Social Anxiety Disorder
What is Social Anxiety Disorder?
Social anxiety disorder, also known as social phobia, is a mental health condition where a person experiences intense fear or anxiety in social situations. This goes beyond ordinary shyness. People may avoid conversations, public speaking, or even daily activities because of fear of being judged, embarrassed, or rejected.
It is classified under Anxiety Disorders in the DSM-5.
Social anxiety disorder affects about 7% of the U.S. population in any given year.
NIMH: National Institute of Mental Health [source]
SYMPTOMS AND PATTERNS
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This can include speaking in front of others, meeting new people, eating in public, or even walking into a crowded room. The fear often feels uncontrollable and disproportionate to the actual situation.
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Many individuals spend hours or even days beforehand worrying about a social interaction. They may replay conversations in their minds afterward, analyzing every detail for mistakes or signs of rejection.
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When faced with feared situations, the body often reacts strongly. Symptoms may include blushing, trembling, excessive sweating, nausea, dizziness, or a racing heartbeat. These reactions can heighten self-consciousness, reinforcing the cycle of anxiety.
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To cope with the overwhelming discomfort, people may start avoiding social situations altogether. This can mean skipping school, refusing work presentations, or declining invitations to social gatherings. In some cases, individuals force themselves through events but endure them with intense inner distress, which can be exhausting and isolating.
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Even after an interaction has ended, the anxiety often continues. Many people dwell on what they said or how they behaved, convinced they appeared awkward or foolish — even when others noticed nothing unusual.
WHAT TREATMENTS ARE AVAILABLE?
PSYCHOTHERAPY
CCBT is the most well-researched and effective psychotherapy for social anxiety disorder. It focuses on identifying and reshaping the negative thought patterns that fuel fear of judgment and embarrassment. Over time, individuals learn to challenge anxious thoughts, reduce avoidance behaviors, and develop healthier coping strategies. CBT can also be delivered effectively outside of traditional face-to-face sessions. Online modules, video therapy, and telehealth options allow more people to access this treatment in flexible ways.
EXPOSURE THERAPY
Exposure therapy is a specific CBT-based technique that gradually and systematically helps individuals face the social situations they fear. By confronting these fears step by step, such as starting with speaking in front of a small group and working up to larger settings, people often find their anxiety decreases and their confidence grows.
SOCIAL SKILLS TRAINING
For many, social anxiety is connected to uncertainty about how to interact with others. Social skills training provides structured opportunities to practice communication, eye contact, assertiveness, and conversation techniques in a safe, supportive environment.
GROUP THERAPY
Participating in therapy groups can be especially powerful for people with social anxiety. These groups provide a supportive setting where individuals can share experiences, practice social interactions, and receive feedback from others who understand what they are going through.
MEDICATION
ELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
SSRIs such as sertraline (Zoloft) and paroxetine (Paxil) are often the first-line medications for social anxiety disorder. They help regulate serotonin levels in the brain, reducing the intensity of anxiety over time.
SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)
Medications such as venlafaxine (Effexor XR) may also be prescribed. These affect both serotonin and norepinephrine and can be effective in reducing symptoms.
BETA-BLOCKERS
Beta-blockers are sometimes used for individuals with performance-only social anxiety (such as public speaking). They help manage the physical symptoms of anxiety, such as rapid heartbeat and trembling.
BENZODIAZEPINES
These medications can provide short-term relief of severe anxiety but carry risks of dependency. They are generally not recommended for long-term use, but may be considered in specific circumstances under close medical supervision..
Antidepressants. Many antidepressants may also be useful for treating anxiety. These can also be useful if your anxiety has a co-occurring depression.
SELF MANAGEMENT
Mindfulness and Relaxation Techniques
Limiting caffeine and alcohol
Preparing ahead for social events
Gradual exposure
Joining support groups
HOW DO I GET HELP?
BECOME AN EXPERT
Educate yourself about social anxiety disorder, treatment options, and coping strategies. Explore resources from trusted organizations such as the National Institute of Mental Health (NIMH) and the Anxiety & Depression Association of America (ADAA). The more you understand the condition, the more empowered you’ll be in making treatment decisions.
KNOW YOUR TRIGGERS AND STRESSORS
Pay attention to which situations cause the most anxiety. For example, if speaking up in large meetings feels overwhelming, consider practicing in smaller groups first. If eating in public makes you nervous, try going out with a close friend before facing larger social settings. Awareness of triggers helps you prepare and build strategies to reduce stress.
PARTNER WITH YOUR HEALTH CARE PROVIDERS
Work closely with your doctor, therapist, or psychiatrist to create a plan that fits your needs. Share your goals, be honest about your struggles, and actively participate in your treatment. Progress may be gradual, so stay consistent and talk openly about adjustments that may help.
GET HEALTHY
Lifestyle choices strongly influence anxiety. Regular exercise, balanced nutrition, and healthy sleep patterns all contribute to emotional well-being. Activities such as yoga, Tai Chi, or meditation can help reduce stress and regulate mood.
AVOID DRUGS AND ALCOHOL
Although substances like alcohol or recreational drugs may feel like they reduce anxiety in the moment, they often make symptoms worse in the long run. They can also interfere with medications and disrupt sleep, ultimately heightening anxiety levels.
