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Social anxiety

by Psychologytherapy
Social anxiety, shy

What is social anxiety?

Social anxiety is an anxiety disorder characterised by an irrational fear to social situations. The person behaves in a shy and anxious way in these types of settings, and this makes it difficult to engage or interact with other people, which can have a real impact on the person’s daily life.

It is considered a disorder when the intensity of the phobia or fear experienced is intense and excessive, irrational, and impacts the person’s life.

Some of the worries or thoughts that cause the anxiety are:

  • Worry or desire to avoid being the centre of attention at all costs.
  • Fear to be seen eating or drinking in public.
  • Fear to talk in front of other people, or even with friends.
  • Difficulty facing certain tasks at work that involve making complaints.
  • Tendency to avoid closed places where there are other people.
  • Fear to suffer embarrassment in public.


People that suffer from social anxiety feel an irrational fear when facing social situations, as they believe other people can look at them or judge them.

The National Institute of Mental Health (NIMH) explains that this disorder “sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety”.

The problem can start during teenagerhood and the trigger can be having overprotective parents or limited social opportunities.

Social anxiety affects the same to men and women, and patients with this disorder tend to be more disposed to develop drug addiction or alcoholism, as these substances can help to inhibit the person and socializing better.

People with social anxiety is aware of the irrationality of their thoughts and fears, but it is difficult for them to stop anticipating negative irrational outcomes.


People with social anxiety suffer from anxiety and extreme shyness in social situations of daily life. The fear is persistent and chronic, and therefore, the anxiety can last days or even weeks.

This phobia can be focused on a specific social situation or it can be broader and affect any type of social interaction with anyone that is not a member of the person’s family.

As the Anxiety and Depression Association of America (ADAA) explains, social anxiety can make patients to decline a job opportunity that requires frequent interaction with new people or avoid going out to eat with friends due to a fear that their hands will shake when eating or drinking.

Some of the physical symptoms include:

  • Blushing.
  • Stumbling over words.
  • Having dry mouth.
  • Difficulty speaking.
  • Sweating intensely.
  • Nauseas.
  • Rapid heart rate.
  • Shaking and palpitations.
  • Problems focusing that lead to forgetting information or ideas that the person wanted to share when speaking.

Social anxiety is not the same as shyness, as people that is shy is able to participate in social situations, whereas people with social anxiety are blocked and incapable to engage, which makes them to isolate. If the condition is very severe, the person with social anxiety can suffer from panic attacks.


There are two types of social anxiety depending on the focus of the fear:

  • Broad social anxiety: when the person fears any social situation.
  • Specific social anxiety: the person develops fear to specific moments or situations, such as speaking in public or eating in public.


The purpose of the treatment is for the patient to be able to have a normal social life and lose the intense fear in the problematic circumstances.

The main treatment for social anxiety is physiotherapy and medication. The type of therapy most useful for any kind of anxiety disorder is Cognitive-Behavioural Therapy (CBT), where the therapist helps the person to identify the irrational thoughts and challenge them, replacing them for other more productive and realistic thoughts.

CBT should include Exposure Response Therapy (ERP), as part of the therapy. This is a method that consists of exposure to the feared situations. By doing this, the anxiety will raise, but with time it will start dropping, as the person will adapt to the feeling. If doing this multiple times, the anxiety will be less intense each time, as the brain will adapt and see that the most feared consequences won’t happen.

It is possible to use antidepressant medication, usually selective serotonin reuptake inhibitor (SSRI), such as escitalopram or sertraline. This can help to reduce the symptoms and anxiety and makes it easier for the person to engage with the CBT and ERP.

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