Social anxiety disorder

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.

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.

Video: You'll Never See Social Anxiety The Same After Watching This

This animated video explains why people experience social anxiety symptoms, the underlying reasons behind these feelings and how they can be overcome. This video may take a few moments to load.

(Sebastiaan van der Schrier, 2015)

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. 

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. 

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. 

Read more about living well with social anxiety below.

Video: Real Stories - Jo talks about social anxiety

This video may take a few moments to load.

(NHS, UK, 2011)

Apps reviewed by Healthify

You may find it useful to look at some Mental health and wellbeing apps and Nutrition, exercise and weight management apps.

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

There are things you can do to care for yourself and reduce the effect your anxiety has on your life. 

Learn about social anxiety

Start with the brochures, self-help books, videos, apps ,or online courses listed on this page. It can really help to understand how anxiety develops, to find out that you’re not alone, and to learn the techniques that other people have used to recover from or manage their social anxiety better. This helps you to take charge of your fear, rather than your fear being in charge of you. 

Learn a controlled breathing or relaxation technique

Learning how to breathe deeply can reduce anxiety and feelings of panic when you encounter situations that trigger your social anxiety. Find out more about managing panic.

Learning how to do progressive muscle relaxation can help you with general relaxation, as well as relaxing before entering a social situation. See, eg, How to do progressive muscle relaxation(external link) AnxietyBC, Canada.

Try a self-help programme

It can be really helpful to try a self-help programme. The following are recommended:

• a workbook such as Shy no longer(external link) (Centre for Clinical Interventions, Australia)
• a book like Gillian’s Butler’s Overcoming social anxiety and shyness – a self-help guide using cognitive behavioural techniques(external link) 
• an online programme like This Way Up(external link).

Get help if you need it

Although there is a lot you can do to support yourself, it’s also okay to ask for help. Talking therapy can help a lot, and if you need it you can also get medication that helps. 

Find a counsellor or therapist(external link) or a psychologist(external link) or a clinical psychologist(external link) and talk to your doctor about whether medication would help you. It can be helpful to ask if the health professional is trained in cognitive behaviour therapy, as this is currently the treatment of choice for social anxiety. 

Join a support group

Joining a support group in your area is a good way to learn from other people ideas for managing social phobia, as well as feeling as though someone else understands what you are experiencing. Ask your doctor, phone Healthline 0800 611 116 or Anxiety NZ 0800 ANXIETY (0800 269 4389) to see if there is one in your area. If you can’t go out to a group, check out the online forums and find one that works for you. 

Stretch yourself

If you feel you can confront your social anxiety, the best strategy is to face the social situations in small doses as often as possible. It’s very empowering to learn that you can feel the feel the fear and do it anyway!

If you have recovered from a social phobia, it’s a good idea to keep practicing being in a situation you used to fear. For example, if you know you are quite anxious about meeting new people, don’t avoid doing this. If you take every opportunity to meet new people, your confidence will grow. 

Stay connected to others

Tell your family and friends what you are experiencing. Help them to understand that telling you to just relax or ignore your fears won’t help. Tell them that what you need instead is their support and encouragement for you to slowly understand and face your anxiety, one small step at a time. They can also help by coming to social situations with you so you don’t need to manage on your own. 

Stay engaged with your life

Your social anxiety doesn’t affect every aspect of your life, so make sure you keep up your activities and interests that aren’t affected by your social anxiety. This improves your quality of life and resources you for dealing with your social phobia. 

Avoid alcohol and other drugs

Alcohol and other drugs are not recommended for managing your social anxiety. You will probably feel more anxious afterwards making your anxiety worse. Read more about alcohol and mental health alcohol and mental health. 

Be physically active

We now know that exercise benefits your mind as well as your body. In particular, researchers have found that regular exercise can help you to manage anxiety, include panic disorder and social anxiety. Find out more about physical activity and mental health and the general benefits of being active. 

Spend time in nature

Nature is key to unlocking your wellbeing. Researchers have found that spending time in nature improves your physical and mental wellbeing. Find out some ideas for ideas for spending time in nature. 

Eat a healthy diet

Eating to ensure you have good nutrition gives you the sustained energy to help you to manage your anxiety. Learn more about healthy eating basics.   

Find a greater purpose

Connecting with something that has greater meaning can be a useful support when you are managing any mental health issue, including a social anxiety. This could be through religion or spirituality, through connecting with your culture or whakapapa, through a creative project, or through volunteering or helping others in need. This can distract you from your own problems for a while and build your resilience to manage your anxiety when they affect you.