Social anxiety disorder

Also known as social phobia

Social anxiety is a fear of social activities and situations largely because you think others might be judging you negatively. Fortunately, there are things you can do to help yourself and there are people and resources to support you.

Key points

  1. Social anxiety is a type of anxiety disorder that is much more than just being shy – it's an intense fear that when you are in a social situation you will be judged, humiliated or embarrassed.
  2. Most people with social anxiety know that it's not rational to be so scared of social situations, but they feel they can't control their fear.
  3. Social anxiety can also sometimes occur when doing common things when others are around such as eating, speaking, drinking, writing or going to the bathroom.
  4. It can lead to withdrawing from contact with others and affecting your everyday activities, self-confidence, relationships, and work or school life.
  5. Social anxiety often starts in your pre-teen years.
  6. The good news is there are things you can do to help yourself feel less anxious and self-conscious and there are resources and people to help you.

What is social anxiety?

It’s common for most of us to have occasional moments where social situations can feel a bit daunting, but someone with social anxiety experiences strong anxiety or panic in most social situations.

In some way, anxiety about social encounters sits on a bit of continuum: at the low end is shyness, where you might be a little concerned about social situations but you go along anyway. Next is social anxiety where you have an intense fear about being judged by others that might lead you to avoid social events or tolerate them with significant distress. Lastly, at the top end of the spectrum is avoidant personality disorder. This is when an extreme sensitivity to being judged negatively and the possibility of being rejected leads to avoidance of social interactions.

What are the causes of social anxiety?

There doesn’t seem to be one cause of problems with anxiety, but there are several factors that might play a part in developing anxiety in social situations.

  • A specific incident or event – if you experienced shame or humiliation in a particular situation, you may develop anxiety about similar situations or experiences that you associate with that event.
  • Family environment – parents who were very worried or anxious when you were growing up can have an effect on the way you cope with anxiety in later life, and you may even develop the same anxiety as a parent or older sibling.
  • Genetics – some people appear to be born with a tendency to be more anxious than others, which can develop into an anxiety disorder.
  • Long-term stress – this can cause feelings of anxiety and depression, and reduce your perceived ability to cope in particular situations. This can make you feel more fearful or anxious about being in those situations again, and over a long period, may increase your anxiety about those situations.

What are the symptoms of social anxiety?

You may have social anxiety if you have a combination of some of the following:

  • worry about your performance and being judged by others when you are in social situations
  • dread or avoid everyday activities, such as meeting strangers, starting conversations, speaking on the phone, catching public transport, or talking to shop assistants
  • avoid or worry a lot about social activities, such as group conversations, eating with company, and going to parties
  • worry about doing something in public that you think is embarrassing, such as blushing, sweating, or making some social error
  • find it difficult to do things when others might be watching – like eating, drinking, or writing
  • often have symptoms such as feeling queasy, hot, sweating, trembling or a pounding heartbeat (palpitations) when anticipating or entering social situations
  • have panic attacks panic attacks, where there is an overwhelming sense of fear and anxiety (usually only for a few minutes).

Some people with social anxiety may also have other mental health issues, such as depression, generalised anxiety disorder or body dysmorphic disorder. 

How is social anxiety treated?

Most people who suffer from anxiety find relief from their symptoms when treated with therapy, medication, and psychoeducation, or a combination of these. These can help you feel less anxious and fearful and manage social situations more easily. 

Psychoeducation

Psychoeducation can be a helpful first step towards recovering from or managing your anxiety better. You can start by looking at the self-help books and websites suggested on this page. They can help you:

  • understand how social anxiety develops
  • find ways of describing what happens to you, including problems that you may have kept completely to yourself up to now
  • teach you about some of the ways of dealing with your anxiety
  • learn about how addressing your anxiety can help you engage more in social situations
  • realise that you are not alone – lots of people experience anxiety, and especially social anxiety, and most learn ways to manage better enabling them to engage more socially. 

Counselling or therapy

There are trained professionals who know about anxiety and how to help someone who is struggling with their anxiety. They can provide you with support and help for working through distressing thoughts and feelings you have and support you to make positive changes in your life. For some people, it might be helpful to understand why your social anxiety developed and may involve processing earlier negative events. For others, this is not important or useful and, instead, the key is to focus on evaluating and changing your thinking, emotions and behaviour.

Cognitive-behavioural therapy (CBT), a psychological therapy that largely focuses on challenging and changing unhelpful thoughts and beliefs, has been shown to work well with social anxiety disorder.  It can be important to understand that sometimes your thinking can be distorted, and that distorted thinking doesn’t make you feel great, so then you avoid situations, which creates a negative loop that can make you feel stuck. While much of therapy involves talking about your experience, it also involves taking some action towards change. Making changes can be difficult, but this is always done in collaboration with your therapist, and at a pace that is right for you.

If you experience social anxiety, you may also benefit from training in social skills or assertiveness techniques. These may be taught either individually by a therapist or counsellor, or in a group. 

Medication

Antidepressant medication that has an anxiolytic (anxiety reducing) effect has been demonstrated effective, alongside therapy, in improving the symptoms of anxiety. Medications such as selective serotonin reuptake inhibitors (SSRIs) may be used together with anxiety management techniques and psychological therapy. These may be prescribed to help manage your anxiety, as well as to help you engage with psychological treatments. The choice of medication will depend on your preference, response to previous medication, and consideration of possible side effects. 

How can I care for myself with social anxiety?

The key things you can do to help yourself are to:

  • learn about anxiety and how to manage and improve your symptoms of anxiety
  • learn a controlled breathing or relaxation technique
  • get help if you need it
  • join a support group
  • stretch yourself a small step at a time in confronting your social anxiety
  • stay connected to others
  • stay engaged with the rest of your life that’s not affected by your anxiety
  • avoid alcohol and other drugs
  • be physically active
  • spend time in nature
  • eat a healthy diet. 

Find out more about living well with social anxiety.

What support is available with social anxiety?

1737 Free call or text 24/7 to talk to a trained counsellor
Anxiety New Zealand Trust 24/7 anxiety helpline phone 0800 14 269 4389 Auckland
Wellington anxiety specialists Wellington phone 04 386 3861
Social Anxiety Support Canterbury phone 03 377 9665
Find a GP or counsellor Mental Health Foundation of NZ
New Zealand College of Clinical Psychologists phone 04 801 6088
Grow A support group for mental wellness using the 12-step programme run by people who have experienced mental illness. 

Learn more

The following links provide further information about social phobia or anxiety. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Social anxiety NHS, UK, 2017
Social anxiety disorder Patient Info, UK, 2016
Social anxiety disorder – more than just shyness National Institute of Mental Health, US

Online courses 

Social phobia course Evidence-based online course to do on your own or with clinician support. This Way Up, Australia
Coping with social anxiety Centre for Clinical Interventions. Australia, 2016
Aunty Dee Free online tool that uses structured problem solving to help you work through your problems, LeVa, NZ, 2017
Moodzone – anxiety control training podcast NHS, UK, 2015

References

  1. Understanding phobiasMind, UK, 2014
  2. PhobiasMental Health Foundation, NZ, 2014
  3. Social anxiety disorder Institute for Clinical Excellence, UK, 2013
  4. Social anxiety disorder  National Institute for Health & Care Excellence, UK

Reviewed by

Dr Angela McNaught is a clinical psychologist with more than 15 years’ experience working in community mental health, psychiatric liaison and private practice. She held a senior lecturer post in the Cognitive Behaviour Therapy (CBT) post-graduate programme at Massey University for 9 years, and currently teaches CBT to psychiatry registrars through Auckland University.  She now works primarily in private practice and has a keen interest in social anxiety disorder as well as mood and personality disorders.
Credits: Health Navigator Editorial Team . Reviewed By: Angela McNaught, Clinical Psychologist Last reviewed: 25 Mar 2019