Social anxiety disorder, or social phobia, is a common mental health issue affecting 15 million American adults.
As a psychologist, I’ve seen how social anxiety greatly impacts people’s lives.
The fear of judgment leads sufferers to avoid social situations and interactions.
This only worsens the problem, as isolation breeds more anxiety.
The good news is social anxiety is highly treatable through techniques like cognitive behavioral therapy and exposure therapy.
People with social anxiety can improve symptoms, change negative thoughts, and live fulfilling lives through proper treatment.
In this guide, I explain social anxiety disorder, its symptoms, causes, and effective treatments based on research.
What is Social Anxiety Disorder?
Social anxiety disorder involves intense fear of social situations and interactions. Sufferers are terrified they’ll act embarrassingly while others watch and judge them negatively.
This overwhelming anxiety drives them to avoid social events and speaking in front of groups.
People with social anxiety often experience physical symptoms like blushing, sweating, trembling, and nausea when in social situations. Even everyday activities like eating, drinking, writing, or presenting in front of others provoke extreme anxiety.
Sufferers convince themselves they are closely watched and critically evaluated at all times.
Many people experience some shyness or nerves when meeting new people or speaking publicly. But social anxiety sufferers have excessive fear persisting over six months that disrupts their lives significantly. Their anxiety exceeds normal reticence.
Social anxiety disorder typically starts in the early to mid-teens and is more common in women than men. Without treatment, it tends to last lifelong rather than naturally improving.
The disorder affects people from all walks of life.
But experiencing trauma, bullying, moving, or changing schools often precedes onset.
Common Symptoms of Social Anxiety Disorder
People with social anxiety disorder experience emotional, physical, and behavioral symptoms. Some common ones include:
- Intense fear and anxiety around social situations like parties, meetings, and public speaking
- Extreme fear of embarrassment, rejection, or judgment in social interactions
- Avoids speaking unless absolutely necessary
- Avoids eye contact and appears very shy
- Worries for days or weeks before an upcoming event
- Blushes, sweats, trembles, or feels nauseated around others
- Rapid heartbeat, shortness of breath, dizziness in social situations
- Extreme self-consciousness and fear of showing anxiety signs
- Worrying people notice every flaw, mistake or imperfection
- Fearing people will judge them as stupid, awkward or boring
- Severe anxiety impairs focus and absorbing information
- After events, analyzes every mistake, flaw and imperfection
- Avoids activities involving social interaction
- Some use drugs or alcohol to manage anxiety
As you can see, social anxiety disorder exceeds normal shyness, apprehension, or occasional nervousness. It’s constant, intense wariness about social interactions that hugely impacts daily life.
Sufferers know their anxiety is excessive but struggle to control it without help and techniques.
Social anxiety is not a personality trait that can be willed away. It’s a disorder rooted in biological and psychological factors.
Causes of Social Anxiety Disorder
Social anxiety disorder arises from genetic, biological, emotional, and environmental factors. Research indicates:
- Genetics – It tends to run in families, pointing to genetic differences. Gene variations regulating brain chemicals like dopamine and norepinephrine link to risk.
- Brain structure and function – People with social anxiety tend to have a hyperactive amygdala and differences in neurotransmitter release.
- Trauma, bullying, loss, and family problems often precede onset.
- Those with social anxiety have exaggerated thinking patterns about scrutiny.
- Lack of social exposure contributes to poorer skills, more anxiety and avoidance.
- Sufferers often have distorted, critical self-views fueling anxiety about others’ perceptions.
- Avoiding feared situations brings short-term relief, so avoidance is learned and reinforced over time.
Social Anxiety Disorder Treatment
Experts recommend Cognitive behavioral therapy (CBT) as the best psychological treatment for social anxiety. CBT helps patients identify, challenge, and overcome unhelpful thoughts and behaviors sustaining anxiety.
Effective CBT techniques include:
This gradually exposes patients to feared social situations in a controlled, therapeutic setting. “Exposure training” teaches feared consequences won’t happen. With enough practice, anxiety naturally decreases.
The therapist helps patients identify negative automatic thoughts fueling anxiety like “everyone will think I’m stupid.” Together they challenge those thoughts and replace them with realistic, helpful alternatives.
Social Skills Training
Many social anxiety sufferers have skill gaps from avoidance. The therapist uses instruction, modeling and role play to teach effective social skills.
These techniques help control anxiety when entering challenging situations. Examples are deep breathing, mindfulness and muscle relaxation.
CBT uses a tailored, multi-pronged approach based on the patient’s unique symptoms. Improvement usually occurs within 12-16 weeks, although session number varies. CBT provides lifelong tools to prevent future flare-ups.
Doctors may prescribe antidepressants like SSRIs with CBT to further reduce symptoms.
While options like Prozac, Zoloft and Paxil can help, medication alone is usually less effective than combined treatment. Many patients also dislike side effects and prefer to avoid medication if possible.
This exposes patients to social interactions in a therapeutic setting. Group CBT helps retrain unhelpful thoughts and build skills. It can augment individual CBT.
Joining a group provides community, social practice, and motivation to confront fears. Professionals lead these groups using set formats.
More exercise, better sleep and diet, stress management, and less alcohol can also help treatment. Some supplements may assist too.
With proper tailored treatment, around 75% of patients achieve significant symptom relief. They can live life fully and enjoy social interactions without disabling fear and worry.
The first step is acknowledging the problem rather than hiding it. Help is available.