Social anxiety: more than shyness, and what helps

Social anxiety, also called social phobia, is a long-lasting and overwhelming fear of social situations, usually centred on being judged, criticised or embarrassed. The NHS describes it as more than shyness: it is a persistent fear that affects everyday activities, confidence, relationships and work. It is common, it often starts in the teenage years, and it is very treatable, with cognitive behavioural therapy (CBT) recommended as the first choice.

Key points

• Shyness is a mild fear that does not usually get in the way of life. Social anxiety does.
• People with social anxiety often worry before, during and after social situations, not just in the moment.
• Physical signs such as blushing, sweating, trembling and a pounding heart are common, and can themselves become a focus of fear.
• “Safety behaviours”, like avoiding eye contact or rehearsing what to say, bring relief but can keep the anxiety going.
• NICE recommends individual CBT developed specifically for social anxiety. In England you can refer yourself to NHS Talking Therapies.

What is the difference between shyness and social anxiety?

Most people feel nervous in some social situations, such as a job interview, a first date or a speech. Shyness is a quieter, milder version of this, and many shy people still live full social lives. The Royal College of Psychiatrists explains that a fear becomes a phobia when it stops you enjoying things or doing them easily.

With social anxiety, the fear is stronger and more persistent. You might spend days dreading an event, feel intensely self-conscious while you are there, and then go over every moment afterwards looking for things you got wrong. The Royal College of Psychiatrists estimates that around 5 in 100 people have some degree of social phobia, so if this sounds familiar, you are far from alone.

For some people the fear covers many situations, such as meeting new people, eating in front of others or going into shops. For others it is more specific, for example speaking or performing in front of a group, while they feel fairly comfortable socialising otherwise.

What are the signs of social anxiety?

The NHS lists signs including:

• Worrying about everyday activities such as meeting strangers, starting conversations, speaking on the phone, working or shopping.
• Avoiding or dreading group conversations, eating with company and parties.
• Fear of doing something you think is embarrassing, such as blushing, sweating or appearing incompetent.
• Feeling that you are always being watched and judged.
• Fear of criticism, avoiding eye contact and low self-esteem.
• Physical symptoms such as feeling sick, sweating, trembling or a pounding heartbeat.
• Panic attacks, where you have an overwhelming sense of fear for a few minutes.

The NHS also notes that social anxiety often happens alongside other difficulties, such as depression, generalised anxiety disorder or panic disorder. If you experience sudden surges of fear, our guide on what to do during a panic attack may help.

What keeps social anxiety going?

Social anxiety tends to run on a set of predictions: “I’ll say something stupid”, “they’ll see I’m nervous”, “everyone will think I’m odd”. When you go into a situation expecting this, your attention often turns inwards. You monitor your voice, your face and your hands, which makes you feel more awkward and gives you less attention for the actual conversation.

To cope, many people use what are known as safety behaviours. The Royal College of Psychiatrists gives examples such as avoiding eye contact, not sharing anything personal, asking lots of questions so the focus stays on the other person, or having a drink beforehand to feel able to go in. Others include rehearsing sentences, holding a glass to hide shaking hands, or staying near the door.

These make complete sense, and they can bring short-term relief. The difficulty is that they stop you finding out that the feared outcome often does not happen, or that it is more bearable than you expected. If the evening goes well, it can feel as if you only got through because of the safety behaviour. Avoidance works in a similar way: staying away from situations brings relief, but over time the world can shrink.

The going-over afterwards matters too. Replaying a conversation in detail, focusing on the moments that felt awkward, can leave you with a harsher picture of how things went than anyone else would have. If this kind of self-criticism is familiar, our guide to the inner critic explores it further.

What can I do to help myself?

Self-help can be a useful first step, and many people use it alongside therapy. The NHS and the Royal College of Psychiatrists suggest ideas such as:

1. Keep a diary of your thoughts, feelings and behaviour in social situations, so you can see your patterns more clearly.
2. Break difficult situations into smaller steps and work through them gradually, starting with the easiest.
3. Shift your attention outwards. Try to focus on what other people are saying rather than on how you think you are coming across.
4. Drop safety behaviours one at a time, beginning with the easiest, and notice what actually happens.
5. Practise relaxation, such as a slow breathing exercise, to help settle the physical symptoms.

Go gently with this. The aim is not to force yourself into the most frightening situation, but to build up experience bit by bit, so that your mind has a chance to update its predictions.

What treatment is available?

The NHS describes CBT as generally the best treatment for social anxiety. It helps you identify unhelpful thoughts and behaviours and gradually change them. NICE recommends that adults are offered individual CBT designed specifically for social anxiety. NICE notes that group CBT is not usually preferred over individual CBT. These specialised forms of CBT typically include learning about social anxiety, practising shifting attention outwards, testing out feared predictions, and working on the worry before and after events.

For people who would prefer not to have CBT, NICE suggests CBT-based supported self-help, where you work through a self-help book with some support from a practitioner. Medication, usually an SSRI antidepressant such as escitalopram or sertraline, is another option, and is something to discuss with your GP. NICE also describes a form of short-term psychodynamic psychotherapy developed for social anxiety, which focuses on relationships and feelings such as shame, though it notes the evidence is more limited than for CBT.

Your GP is a good first contact, especially if social anxiety is having a big effect on your life. In England, you can also refer yourself directly to NHS Talking Therapies without seeing your GP first.

How therapy with me can help

As an integrative psychotherapist registered with the BACP, I work with adults experiencing many kinds of anxiety, including fear of judgement in social situations. Drawing on CBT-informed ideas, we can look at the predictions and safety behaviours that keep the fear in place and think about manageable steps. Using person-centred and psychodynamic approaches, we can also explore where the fear of being judged might come from, and the shame or self-criticism that often sits underneath it, at a pace that feels safe.

Some people with social anxiety find it easier to start therapy from home. Sessions are available in Farringdon, Central London, or online, in English or Turkish.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If fear of judgement is holding you back from the life you want, you are welcome to get in touch to arrange an initial consultation. We can talk about what has been happening and whether working together feels right for you.