Social Anxiety: Symptoms and Treatment

Social anxiety is the fear of social situations and interaction with other people that automatically bring on feelings of self-consciousness, judgment, evaluation, and criticism. Social anxiety is the fear of being judged and evaluated negatively by other people, leading to feelings of inadequacy, embarrassment, humiliation, and depression.  If a person usually becomes anxious in social situations, but seems fine when they are alone, then "social anxiety" may be the problem.

Social anxiety disorder (social phobia) is a much more common problem than past estimates have led us to believe.  Millions of people all over the world suffer from this devastating and traumatic problem every day of their lives, either from a specific social phobia or from a more generalized social phobia.  In the United States, epidemiological studies have recently pegged social anxiety disorder as the third largest psychological disorder in the country.

A specific social phobia would be the fear of speaking in front of groups, whereas generalized social anxiety indicates that the person is anxious, nervous, and uncomfortable in almost all (or the majority of) social situations.


People with social anxiety disorder usually experience significant emotional distress in the following situations:

  • Being introduced to other people
  • Being teased or criticized
  • Being the center of attention
  • Being watched while doing something
  • Meeting people in authority ("important people")
  • Most social encounters, particularly with strangers
  • Making "small talk" at parties
  • Going around the room in a circle and having to say something

This list is certainly not a complete list of symptoms -- other feelings may be associated with social anxiety as well.

Physiological Symptoms

The physiological manifestations that accompany social anxiety may include intense fear, racing heart, turning red or blushing, dry throat and mouth, trembling, swallowing with difficulty, muscle twitches, shaky hands, excessive sweating, and eye contact problems.

Constant, intense anxiety that does not go away is the most common feature.

People with social anxiety disorder know that their anxiety is irrational and does not make "head" (rational) sense.  The fear is not based on fact.  Nevertheless, "knowing" something is never the same thing as "believing" and "feeling" something.  Thus, in people with social anxiety, thoughts and feelings of anxiety persist and show no signs of going away.  We say that anxiety is chronic in this situation.

The Right Kind of Treatment is Successful

The good news is that cognitive-behavioral therapy for social anxiety has been markedly successful.  People who have had this anxiety problem for long periods of time have blossomed while in therapy.  After therapy, people with this problem report a changed life -- one that is no longer totally controlled by fear and anxiety.


Social anxiety, as well as the other anxiety problems, can be successfully treated.  It always bothers me when I read that a person with social anxiety is just "going to learn to live with it," or "learn to manage it."

There is no rational reason to keep living with social anxiety.  There is no rational reason to believe you must "manage" it the rest of your life.

You don't need to live with social anxiety disorder for the rest of your life!  The decision to get better belongs to you. 

Seeking Effective Treatment

In seeking help for this problem, search for a specialist -- someone who understands this problem well and knows how to treat it. Become an informed client and ask questions. Do they understand that you feel very self-conscious, that others are watching you and forming a negative evaluation about you? – or do they minimize what you’re saying and just say, "No, No, No, you’re look fine to me."

It is true that we who have lived  with social anxiety do realize our mind is over-exaggerating, but it still FEELS like others are watching and judging us. Our self-consciousness is very real. If your psychologist/mental health care worker does not understand this, YOU KNOW MORE THAN THEY DO ABOUT SOCIAL ANXIETY. It is very doubtful they will be able to help you.

Also, remember that the true professional will always welcome your questions.  If they seem stand-offish and unfriendly, they should not be your choice of a therapist. Those of us who have or have had social anxiety need support, encouragement, and a relatively stress-free environment while we progress through active cognitive-behavioral therapy.  Remember: This is YOUR time to get better and heal.  This is YOUR time to move forward in life, away from the effects of anxiety, fear, and avoidance.

Does your therapist say, "Face your fears and they’ll go away?" Sorry, but this therapist does not understand the dynamics of social anxiety.  We all have constantly faced our fears ever since childhood – we’ve HAD TO – and we feel more fearful now than we did then.  Seek another therapist.  It is imperative you find a psychologist who understands social anxiety completely – because if they don’t even know what it is – how will they know what to do to help you overcome it?

Cognitive Therapy is Going to Be Extremely Helpful, but Behavioral Therapy is Necessary, Too.  Are there active groups being run?

Do they run a behavioral therapy group  for people with social anxiety?  This is essential.  If there is no social anxiety therapy group involved, seek treatment elsewhere.  A behavioral therapy group is essential to your ultimate success.  (Note: We are not talking about a "support" group -- what are we supporting anyway? The continuance of social anxiety? Support groups for people with social anxiety do not help people overcome this anxiety disorder.  In fact, they may actually prevent progress.

Secondly, the group should not be a mixed anxiety group.  Although the anxiety experienced by people with anxiety disorders is the same, the treatment for each disorder is different.  A social anxiety therapy group should include only people with social anxiety.

Overcoming social anxiety  is not an easy task; yet many thousands have already done it.

While you’re in the middle of this problem, it can feel hopeless – it can feel like you’ll never get better.  Life is just one gut-wrenching anxiety problem after another. But this can be stopped, quenched, and reduced in a relatively short period of time.  It is important to find a cognitive-behavioral therapist who understands and specializes in the treatment of social anxiety.


The most important elements in conquering social anxiety are:
An understanding and awareness of the problem,

A commitment to carry through with cognitive-behavioral therapy even when it seems difficult,

Practice, practice, practice to get that information deep down into your brain so that the strategies and rational beliefs you learn  become automatic.

Participation in a social anxiety therapy group in which you can slowly and gradually work on problems that cause you anxiety in the real world.

That is, the person who feels anxious while reading in public uses specific strategies to meet his goal, whereas the person who wants to learn how to make anxiety-free introductions and engage in small talk during social activities slowly works toward her goals. We use role-plays, acting, voice recording, and video camera, question and answer periods, mock job interviews, and doing foolish things deliberately as part of our behavioral therapy group for people with social anxiety. 

Everything is voluntary.  A person must be ready to do an activity before they do it.  
Note: We use a ladder or "hierarchy" as a flexible guide in our planning.  We want to practice, meet our goals, move up our expectations, meet our goals, move up our expectations, until our goal is finally met.  WE DO NOT PRESSURE, PUSH, or CAJOLE. NO NEGATIVE tactic is employed, because the individual must choose to participate at her own pace.  If she wants to sit there in group and not say a word, that’s O.K.  No one will ever force her to do or say a thing.  But here’s the secret: This has never happened! Everyone in the group understands why they are there and, despite an amount of anxiety that is present, they voluntarily choose to work on their specific anxieties. This is much more practical and real-life than being forced to do something in a group.  While the therapist and the group should be encouraging and motivating, the ultimate decision on progress resides within the person herself.

Therapy groups should always be encouraging, positive, friendly, and supportive.  Social anxiety people are among the nicest people in the world.  Go to a meeting and find out...

It is impossible to stop a motivated person who refuses to give up practicing.  The role of the therapist is to know specifically what to do and how quickly to do it.  This sounds easy, but it is not.  You must be practicing the right material and you must proceed at the correct pace for your own anxieties.  You are more in control of this than your therapist.

Today, cognitive-behavioral therapy is used to treat all forms of social anxiety.  With cognitive-behavioral therapy, we do not wallow in the past and continually bring it up --- because it doesn’t do us any good.  Instead, we focus on present-day problems and symptoms and use many small strategies, techniques, and methods to eradicate anxiety thinking and anxious feelings. 

Here’s where learning, motivation, and practice come in.  The more you can practice these small strategies at home, and then begin using them in the behavioral therapy group, the quicker anxiety can be reduced and social anxiety can be overcome.

-- Thomas A. Richards, Ph.D.,