Social anxiety (social phobia): Everything you need to know

Social anxiety disorder, also called social phobia, is a long-term and overwhelming fear of social situations.  A person may worry that people will harshly judge them or reject them. These symptoms may be so severe that they hinder a person’s daily life.

Social anxiety, also known as social phobia, can be triggered in a variety of situations such as:

  • Using public restrooms
  • Entering a room filled with people
  • Eating in front of someone else
  • Attending class
  • Going to work
  • Starting a new conversation
  • Dating
  • Going to a party
  • Making eye contact with someone
  • Speaking in public or giving a speech to a large group of people
  • Talking to strangers

While these situations may not seem like a big deal to some people, they can still cause social anxiety and apprehension in people living with social phobia.

Common Causes Of Social Anxiety

What causes someone to develop social anxiety disorder? Like most mental health disorders, social anxiety disorder is caused by the intricate interaction among a variety of biological and environmental factors. Common causes stem from inherited traits, an overactive amygdala, and learned behavior. Let’s explore each common cause of social anxiety together.

  • Genetic Predisposition: Mental health issues such as social anxiety can run in families. However, researchers aren’t entirely sure whether this occurs due to genetics or learned behavior.
  • Amygdala: The amygdala, a structure in the brain that could be involved in controlling the fear response, is sometimes overactive in individuals with a social anxiety disorder. Patients with an overactive amygdala tend to experience a heightened fear response, resulting in increased levels of anxiety during social situations.
  • Past Events: Past social situations that ended in embarrassment may cause people to develop a social anxiety disorder.
  • Environment: Parents who display anxieties and phobias toward specific social situations may pass these tendencies onto their children. Children of overprotective or over-controlling parents may also develop social anxiety.

It’s a common problem that usually starts during the teenage years. It can be very distressing and have a big impact on your life.

For some people it gets better as they get older. But for many people it does not go away on its own without treatment.

It’s important to get help if you are having symptoms. There are treatments that can help you manage it.

Symptoms of social anxiety

Social anxiety is more than shyness. It’s a fear that does not go away and affects everyday activities, self confidence, relationships and work or school life.

Many people occasionally worry about social situations, but someone with social anxiety feels overly worried before, during and after them.

You may have social anxiety if you:

  • worry about everyday activities, such as meeting strangers, starting conversations, speaking on the phone, working or shopping
  • avoid or worry a lot about social activities, such as group conversations, eating with company and parties
  • always worry about doing something you think is embarrassing, such as blushing, sweating or appearing incompetent
  • find it difficult to do things when others are watching – you may feel like you’re being watched and judged all the time
  • fear being criticised, avoid eye contact or have low self-esteem
  • often have symptoms like feeling sick, sweating, trembling or a pounding heartbeat (palpitations)
  • have panic attacks, where you have an overwhelming sense of fear and anxiety, usually only for a few minutes

Many people with social anxiety also have other mental health issues, such as depression, generalised anxiety disorder or panic disorder.

When to get help for social anxiety

It’s a good idea to see a GP if you think you have social anxiety, especially if it’s having a big impact on your life.

It’s a common problem and there are treatments that can help.

Asking for help can be difficult, but a GP will be aware that many people struggle with social anxiety and will try to put you at ease.

They’ll ask you about your feelings, behaviours and symptoms to find out about your anxiety in social situations.

If they think you could have social anxiety, you’ll be referred to a mental health specialist to have a full assessment and talk about treatments.

You can also refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.

Things you can try to overcome social anxiety

Self-help can help reduce social anxiety and you might find it a useful first step before trying other treatments.

The following tips may help:

  • try to understand more about your anxiety – by thinking about or writing down what goes through your mind and how you behave in certain social situations, it can help to keep a diary
  • try some relaxation techniques, such as breathing exercises for stress
  • break down challenging situations into smaller parts and work on feeling more relaxed with each part
  • try to focus on what people are saying rather than just assuming the worst

Treatments for social anxiety

A number of treatments are available for social anxiety.

The main options are:

  • Cognitive behavioural therapy (CBT) with a therapist, which is therapy that helps you identify negative thought patterns and behaviours, and change them. This can be done with just you and a therapist, in a group or with your parents or carers.
  • Guided self-help, which involves working through a CBT-based workbook or online course with regular support from a therapist.
  • Antidepressant medicines, usually a type of medicine called a selective serotonin reuptake inhibitor (SSRI), such as escitalopram or sertraline. These are usually not used to treat people under the age of 15.

CBT is generally considered the best treatment, but other treatments may help if it does not work or you do not want to try it.

Other medications

Your health care provider may also prescribe other medications for symptoms of social anxiety, such as:

  • Other antidepressants. You may have to try several different antidepressants to find the one that’s most effective for you with the fewest side effects.
  • Anti-anxiety medications. Benzodiazepines (ben-zoe-die-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they’re typically prescribed for only short-term use.
  • Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They’re not recommended for general treatment of social anxiety disorder.

Lifestyle and home remedies

Although social anxiety disorder generally requires help from a medical expert or qualified psychotherapist, you can try some of these techniques to handle situations that are likely to trigger symptoms:

  • Learn stress-reduction skills.
  • Get physical exercise or be physically active on a regular basis.
  • Get enough sleep.
  • Eat a healthy, well-balanced diet.
  • Avoid alcohol.
  • Limit or avoid caffeine.
  • Participate in social situations by reaching out to people with whom you feel comfortable.

Practice in small steps

First, consider your fears to identify what situations cause the most anxiety. Then gradually practice these activities until they cause you less anxiety. Begin with small steps by setting daily or weekly goals in situations that aren’t overwhelming. The more you practice, the less anxious you’ll feel.

Consider practicing these situations:

  • Eat with a close relative, friend or acquaintance in a public setting.
  • Purposefully make eye contact and return greetings from others, or be the first to say hello.
  • Give someone a compliment.
  • Ask a retail clerk to help you find an item.
  • Get directions from a stranger.
  • Show an interest in others — ask about their homes, children, grandchildren, hobbies or travels, for instance.
  • Call a friend to make plans.

Prepare for social situations

At first, being social when you’re feeling anxious is challenging. As difficult or painful as it may seem initially, don’t avoid situations that trigger your symptoms. By regularly facing these kinds of situations, you’ll continue to build and reinforce your coping skills.

These strategies can help you begin to face situations that make you nervous:

  • Prepare for conversation, for example, by reading about current events to identify interesting stories you can talk about.
  • Focus on personal qualities you like about yourself.
  • Practice relaxation exercises.
  • Learn stress management techniques.
  • Set realistic social goals.
  • Pay attention to how often the embarrassing situations you’re afraid of actually take place. You may notice that the scenarios you fear usually don’t come to pass.
  • When embarrassing situations do happen, remind yourself that your feelings will pass and you can handle them until they do. Most people around you either don’t notice or don’t care as much as you think, or they’re more forgiving than you assume.

Avoid using alcohol to calm your nerves. It may seem like it helps temporarily, but in the long term it can make you feel even more anxious.

Some people need to try a combination of treatments.

Social anxiety in children

Social anxiety can also affect children.

Signs of social anxiety in a child include:

  • crying or getting upset more often than usual
  • getting angry a lot
  • avoiding interaction with other children and adults
  • fear of going to school or taking part in classroom activities, school performances and social events
  • not asking for help at school
  • being very reliant on their parents or carer

Speak to a GP if you’re worried about your child. They’ll ask you about your child’s behaviour and talk to them about how they feel.

Treatments for social anxiety in children are similar to those for teenagers and adults, although medicines are not normally used.

Therapy will be tailored to your child’s age and will often involve help from you.

You may be given training and self-help materials to use between sessions. It may also take place in a small group.