What is Social Anxiety?
It is common to feel some anxiety in social situations from time to time. Many of us feel anxious when we’re at a job interview, on a first date, or giving a speech. We all want to make a good impression and be liked. However, some people feel very nervous and uncomfortable in social situations. Individuals with social anxiety worry a great deal about doing something embarrassing and others thinking badly of them. They tend to be very self-conscious and constantly feel “on stage.” While some people with social anxiety fear lots of different social situations (e.g., meeting new people, going to parties, starting conversations, being the centre of attention, ordering food in a restaurant, etc.), some people only get anxious in very specific situations (e.g., public speaking). When faced with feared social situations, individuals with social anxiety tend to experience the following:
- Thoughts: negative thoughts about themselves (e.g. “I’ll say something stupid,” “I’ll look anxious,” “I’ll have nothing interesting to say”) and how other people will react to them (e.g. “People won’t like me,” “Classmates will think I’m boring,” “Colleagues will think I’m weird”)
- Feelings: anxiety, fear, nervousness, embarrassment, shame
- Body reactions: sweating, blushing, trembling, shaking, racing heart, upset stomach, nausea, dizziness, lightheadedness, choking sensations, dry mouth
- Behaviours: avoidance of social situations (e.g., skipping the party, not going to a meeting or class, saying “no” to social plans with friends) and the use of safety behaviours, which include any actions used to try and feel safer and less anxious in a social situation (e.g., saying very little, avoiding eye contact, rehearsing what you say before you say it, not expressing your opinion, using alcohol or drugs).
When does social anxiety become a problem?
Social anxiety becomes a problem or is considered a disorder when it feels intense, happens a lot, causes us distress, and affects different parts of our lives including:
- Work and school (e.g., missing work or school, trouble participating in meetings or classes, poor performance at work or school, not pursing certain school programs or jobs/careers, and difficulty talking to bosses and co-workers or teachers and other students)
- Relationships and friendships (e.g., difficulty making and keeping friends, trouble dating, and difficulties being assertive and opening up to people)
- Recreational activities and hobbies (e.g., avoiding trying new activities or joining things such as going to the gym, joining a running club, or taking an art class)
- Day-to-day activities (e.g., difficulty completing daily activities such as grocery shopping, ordering food at a restaurant, making phone calls, asking for help, and using public transit)
Who has problems with social anxiety?
Anyone can have problems with social anxiety. You might not know from the outside that someone is suffering on the inside. When social anxiety causes distress and gets in the way of functioning in life, we call it Social Anxiety Disorder. It is one of the most common anxiety disorders, 8-12% of people being diagnosed at some point in their lives.
Research suggests that both genetics and environment can play a role in the development of social anxiety problems. Social anxiety tends to run in families, which means if someone in your family has an anxiety problem you may be more likely to develop one. Various life events or experiences, such as being teased or bullied, can play a role. Social anxiety problems can develop slowly over time, often starting in elementary school or early adolescence, or after a particularly embarrassing or stressful event.
What treatments help people with social anxiety?
Pharmacological interventions (medications) can help people with Social Anxiety Disorder. Ask your family doctor (General Practitioner) or Psychiatrist about options.
Cognitive Behaviour Therapy (CBT) is the gold standard nonpharmacological treatment for social anxiety disorder. Scientific research shows that CBT helps people with social anxiety. CBT involves learning new ways of thinking (cognition) and acting (behaviour), which can lead to reducuctions in anxiety. A typical course of CBT is 12 to 20 one-hour sessions.
People with social anxiety tend to overestimate the threat of social situations and underestimate their ability to cope with them. CBT teaches cognitive techniques (e.g., identifying and challenging unhelpful thoughts or beliefs) to help people feel less anxious and engage in social situations more.
People with social anxiety also tend to avoid feared social situations or people. Avoidance works well in the short term (e.g., anxiety temporarily goes down by skipping the party) but causes more problems in the long run (e.g., missing out on meeting new friends, sending yourself the message that that situation is dangerous and you can’t cope). A CBT therapist will help you gradually face your excessive fears. The process of “exposure” helps reduce anxiety by teaching people (through experience) that situations are safer than they think and they can manage them.
Mindfulness-based therapy and Interpersonal therapy can also help people with social anxiety; however, they appear to be less effective than traditional CBT. Mindfulness-based therapy (MBT) involves learning to pay attention to your thoughts, feelings, sensations, and surroundings in the present moment, without judging. Interpersonal therapy (IPT) involves exploring issues in relationships with other people to help you understand and improve interpersonal situations.
The good news is that psychotherapy has been shown to be effective for most people with social anxiety disorder, which means most people get better with treatment. However, it can take several weeks to months, or even longer to notice changes. In terms of medication, it can take some trial and error to find the right medication. So stick with it, change takes time.
How can psychologists help people with social anxiety?
- Psychologists educate people about social anxiety so they understand what it is and how to handle it.
- Psychologists conduct assessments that help clarify diagnosis and develop a plan for tackling social anxiety.
- Psychologists provide effective treatments, such as Cognitive Behavioural therapy (CBT).
- Psychologists engage in research to help us better understanding social anxiety and improve treatments.
- Psychologists can advocate for people with social anxiety. Currently, not every Canadian can freely and easily access evidence based psychological treatments for social anxiety disorder.
For more information:
You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and contact information of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/ptassociations/.
You can find additional information and free self-help resources on social anxiety at:
This fact sheet has been prepared for the Canadian Psychological Association, in cooperation with AnxietyBC, by Dr. Melanie Badali and Dr. Kristin Buhr, Registered Psychologists at the North Shore Stress and Anxiety Clinic.
Date: June 29, 2018
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