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 intense—so intense, in fact, that you may go to great lengths to avoid situations that would trigger it. But no matter how painfully shy you may be and no matter how bad the butterflies, you can learn to be more comfortable in social situations and reclaim your life.
IN THIS ARTICLE:
Social anxiety disorder
Common triggers
Signs and symptoms
Challenge negative thoughts
Learn to control your breath
Face your fears
Build better relationships
Change your lifestyle
When self-help isn’t enough
Related links
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What is social anxiety disorder / social phobia?
Matthew’s story
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.
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.
Common social phobia / social anxiety disorder triggers
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:
Meeting new people
Being the center of attention
Being watched while doing something
Making small talk
Public speaking
Performing on stage
Being teased or criticized
Talking with “important” people or authority figures
Being called on in class
Going on a date
Making phone calls
Using public bathrooms
Taking exams
Eating or drinking in public
Speaking up in a meeting
Attending parties or other social gatherings
Signs and symptoms of social anxiety disorder / social phobia
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 disorder treatment #1: Challenge negative thoughts
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:
“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, 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
Social anxiety disorder treatment #2: Learn to control your breath
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 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 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 Stress Relief: Yoga, Meditation, and other Relaxation Techniques.
Social anxiety disorder treatment #3: Face your fears
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.
Social anxiety disorder treatment #4: Build better relationships
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.
For more on how to build these skills, see Relationship Help: Building Great Relationships with Emotional Intelligence Tools.
Social anxiety disorder treatment #5: Change your lifestyle
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.
When self-help for social anxiety / social phobia isn’t enough
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.
Learning more about therapy for social phobia
The length of therapy treatment for social anxiety disorder will differ from person to person. However, many anxiety therapies are relatively short-term. And many of the techniques you learn can be practiced at home and put into daily use.
To learn more about the types of therapy that help anxiety, see Therapy for Anxiety Disorders.
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.
What do we mean by good mental health?
Good mental health isn't something you have, but something you do. To be mentally healthy you must value and accept yourself. This means that:
· You care about yourself and you care for yourself. You love yourself, not hate yourself. You look after your physical health – eat well, sleep well, exercise and enjoy yourself.
· You see yourself as being a valuable person in your own right. You don't have to earn the right to exist. You exist, so you have the right to exist.
· You judge yourself on reasonable standards. You don't set yourself impossible goals, such as 'I have to be perfect in everything I do', and then punish yourself when you don't reach those goals.
If you don't value and accept yourself, you are always frightened that other people will reject you. To prevent people seeing how unacceptable you are, you keep them at a distance, and so you are always frightened and lonely. If you value yourself, you don't expect people to reject you. You aren't frightened of other people. You can be open, and so you enjoy good relationships.
If you value and accept yourself, you are able to relax and enjoy yourself, without feeling guilty. When you face a crisis, you know that, no matter how difficult the situation is, you will manage. How we see ourselves is central to every decision we make. People who value and accept themselves cope with life.
All of us grow up with a set of ideas about who we are, what our life was and will be, and what the world is like. These ideas come from our past experience, and, because no two people ever have the same experience, no two people ever see things in exactly the same way.
Our ideas aren’t an exact picture of what’s going on around us, but a set of guesses or theories about what’s going on. If we grow up with certain views or beliefs about how life is or should be we can then be greatly shocked if we discover that things aren’t the way we thought they were and that we’ve made a serious error of judgement.
Whenever we encounter some unexpected disaster or setback, we discover that there's a serious discrepancy between what we thought our life was and what it actually is. Perhaps we thought our life was safe and secure, and then we suffered a terrorist attack. Perhaps we thought we were going to spend the rest of our life with one special person, and then that person left us, or died. Perhaps we'd grown up believing that if we were good, nothing bad would happen to us, and then something did.
Whenever we discover we've made a serious error of judgement, we may start to doubt every judgement we've ever made. Then we start to feel very unsure of ourselves.
If we value and accept ourselves, we have confidence in ourselves, and, even though we're frightened, we tell ourselves that this feeling will pass, that we'll be able to meet the challenge and cope with whatever follows. If we don't value and feel positive about ourselves in this way, we may feel that we're about to beak down, and so we have to find some defence to hold ourselves together. The less good we feel about ourselves, the more desperate the defence we resort to.
These defences might include:
· harming our body by injuring it or by starving it
· blaming ourselves for the disaster or setback, and so becoming depressed
· locating the cause of our fear in the world around us and becoming too frightened to venture out
· getting busier and busier to avoid thinking about any problems
· trying to make everything secure by obsessively cleaning and checking
· retreating into our own inner world and giving up trying to make sense of the world around us in the way other people do.
We don't consciously choose a particular defence. Instead, we unconsciously and quickly resort to the one defence available to us because of the way we see ourselves and our world. For instance, if you are well practised in blaming yourself for everything that goes wrong, you’ll blame yourself for any crisis or bad luck you have.
Mental distress is not compulsory. However, if we don't value and accept ourselves, we're making sure that we will feel mental distress when life is difficult. If we do feel positive about ourselves, then when we suffer loss, we feel sad, not depressed. So, when someone treats us badly, we feel angry, but not guilty because we feel angry. When someone or something threatens us, we feel frightened, but we're not overwhelmed, because we look after ourselves and make ourselves safe.
What causes us to become mentally distressed is not loss, or poverty, or sickness, or people treating us badly. It's how we interpret our loss, or poverty, or sickness, or the fact that people are treating us badly.
Many people defeat themselves by interpreting what happens to them in way that makes suffering inevitable. If we see ourselves as being bad and unacceptable, and we believe that we live in a 'just world' where goodness is rewarded and badness punished, then, when we suffer a disaster or setback, we interpret the event as being the punishment for our wickedness. If we see ourselves as being insignificant and worthless then, when the chance for happiness comes along, we say to ourselves, 'I wasn't meant to be happy.' If we are frightened of other people, when other people treat us badly we feel we've no right to stand up for ourselves.
If we desperately need other people around us, but see ourselves as unattractive and unlovable, we bury our anger. We let other people walk all over us, because we dare not show our displeasure in case other people reject us. If we believe that it's inevitable that other people will let us down and everything turn out badly, we'll not do anything to improve our life. So we suffer.
Some people like to blame their genes or their fate for their misery, because then it seems that they're not responsible for what has happened to them. Many doctors like to blame some undiscovered gene or biochemical change for their patients' misery. This is because such doctors feel more comfortable with medical interpretations of events than with psychological interpretations. However, genes are very much affected by the environment, and despite the huge amount of time, money and effort that has been spent in the search for the genes that directly cause mental disorders, none has been discovered.
Serotonin levels
Changes in the levels of the chemicals (neurotransmitters) serotonin and noradrenaline have been found in the brains of people who are depressed - but not always. The biochemical changes that are associated with depression may be the result of the mood change rather than the cause of it, and no biochemical change has been found to precede the onset of depression. It is not correct to say that depression is caused by a chemical imbalance in the brain.
Genetics
It's often claimed that research shows that depression runs in families and is therefore genetically inherited. But analysis of this research still leaves this open to question. We usually inherit a lot about our environment from our parents as well as our genes. Much of what we get from our parents, is through learning. We can learn, from our family, ways of thinking that lead to distress. If a parent is constantly frightened and pessimistic, their child is likely to grow up believing that the world is a terrible place, and so the child becomes frightened and pessimistic.
Accept that you can change. Nobody stays the same, so you may as well change for the better. The big change that you need to make is to come to value and accept yourself. If you've spent most of your life believing that you're unacceptable and of little value, it's hard to change, because all your ideas and ways of behaving are based on that assumption.
The trick is to say to yourself, 'I don't think much of myself, but from now on I'm going to act as if I'm my own best friend. I'm going to be kind to myself, look after myself, and stop criticising myself and putting myself down.' Acting as if you're your own best friend will lead you to become that.
You need to be very aware of how you talk to yourself. Listen to the voice in your head. Write down the hurtful, critical things that voice says to you, and then think of better, kinder, more encouraging things to say to yourself. For instance, when you have to do something, if you always say to yourself, 'You're sure to fail. You always make a mess of everything you do', write that down, and then beside it put, 'You're going to do the best you possibly can. It doesn't matter if you don't get it perfectly right, because the good thing about mistakes is that you learn from them.' Practise saying encouraging things to yourself.
Question the assumptions on which you base your ideas. Is it really true that everybody in the whole world hates you, or that everything you've ever done has turned out badly? Is it really true that every unfortunate thing that happens to you is your punishment for being such a wicked person? Look at the consequences of your ideas. If you don't get close to anyone because you fear being rejected, doesn't it follow that you will always be lonely?
If you think of yourself as bad try to remember how you came to think of yourself that way. Is this what your parents or spouse always told you? Were you really bad, or were they taking their bad feelings out on you?
Writing these things down puts what you're thinking and feeling outside of yourself, and you can see it more clearly.
Talk it through
Talk about these things to other people and find out how they see things. Talk to friends, call at a local drop-in centre, join a self-help group.
Talking to a therapist or counsellor can be very helpful. There are many different kinds of therapies, but they all fall into one of two groups. There are prescriptive therapies and exploratory therapies. Prescriptive therapies, such as cognitive therapy, teach skills to overcome specific problems. Exploratory therapies, such as psychotherapy, explore your ideas and your experiences. Most therapists and counsellors use a bit of both.
Finding a therapist or counsellor can be difficult. Ask your GP whether there's a counsellor at their practice or whether she or he can refer you to an NHS psychologist or psychotherapist. See what your local Mind association has to offer. Look through the registers of psychotherapists and counsellors at your local library or on the internet (see 'Useful Organisations'). The fact that a psychotherapist's or counsellor's name is on a register isn't a guarantee that the person is an effective psychotherapist or counsellor. But it does mean that if something goes wrong, you can complain to that person's professional organisation. No therapist or counsellor can wave a magic wand and make you better, but they can act as a guide on your journey of self-discovery.
Remember, it's not what happens to us that causes our distress, but how we interpret what happens to us.
For example, if your mother always belittles and hurts you, and if you believe you have to visit her every week, then you make sure that you suffer.
If you decide that it isn't strictly necessary to see her every week and it's your responsibility to look after yourself, then you can control how often and for how long you see her. You'll create an emotional distance between yourself and her by seeing her not as your mother, but as a woman who prefers the immediate satisfaction of taking her bad feelings out on someone to the long-term satisfaction of having a loving child who wants to be with her.
This is what you need to do with all the things in your life that you can’t change: find an interpretation of events that you can live with. Don’t let these things dominate your life, taking up all your time and effort.
Even when life is at its most difficult, make sure that, every day, you give yourself something nice. This could be a treat, or time to do nothing but rest, chat with a friend, look at nature, or listen to music. Even if nobody else is looking after you, you can look after yourself. (See Mind's bookletHow to look after yourself.)
How can I stay well while caring for others who are in mental distress?
People who have gone through a period of mental distress will often say afterwards how much they appreciated having someone who was there for them, who encouraged and supported them, even though they did not show their appreciation at the time.
People in mental distress are struggling to hold themselves together as a person. It’s a fight for survival, and so often people in this situation become extremely selfish. Sometimes they can’t see anything of what other people are going through, and so they may become very difficult to live with. They may see everything in stark terms, as good or bad, or as right or wrong. Their sense of humour vanishes, and the most ordinary things become sources of anxiety, even terror. They may be quite reasonable one minute and totally unreasonable the next. Friends and family, no matter how loving and concerned they are, must take care of themselves.
If you're looking after someone in mental distress, it's vital that you have time to yourself to recover, to rest, and to enjoy some recreation. You shouldn't feel guilty about this. If you don't look after yourself, you'll be unable to look after anyone else.
When we see someone suffering anxiety, fear and despair, or being depressed, or hearing horrible voices, we long to take their suffering away from them. However, we shouldn't feel that it's our duty to make the person better, and that if they don't get better that we have failed. The truth is, only one person has the power to make that person better. We can give support and encouragment, we can give love and comfort, we can listen and try to understand, and all this can help the person. But it's the person who has to decide to change.
The person has to accept that they can change, and then to risk changing; that is, to act without guarantees or certainty about what change will mean. This isn't easy. Many of us decide to stay with the devil we know because, painful though that is, we feel secure in our misery, because we know what it is. It takes courage to decide to change.
I know many people who found that courage and now enjoy their life. All of them were very different people, living in very different circumstances, but each of them can say what was the important wisdom they learnt. It was, 'I am responsible for myself. The only person who can save me is me. I value and accept myself, and so I look after myself.'
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