SOCIAL ANXIETY DISORDER
By Melinda Smith, M.A., Jeanne Segal, Ph.D., and Jennifer Shubin
Feel intensely uncomfortable in social situations? Use this guide to learn about the symptoms, treatment, and self-help for social phobia.
What is social anxiety disorder or social phobia?
Many people get nervous or self-conscious on occasion, like when giving a speech or interviewing for a new job. But social anxiety disorder, or social phobia, is more than just shyness or occasional nerves. Social anxiety disorder 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 situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them, disrupting your life in the process.
Underlying social anxiety disorder 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. 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.
What causes social anxiety?
Although it may feel like you’re the only one with this problem, social anxiety 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 situations. For others, anxiety is connected to specific social situations, such as speaking to strangers, mingling at parties, or performing in front of an audience. Common social anxiety triggers include:
- Meeting new people
- Making small talk
- Public speaking
- Performing on stage
- Being the center of attention
- Being watched while doing something
- Being teased or criticized
- Talking with “important” people or authority figures
- Being called on in class
- Going on a date
- Speaking up in a meeting
- Using public restrooms
- Taking exams
- Eating or drinking in public
- Making phone calls
- Attending parties or other social gatherings
Signs and symptoms of 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 feel shy or self-conscious on occasion, 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, 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 signs and symptoms of social anxiety disorder:
- 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 will embarrass or humiliate yourself
- Fear that others will notice that you’re nervous
Physical signs and symptoms:
- 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 signs and symptoms:
- 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 in children
There’s nothing abnormal about a child being shy, but children with social anxiety disorder experience extreme distress over everyday situations such as playing with other kids, reading in class, speaking to adults, or taking tests. Often, children with social phobia don’t even want to go to school.
How to overcome social anxiety disorder
Tip 1: Challenge negative thoughts
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. The first step is challenging your mentality.
Social anxiety sufferers have negative thoughts and beliefs that contribute to their fears and anxiety. These can include thoughts such as:
- “I know I’ll end up looking like a fool.”
- “My voice will start shaking and I’ll humiliate myself.”
- “People will think I’m stupid”
- “I won’t have anything to say. I’ll seem boring.”
Challenging these negative thoughts is an effective way to reduce the symptoms of social anxiety.
Step 1: 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.”
Step 2: Analyze and challenge these thoughts. 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.
It can be incredibly scary to think about why you feel and think the way you do, but understanding the reasons for your anxieties will help lessen their negative impact on your life.
Unhelpful thinking styles that fuel social anxiety
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. For example, 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.
Tip 2: Focus on others, not yourself
When we’re in a social situation that makes us nervous, many of us tend to get caught up in our anxious thoughts and feelings. You may be convinced that everyone is looking at you and judging you. Your focus is on your bodily sensations, hoping that by paying extra close attention you can better control them. But this excessive self-focus just makes you more aware of how nervous you’re feeling, triggering even more anxiety! It also prevents you from fully concentrating on the conversations around you or the performance you’re giving.
Switching from an internal to an external focus can go a long way toward reducing social anxiety. This is easier said than done, but you can’t pay attention to two things at once. The more you concentrate on what’s happening around you, the less you’ll be affected by anxiety.
Focus your attention on other people, but not on what they’re thinking of you! Instead, do your best to engage them and make a genuine connection.
Remember that anxiety isn’t as visible as you think. And even if someone notices that you’re nervous, that doesn’t mean they’ll think badly of you. Chances are other people are feeling just as nervous as you—or have done in the past.
Really listen to what is being said not to your own negative thoughts.
Focus on the present moment, rather than worrying about what you’re going to say or beating yourself up for a flub that’s already passed.
Release the pressure to be perfect. Instead, focus on being genuine and attentive—qualities that other people will appreciate.
Tip 3: Learn to control your breathing
Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly. Overbreathing (hyperventilation) 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 bring your physical symptoms of anxiety back under control. Practicing the following breathing exercise will help you stay calm:
- 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 4 seconds. The hand on your stomach should rise, while the hand on your chest should move very little.
- Hold the breath for 2 seconds.
- Exhale slowly through your mouth for 6 seconds, pushing out at 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.
Tip 4: Face your fears
One of the most helpful things you can do to overcome social anxiety is to face the social situations you fear rather than avoid them. Avoidance keeps social anxiety disorder going. 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 the long term. In fact, the more you avoid a feared social situation, the more frightening it becomes.
Avoidance can 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.
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. To work your way up a social 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 may 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.
Socially interacting with co-workers: A sample anxiety ladder
Step 1: Say “hello” to your co-workers.
Step 2: Ask a co-worker a work-related question.
Step 3: Ask a co-worker what they did over the weekend.
Step 4: Sit in the break room with co-workers during your coffee break.
Step 5: Eat lunch in the break room with your co-workers.
Step 6: Eat lunch in the break room and make small talk with one or more of your coworkers, such as talking about the weather, sports, or current events.
Step 7: Ask a co-worker to go for a coffee or drink after work.
Step 8: Go out for lunch with a group of co-workers.
Step 9: Share personal information about yourself with one or more co-workers.
Step 10: Attend a staff party with your co-workers.
Tip 5: Make an effort to be more social
Actively seeking out supportive social environments is another effective way of challenging your fears and overcoming social anxiety. 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.
Tips for making friends even if you’re shy or socially awkward
No matter how awkward or nervous you feel in the company of others, you can learn to silence self-critical thoughts, boost your self-esteem, and become more confident and secure in your interactions with others. You don’t have to change your personality. By simply learning new skills and adopting a different outlook you can overcome your fears and anxiety and build rewarding friendships.
Tip 6: Adopt an anti-anxiety lifestyle
The mind and the body are intrinsically linked—and more and more evidence suggests that how you treat your body can have a significant effect on your anxiety levels, your ability to manage anxiety symptoms, and your overall self-confidence.
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, soda, and energy drinks act as stimulants that increase anxiety symptoms. Consider cutting out caffeine entirely, or keeping your intake low and limited to the morning.
Get active – Make physical activity a priority—30 minutes per day if possible. If you hate to exercise, try pairing it with something you do enjoy, such as window shopping while walking laps around the mall or dancing to your favorite music.
Add more omega-3 fats to your diet – Omega-3 fatty acids support brain health and can improve your mood, outlook, and ability to handle anxiety. The best sources are fatty fish (salmon, herring, mackerel, anchovies, sardines), seaweed, flaxseed, and walnuts.
Drink only in moderation – You may be tempted to drink before a social situation to calm your nerves, but alcohol increases your risk of having an anxiety attack.
Quit smoking – Nicotine is a powerful stimulant. Contrary to popular belief, smoking leads to higher, not lower, levels of anxiety. If you need help kicking the habit, see: How to Quit Smoking.
Get enough quality sleep – When you’re sleep-deprived, you’re more vulnerable to anxiety. Being well-rested will help you stay calm in social situations.
Social anxiety disorder treatment
If you’ve tried the self-help techniques above and you’re still struggling with disabling social anxiety, you may need professional help as well.
Of all the professional treatments available, cognitive-behavioral therapy (CBT) has been shown to work best for treating social anxiety disorder. CBT 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.
CBT for social phobia may involve:
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.
Role-playing, social skills training, and other CBT techniques, often as part of a therapy group. Group therapy 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 your anxiety will lessen.
Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure. Medication is considered most helpful when used in addition to therapy and self-help techniques that address the root cause of your social anxiety disorder.
Three types of medication are used in the treatment of social anxiety:
Beta blockers are used for relieving performance anxiety. While they don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
Antidepressants may be helpful when social anxiety disorder is severe and debilitating.
Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so are typically prescribed only when other medications have not worked.