abnormal about a child being shy, but children with social anxiety disorder or social phobia experience extreme distress over everyday activities and situations such as playing with other kids, reading in class, speaking to adults, taking tests, or performing in front of others. Often, children with social phobia don’t want to go to school.
Social anxiety sufferers have negative thoughts and beliefs that contribute to their anxiety. If you have social anxiety disorder, or social phobia, you may find yourself overwhelmed by thoughts like:
Challenging these negative thoughts, either through therapy or on your own, is one effective way to reduce the symptoms of social anxiety disorder.
The first step is to identify the automatic negative thoughts that underlie your fear of social situations. For example, if you‘re worried about an upcoming work presentation, the underlying negative thought might be: “I’m going to blow it. Everyone will think I’m completely incompetent.”
The next step is to analyze and challenge them. It helps to ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to blow the presentation?” or “Even if I’m nervous, will people necessarily think I’m incompetent?” Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety.
Unhelpful thinking styles involved in social phobia
In particular, ask yourself if you’re engaging in any of the following unhelpful thinking styles:
- Mind reading – Assuming you know what other people are thinking, and that they see you in the same negative way that you see yourself.
- Fortune telling – Predicting the future, usually while assuming the worst will happen. You just “know” that things will go horribly, so you’re already anxious before you’re even in the situation.
- Catastrophizing – Blowing things out of proportion. If people notice that you’re nervous, it will be “awful,” “terrible,” or “disastrous.”
- Personalizing – Assuming that people are focusing on you in a negative way or that what’s going on with other people has to do with you.
How can I stop thinking that everyone is looking at me?
In order to reduce self-focus, pay attention to what is happening around you, rather than monitoring yourself or focusing on symptoms of anxiety in your body:
- Look at other people and the surroundings.
- Really listen to what is being said (not to your own negative thoughts).
- Don't take all the responsibility for keeping conversations going—silence is okay, other people will contribute.
Adapted from: Moodjuice
Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly. Overbreathing throws off the balance of oxygen and carbon dioxide in your body—leading to more physical symptoms of anxiety, such as dizziness, a feeling of suffocation, increased heart rate, and muscle tension.
Learning to slow your breathing down can help you bring your physical symptoms of anxiety back under control. Practicing the following breathing exercise will help you stay calm when you’re the center of attention.
A breathing exercise to help you keep your calm in social situations
- Sit comfortably with your back straight and your shoulders relaxed. Put one hand on your chest and the other on your stomach.
- Inhale slowly and deeply through your nose for four seconds. The hand on your stomach should rise, while the hand on your chest should move very little.
- Hold the breath for two seconds.
- Exhale slowly through your mouth for six seconds, pushing out as much air as you can. The hand on your stomach should move in as you exhale, but your other hand should move very little.
- Continue to breathe in through your nose and out through your mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out.
Relaxation techniques for anxiety relief
In addition to deep breathing exercises, regular practice of relaxation techniques such as meditation, yoga, and progressive muscle relaxation will also help you get control over the physical symptoms of anxiety.
For step-by-step advice on getting started, see Relaxation Techniques for Stress Relief: Finding the Relaxation Exercises that Work for You.
One of the most helpful things you can do to overcome social anxiety disorder, or social phobia, is to face the social situations you fear rather than avoid them. Avoidance keeps social anxiety disorder going.
Avoidance leads to more problems
While avoiding nerve-wracking situations may help you feel better in the short term, it prevents you from becoming more comfortable in social situations and learning how to cope. In fact, the more you avoid a feared social situation, the more frightening it becomes.
Avoidance may also prevent you from doing things you’d like to do or reaching certain goals. For example, a fear of speaking up may prevent you from sharing your ideas at work, standing out in the classroom, or making new friends.
Challenging social anxiety one step at a time
While it may seem impossible to overcome a feared social situation, you can do it by taking it one small step at a time. The key is to start with a situation that you can handle and gradually work your way up to more challenging situations, building your confidence and coping skills as you move up the “anxiety ladder.”
For example, if socializing with strangers makes you anxious, you might start by accompanying an outgoing friend to a party. Once you’re comfortable with that step, you might try introducing yourself to one new person, and so on.
Working your way up the social phobia “anxiety ladder”
- Don’t try to face your biggest fear right away. It’s never a good idea to move too fast, take on too much, or force things. This will backfire and reinforce your anxiety.
- Be patient. Overcoming social anxiety takes time and practice. It’s a gradual step-by-step progress.
- Use the skills you’ve learned to stay calm, such as focusing on your breathing and challenging negative assumptions.
Actively seeking out and joining supportive social environments is another effective way of tackling and overcoming social anxiety disorder or social phobia. The following suggestions are good ways to start interacting with others in positive ways:
- Take a social skills class or an assertiveness training class. These classes are often offered at local adult education centers or community colleges.
- Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign — anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.
- Work on your communication skills. Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help.
While lifestyle changes alone aren’t enough to overcome social phobia or social anxiety disorder, they can support your overall treatment progress. The following lifestyle tips will help you reduce your overall anxiety levels and set the stage for successful treatment:
- Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy drinks, and chocolate act as stimulants that increase anxiety symptoms.
- Drink only in moderation. You may be tempted to drink before a party or other social situation in order to calm your nerves, but alcohol increases your risk of having an anxiety attack.
- Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.
- Get adequate sleep. When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations.
The best treatment approach for social anxiety disorder varies from person to person. You may find that self-help strategies are enough to ease your social anxiety symptoms. But if you’ve tried the techniques above and you’re still struggling with disabling anxiety, you may need professional help as well.
Therapy for social anxiety disorder / social phobia
Of all the professional treatments available, cognitive-behavioral therapy (CBT) has been shown to work the best for treating social anxiety disorder, or social phobia. Cognitive-behavioral therapy is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.
Cognitive-behavioral therapy for social phobia typically involves:
- Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.
- Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.
- Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.
While you can learn and practice these exercises on your own, if you’ve had trouble with self-help, you may benefit from the extra support and guidance a therapist brings.
Group therapy for social anxiety disorder / social phobia
Other cognitive-behavioral techniques for social anxiety disorder include role-playing and social skills training, often as part of a therapy group.
Group therapy for social anxiety disorder uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable and confident in your social abilities, and your anxiety will lessen.
Medication for social anxiety disorder / social phobia
Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure for social anxiety disorder or social phobia. If you stop taking medication, your symptoms will probably return full force. Medication is considered most helpful when used in addition to therapy and other self-help techniques that address the root cause of social anxiety disorder.
Three types of medication are used in the treatment of social anxiety disorder / social phobia:
- Beta blockers – Beta blockers are used for relieving performance anxiety. They work by blocking the flow of adrenaline that occurs when you’re anxious. While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
- Antidepressants – Antidepressants can be helpful when social anxiety disorder is severe and debilitating. Three specific antidepressants—Paxil, Effexor, and Zoloft—have been approved by the U.S. Food and Drug Administration for the treatment of social phobia.
- Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so they are typically prescribed only when other medications for social phobia have not worked.
More help for social anxiety disorder and social phobia
- How to Stop Worrying: Self-Help Strategies for Anxiety Relief
- Anxiety Medication: What You Need to Know About Anti-Anxiety Drugs
- Panic Attacks and Panic Disorder: Symptoms, Causes, and Treatment
- Stress Relief in the Moment: Using Your Senses to Quickly Change Your Response to Stress
- Therapy for Anxiety Disorders: Cognitive Behavioral Therapy, Exposure Therapy, and Other Options
- Benefits of Mindfulness: Practices for Improving Emotional and Physical Well-Being
Resources and references
Signs and symptoms of social anxiety disorder (social phobia)
Social Anxiety Phobia Symptoms – An introduction to social anxiety and the symptoms used for diagnosis. (PsychCentral)
Social Anxiety Fact Sheet – Covers what can trigger social anxiety, signs and symptoms, and treatment options. (Social Anxiety Association)
Social anxiety disorder (social phobia) in children and adolescents
Social Phobia – Written for teens, this article provides an overview of social phobia, its causes, and tips for dealing with it. (TeensHealth)
Social Anxiety Disorder in Children and Adolescents – Describes the signs, symptoms, and treatment of social phobia in children and teens. (Jim Chandler, M.D.)
Self-help for social anxiety disorder (social phobia)
Shyness and Social Phobia: A Self-Help Guide – Offers self-help strategies for dealing with the symptoms of social anxiety disorder, including cognitive-behavioral techniques. (Moodjuice)
Shy No Longer – Series of self-help workbooks with step-by-step tips on how to cope with and overcome social anxiety disorder. (Centre for Clinical Interventions)
Tips For "Shaking Your Shyness" – Provides a number of tips for taking steps towards conquering shyness and social anxiety. (Renee Gilbert, Ph.D.)
Self-Help: Overcoming Social Anxiety – Gives valuable tips for college students. (University of Texas at Dallas)
Treatment for social anxiety disorder (social phobia)
What is Comprehensive Cognitive-Behavioral Therapy? – Describes how cognitive-behavioral therapy is used in the treatment of the physical and emotional symptoms of social phobia. (Social Anxiety Institute)
Treatment Options – Covers treatment options for social anxiety disorder, including cognitive-behavioral therapy, exposure therapy, and slow breathing. (Shyness & Social Anxiety Treatment Australia)