Social anxiety: what it is, why it happens, and how to overcome it

Your heart pounds before you speak up in a meeting. You rehearse what to say, then replay it for hours afterwards. You skip the party, or stand at the edge, phone in hand.

If social situations fill you with dread, you may have social anxiety. It’s one of the most common mental health conditions, and one of the most treatable. Here’s what it is and how to overcome it.

What is social anxiety?

Social anxiety disorder is an intense, lasting fear of social situations where you might be watched, judged, embarrassed or rejected. Its older name, still widely used, is social phobia.

It’s much more than shyness. Shyness usually fades as you warm up. Social anxiety can make everyday situations, like talking to a colleague, eating in front of others or making a phone call, feel overwhelming, and it often leads people to avoid them.

How common is it?

According to the National Institute of Mental Health, about 7.1% of US adults have social anxiety disorder in a given year, and about 12.1% at some point in their lives. It often starts in the teenage years.

How doctors diagnose it

Doctors use the criteria in the DSM-5, the manual for diagnosing mental health conditions. In plain language, they look for:

• marked fear or anxiety about one or more social situations where you might be scrutinised by others
• fear of acting in a way, or showing anxiety symptoms, that will be judged negatively
• social situations almost always provoking fear
• avoiding these situations, or enduring them with intense fear
• fear that’s out of proportion to the actual threat
• lasting six months or more, and causing distress or getting in the way of life

For some people, the fear is limited to performance situations, like public speaking. Our post on social anxiety disorder symptoms goes through the signs in detail.

What keeps social anxiety going

Research into social anxiety, including the models used in leading treatments, highlights a few patterns:

• Self-focused attention. In social situations, attention turns inward, to how you look and sound, which makes you more self-conscious and less able to notice that people are actually fine.
• Safety behaviours. Avoiding eye contact, rehearsing sentences, staying quiet or holding a drink to hide shaking feel protective, but they keep the fear going and can make you seem more distant.
• Avoidance. Skipping situations brings relief but stops you learning that you can cope.
• The post-mortem. Replaying conversations afterwards, focusing on every awkward moment, makes the next situation feel even scarier.

What causes it?

It’s usually a mix of things:

• temperament: being naturally cautious or sensitive as a child
• family: anxiety running in the family, or growing up with very critical or overprotective parenting
• experiences: bullying, humiliation or rejection, especially in childhood or the teenage years
• learned beliefs: like “people will think I’m boring” or “I mustn’t make mistakes”

Treatment that works

• CBT designed for social anxiety. The UK’s National Institute for Health and Care Excellence (NICE) recommends individual CBT specifically developed for social anxiety as the first treatment for adults. It helps you shift attention outward, drop safety behaviours, test your fears in real situations and stop the post-mortem.
• Medicine. An SSRI can help, particularly if therapy isn’t available or isn’t enough.
• Guided self-help based on CBT can be a good start.

Everyday steps that help

• Shift your attention outward. In conversation, focus on what the other person is saying, rather than how you’re coming across.
• Drop one safety behaviour at a time, and notice what actually happens.
• Test your predictions. Before a situation, write down what you fear will happen. Afterwards, write down what did. Our post on a journal for social anxiety shows how.
• Take small steps. Make a ladder of social situations from easiest to hardest and work up it.
• Replace the post-mortem with a short, kind review: what went okay, and what a friend would say.
• Breathe slowly before and during hard moments.

When to get help

Talk to a doctor if social anxiety is stopping you from working, studying, making friends, dating or doing things you want to do. It’s very treatable, and you don’t have to wait until it’s severe.

If you’re having thoughts of ending your life, call or text 988 (US) now.

Frequently asked questions

Is social anxiety the same as social phobia?

Yes. Social phobia is the older name for social anxiety disorder. Both describe an intense fear of being judged or embarrassed in social situations.

Is social anxiety the same as being an introvert?

No. Introverts prefer quieter settings and recharge alone, but they don’t necessarily fear being judged. Social anxiety is driven by fear, and it often makes people avoid things they’d actually like to do.

Can social anxiety go away?

Yes. Many people recover fully with CBT designed for social anxiety, and most improve a great deal. Without treatment, it often lasts for years, so it’s worth getting help.

Is social anxiety a disability?

In the US, an anxiety disorder can count as a disability under the Americans with Disabilities Act if it significantly limits your daily life, which may give you the right to reasonable adjustments at work or school.

How Breatheasy can help

Breatheasy can help before, during and after social situations. A one-minute breathing exercise before a meeting or party pulses your phone gently as you breathe in. If anxiety spikes, tap “I’m feeling anxious” and Luma walks you through slow breathing and grounding. Afterwards, the journal helps you write a kinder review instead of replaying every moment, and ten-second check-ins show your progress over time. Breatheasy is coming soon to iPhone and Android.

Sources

• Social anxiety disorder statistics, National Institute of Mental Health
• Social anxiety disorder: recognition, assessment and treatment (CG159), National Institute for Health and Care Excellence
• Social anxiety (social phobia), NHS
• Depression, PTSD and other mental health conditions in the workplace: your legal rights, US Equal Employment Opportunity Commission