Understand and Overcome Social Anxiety: The Complete Guide


April 26, 2018 - Gini Beqiri

Social anxiety is one of the most common anxiety disorders. In the US, studies have found that it's the third most common mental health problem, after depression and alcoholism (Kessler et al., 2005). Social anxiety is a debilitating condition as it can limit you in all aspects of life, from having the job you really want to simply going shopping.

Overcome your social anxiety disorder, social phobia and glossophobia with the help of this guide and our VR App.

  1. What is social anxiety disorder?
  2. Symptoms of social anxiety
  3. What causes social anxiety disorder?
  4. What stops us overcoming social anxiety?
  5. Testing for social anxiety
  6. Techniques for overcoming social anxiety
  7. Treating social anxiety disorder in adults
  8. Glossophobia

What is social anxiety disorder?

Social anxiety disorder (social phobia) is a persistent and overwhelming fear of social situations which is much more than “shyness." If you have this disorder, you often worry about being negatively judged by others and you feel very self-conscious in social situations. It can be debilitating because simple everyday activities can become a burden.

You may dread everyday activities, such as:

  • Meeting new people
  • Talking in groups or starting conversations
  • Speaking on the telephone
  • Working
  • Speaking to people in authority
  • Public speaking
  • Eating or drinking with company
  • Shopping
  • Using public toilets

The fear and anxiety is not in proportion to the actual threat of the situation.

Social anxiety can stop you from doing the things you want to do - it's an invasive disorder which causes fear in most areas of a person's life. It often starts during childhood or adolescence and is frequently linked to low self-esteem.

Insight

People with social anxiety understand that their fear is irrational but their anxiety persists. This is even though you may be confronting your fears on a daily basis when, for example, you have to make phone calls for work.

Perceptions

Others may think people with social anxiety are:

  • Cold
  • Shy
  • Quiet
  • Unfriendly
  • Uninterested

Even though you want to make friends and be more involved in social activities, your social anxiety may be stopping you.

Symptoms of social anxiety

Cognitive symptoms

If you have social anxiety, you often experience negative thoughts and worry about:

  • Embarrassing yourself in front of others.
  • All the things that could "go wrong" at an anticipated social event.
  • Being criticised or made fun of.
  • Being negatively judged.
  • Others realising how anxious you are/your physical symptoms being visible.
  • Sounding boring, stupid, incompetent - you have a negative view of yourself that you worry others will see.
  • Being rejected.
  • Speaking to people in authority - you may believe these people are superior and you are inferior.
  • The social situation excessively beforehand - this can even be weeks before.
  • Upsetting/offending other people.
  • The social situation afterwards - you may pick apart a social situation and judge your "performance." You repeatedly think about what you did wrong and what you should have done, for example, "Why did I say that? That's such an embarrassing thing to say. I shouldn't have commented."
  • Being centre of attention.
  • People watching you, for example, when you walk into a busy staff room.

Physical symptoms

The physical symptoms of social anxiety are the same as general anxiety because the same stress response is triggered. When we feel anxious our bodies release stress hormones, including cortisol and adrenaline. This is the body's way of preparing us to respond to a perceived threat or danger, such as, breaking immediately when somebody walks out in front of your car. These hormones produce physically unpleasant symptoms, such as, an increased heart rate and muscle tension.

It's thought that this response has an evolutionary background because it would have been beneficial in prehistoric environments and it’s useful in dangerous situations. But when you have social anxiety, social situations are perceived as threats so this response can be set off frequently and easily which then means it's a problem because there is no actual danger.

The physical symptoms include:

  • Blushing
  • Increased heart rate or palpitations
  • Sweating
  • Tight or painful chest
  • Dry throat and mouth
  • Shaking
  • Your stomach churning/butterflies
  • Shaky voice
  • Changes in breathing
  • Having to go to the toilet
  • Numbness or tingling in fingers and toes
  • Dizzy/light-headed
  • Difficulty swallowing
  • Nausea
  • Twitching muscles, especially in the face and neck

Emotional symptoms

You may feel:

  • Anxious
  • Fearful
  • Nervous
  • Scared
  • Insecure
  • Self-conscious
  • Vulnerable
  • Embarrassed

Behavioural symptoms

  • Avoidance of feared situations, such as, avoiding eating out and leaving jobs that require public speaking.
  • Social withdrawal.
  • Misuse of drugs or alcohol to try to reduce anxiety.
  • Avoiding eye contact.
  • Lacking assertiveness.
  • Impaired work performance and under-achievement.
  • Leaving/escaping from social situations quickly.
  • Engaging in safety behaviours - these are behaviours that make you feel safe in situations, such as, wearing make-up to hide your blush, bringing a friend with you to parties, not saying anything.
  • Problems with interpersonal relationships.

This is what anxiety feels like:

The “A Day With Mental Health” series is brought to you by Headspace and Bring Change to Mind (BC2M). This series features videos highlighting the myths around mental health, as well as personal stories on what it’s like to live with a mental health diagnosis.

Each essay describes a singular and unique experience, and is not meant to be representative of every diagnosis, but to give us a peek into one person’s mind so we may be more empathetic to all.

What causes social anxiety disorder?

As with many mental health conditions, social anxiety disorder is most probably the result of a combination of genetic and environmental factors.

Genetics:

Anxiety disorders often run in families, so you’re more likely to have social anxiety disorder if a close family member is affected. However, the exact nature of the relationship between genetics and learned behaviour is uncertain.

Parenting style:

The behaviour of parents may also have an influence on whether their child will develop social anxiety disorder. If you have anxious parents or parents that worry a lot, it can often affect your ability to cope with anxiety during childhood, adolescence and adulthood.

People with social anxiety disorder often describe their parents as:

  • Overprotective
  • Not affectionate enough
  • Constantly criticising them and worrying they may do something wrong
  • Overemphasising the importance of manners and grooming
  • Exaggerating the danger of approaching strangers

Early negative experience:

Social events in your early life may have triggered the social anxiety, for example, bullying, abuse, embarrassment during a social situation, such as forgetting the words in a speech and hearing others laugh at you due to this. You may worry that similar social situations will produce the same outcome so you begin to avoid and fear them - the more a situation is avoided, the more scared you will be of that situation and similar situations.

Evolutionary theory:

Humans are social species who needs to spend time with other humans so they don't want to upset others and risk being rejected. Individuals with social anxiety may be overly sensitive to being perceived negatively due to the risk and consequences of rejection, such as, loneliness and depression.

What stops us overcoming social anxiety?

Sometimes people become more confident as they become older and so they overcome their social anxiety but with others it can be persistent.

Long-term beliefs: If you've been socially anxious for many years it's likely that you have long-term beliefs that you are bad in social situations. But research has suggested that people with social anxiety have the same social skills as others but they don't believe this.

Avoidance: Individuals with social anxiety avoid situations they fear. If they are unable to completely avoid it, they will try to leave the situation as soon as they can. This avoidance is a main preventative factor in overcoming the disorder because:

  • When you avoid situations you do not give yourself the chance of disproving your predictions and learning that you can cope and even have a positive experience.
  • The longer you avoid something, the more fearful you become of it.
  • By staying in a feared situation for longer, anxiety decreases after a while. Your body cannot continuously produce the physical symptoms - it becomes tired.

Focusing on yourself: In social situations, you may monitor your physical symptoms because individuals with social anxiety generally believe that they are the centre of everyone's attention and they have a strong negative image of themselves in their mind of how they look to others. For example, you may be trying to work out whether you're shaking is noticeable or whether you're blushing too much.

However, this self-focus actually increases your anxiety. It also means that you won't be focusing on the conversation which makes it harder to contribute thus subsequently reinforcing your beliefs that you are no good in social situations.

Fear of fear: You may think that you will be anxious in certain social situations and so you predict your symptoms, for example, "I know I will shake." These thoughts will increase your anxiety beforehand which may subsequently cause the feared symptoms and strengthen your fear of future similar situations.

Safety behaviours: As mentioned earlier, safety behaviours make you feel safe in situations, for example, you may:

  • Not speak or speak quietly
  • Bring a friend with you to events you feel anxious about
  • Pretend to be on your phone
  • Drink more alcohol than usual
  • Hide visible signs of anxiety, such as wearing make-up to hide your blush
  • Avoid sharing personal information, perhaps by asking the other person lots of questions etc

Safety behaviours may be beneficial in the short-term but in the long-term they prevent you from learning that you can cope in a situation because you think your success was due to the safety behaviour: "I only coped because of the amount of alcohol I drank." This means that your confidence and self-esteem won't be any better.

Also safety behaviours can assist you in living up to your self-fulfilling prophecies. For example, by pretending to be on your phone and therefore not speaking with others, people may assume that you're uninterested in engaging in conversation so they don't approach you. You then continue to think that you're not good at speaking with others and that others don't want to speak with you.

Testing for social anxiety

There are several online tests available to check for social anxiety. These tests are usually questionnaire based, with the user picking answers depending on the hypothetical situation the question puts them in. We suggest the following tests to find out if you have social anxiety disorder:

Techniques for overcoming social anxiety

Understand your social anxiety

To learn how to manage your social anxiety, first you must understand it. This can be done by monitoring the situations that make you anxious and writing down in a diary:

  • Who, what, where and when (the time and date)
  • Your thoughts and any images that come to mind
  • Emotions
  • Physical symptoms
  • Your reactions, including any safety behaviours

For example:

Situation date and time Unhelpful thoughts or images Emotions (Intensity 0-100) Physical symptoms How I responded and safety behaviours
Monday 1pm - At work my supervisor asked me about the progress of my project. "He thinks I'm too slow, that's why he's asking." "I hope he doesn't see my blush, he'll think I'm pathetic." Anxious - 90, Nervous - 90 Blushed, increased heart rate, dry mouth Avoided eye contact, spoke quickly, focused on my blush

Challenging unhelpful thoughts

Individuals with anxiety disorder tend to have negative thoughts about themselves and negative predictions about future social events, for example, "No one will talk to me", "I'll have nothing to say." These thoughts should be challenged as they are often formed using incorrect assumptions.


Steps to challenge your thoughts:

1. First you must recognise your unhelpful thoughts and any images - you can use the diary again to pick out these thoughts.

Unhelpful thoughts Images
"Everyone will look at me when I enter the room" Image of walking into the kitchen and everyone stopping their conversation and staring.
"I'll sound really stupid if I answer the question incorrectly." Image of people holding in their laughs and looking annoyed.
"I'll blush and then it'll be really obvious that I'm nervous." Image of looking bright red and sweaty.

To help identify these thoughts ask yourself what you're afraid of happening in a social situation. It's usually either:

  • Something you may do, such as, "I won't be able to speak."
  • Or something that others may think or do, for example, "Everyone will laugh at me", or "They'll think I'm strange."

2. Then ask yourself whether you are experiencing any of these unhelpful thinking styles:

Catastrophising

Predicting the worst possible outcome: "If I do badly in this presentation, they'll fire me."

Predictive thinking

Assuming you know what's going to happen in a future social situation: “Everyone will notice me shaking and think I'm pathetic." This will make you even more anxious before the situation.

Mind reading

Assuming you know what others are thinking even though you have no factual evidence: "Everyone thought I was embarrassing."

Magnification and minimisation

Unfairly magnifying the negative and minimising the positive: After a networking event an individual is dwelling on the thought: "I really couldn't get my words out when I spoke to Mr Tailor" and they're ignoring the fact that they spoke with lots of other people confidently.

Mental filter

Focusing only on the most negative aspects of a situation whilst filtering out the positive features, for instance, in the example above the individual may have filtered the information so they can only remember the conversation that they perceived as negative.

Woman with social anxiety at the office

Personalisation

Assuming that others are behaving negatively because of you: "Charlie hasn't said much to me today, I must have upset him" or "They're all laughing, they must be laughing about me."

Over-generalisation

If something bad has happened once, you believe it will happen every time: "That presentation I did went badly, all my presentations will go badly."

Labelling

Labelling yourself or others without fully considering the evidence: “I’m boring.” These are generally beliefs you've had about yourself for years.

Emotional reasoning

Mistaking your anxious feelings for facts: “I feel really nervous so I must be in danger.”

These thinking styles confirm that you don't view yourself fairly in social situations.


3. Try challenging these thoughts by looking at the evidence for and against the thought. A good way to do this is by asking "If my friend said this to me about himself/herself, what would I say?" Weigh up the evidence and create a more balanced thought. This doesn't mean the new thought has to be really positive - it must be formulated using the evidence.

For example, you're running a group session with another colleague and your fear is: "I'm shaking, they must think I'm strange." You look at the evidence - make sure that you use factual evidence and not opinions:

Evidence supporting the thought Evidence against the thought
When I picked up a piece of paper I noticed it was slightly trembling so I am definitely shaking more than usual. I have received positive feedback from clients in previous group sessions - no one has said anything about me shaking or being strange.
Three colleagues have previously said that I always seem calm and confident when presenting.
Shaking doesn't mean that a person is strange.
Lots of people feel nervous when they present to a group of people.

After weighing up the evidence, your new thought is now "I'm only shaking slightly and that doesn't mean people think I'm strange. I have received complimentary feedback regarding my presentation skills from clients and colleagues."

If you continue to practice challenging and balancing thoughts, you will be able to challenge unhelpful thoughts straight after experiencing them.

Managing core beliefs

Sometimes it may be more difficult to believe a new balanced thought. This may be due to a core belief at the base of the unhelpful thought. Core beliefs are strongly-held and inflexible beliefs regarding how we see: ourselves, others, the world and the future.

For example:

  • I must be perfect to be liked
  • Being anxious is not acceptable
  • Everyone must like me
  • I'm unlovable

When you have core beliefs you tend to focus on the information supporting it and ignore the evidence against it.

Identify your core beliefs: With your unhelpful thoughts, ask "What's bad about that?" and "What does that say about me?" Continue to ask these questions until you uncover the core belief.

Challenging core beliefs: You can challenge core beliefs similarly to thought challenging by asking "What experiences do I have to show that this belief is not always true?" With this evidence develop an alternative core belief.

Behavioural experiments: You can conduct experiments to test core beliefs:

1. Write down the core belief

"Being anxious is not acceptable."

2. Think of what you can do to test it

"Make my hands shake in front of my colleagues in the cafe."

3. Write down what you predict will happen if it's true

"They'll laugh and they'll think I'm pathetic."

4. Do the experiment

"I made my hand shake very obviously every time I picked up my glass of water and drank from it."

5. Record what happened

"No one said anything to me, there was no changes in their behaviour and they remained friendly."

6. Compare your predictions with the actual outcome and think about what you have learned

"Nothing I predicted came true, people continued to be friendly. I have learned that showing symptoms of anxiety is acceptable."

7. Write down a new balanced belief

"Being anxious is acceptable."


Examples:

  • Spill something
  • Pretend to trip
  • Don't wear make-up during a presentation
  • Muddle up a sentence
  • Ask a "silly" question, such as, asking where the library is a few metres away from the library

Relaxation for physical symptoms

You may already know what helps you relax, if not, there are many relaxation techniques out there to help you de-stress, such as, deep breathing exercises and progressive muscle relaxation. They help reverse the physical symptoms of anxiety by decreasing: heart rate, blood pressure, muscle tension and breathing rate.

Mindfulness is also very beneficial for social anxiety because a lot of your anxious thoughts consist of thinking about past social situations or worrying about future social situations. Mindfulness is a way of bringing your focus of attention back to the present.

Woman with social anxiety outside

Reducing your self-focus

As aforementioned, when you're socially anxious, you monitor your physical symptoms because you're worried that others will notice and this consequently increases your anxiety. Here are some tips to reduce the focus on yourself:

  • Concentrate on what is happening around you rather than focusing on yourself:
    • Look at others involved in the conversation and at your surroundings.
    • Really listen to the conversation you are participating in.
  • Remember that your physical symptoms are not as visible and obvious as you believe. By focusing less on your body you'll stop noticing these symptoms.
  • Don't feel like you have to keep the conversation going. Others will get involved if they have to and there's no problems with silences.
  • Recognise that you don't need to perform "perfectly" in all social interactions - this would be exhausting and no one is able to do this.
  • Look at others to see if you can notice whether they're anxious. It's likely that others around you are also anxious and it's unlikely that you will be able to tell. Remember that lots of people with anxiety disorders think to themselves "Why am I only the only one that can't cope?" It's because the symptoms are never as visible as the individual thinks.
  • Even if you are visibly anxious, it doesn't mean that people will perceive you negatively. Think about whether you would judge someone negatively just because they look anxious - if it's a "no" then try to believe that others don't dislike you for it.
  • Recognise that everyone is not focusing on you.

Graded exposure

The best way to reduce your fear of social situations, is to gradually face them:

  • Remember that if you stay in a situation long enough, without engaging in safety behaviours, your anxiety will gradually decrease.
  • If we confront the same situation repeatedly, the amount of anxiety experienced continually decreases and it decreases quicker each time.

To confront your feared social situations you must create an exposure hierarchy. An exposure hierarchy is a list of social situations that would cause various degrees of anxiety. You start by facing the least anxiety-provoking situation in the hierarchy and work your way up as your anxiety decreases for each situation. This allows you to build-up your confidence slowly.


Steps:

1. Identify the situations that make you anxious and that you avoid. List your safety behaviours as well.

Avoiding: Delivering presentations, speaking at meetings, attending parties

Safety behaviours: Avoiding eye contact, pretending to be on my phone, drinking more alcohol

2. You may have more than one fear so first identify one specific goal to work on.

"I want to be able to deliver presentations at the team meeting and answer questions whilst being able to maintain eye contact with the audience." This person has decided to tackle their fear of delivering work presentations first and they also want to address the safety behaviour of avoiding eye contact at the same time.

3. Rank the situations, relevant to the goal, from the least anxiety-provoking to the most anxiety-provoking. To do this, rate how anxious each situation makes you from 0-100:

  • 0 - Relaxed
  • 25 - mild levels of anxiety
  • 50 - medium levels of anxiety
  • 75 - high levels of anxiety
  • 100 - severe levels of anxiety

If you find out there are big jumps in your hierarchy, for example, the first situation's fear rating is 10 and the second situation's fear rating jumps to 40, add more steps in-between.

Step Fear rating
10 Give a presentation during the weekly team meeting and answer questions, maintaining eye contact 100
9 Provide an update on how my team are doing during a weekly team meeting, maintaining eye contact 90
8 Provide answers to questions during the weekly team meeting, making eye contact 80
7 Ask a question during the weekly team meeting, making eye contact 70
6 Make a comment in the weekly team meeting, making eye contact 60
5 Give a shortened version of the presentation in front of four colleagues, answering their questions, maintaining eye contact 60
4 Give a presentation in the meeting room in front of four close colleagues, maintaining eye contact 50
3 Give a presentation in the meeting room in front of a close colleague, maintaining eye contact 30
2 Give a presentation in the meeting room at work when no one is there. 20
1 Give a presentation at home in front of my husband, maintaining eye contact. 15

4. Carry out the least anxiety-provoking task first and remember:

  • Your anxiety will initially rise but if you remain in the situation for long enough the anxiety will decrease.
  • The anxiety may feel uncomfortable but it's not harmful.
  • Remain in the situation until your anxiety reduces by at least half of what it was at the start, for example, if you entered the task at 70 then you should wait until your anxiety goes down to 35 or less.
  • Depending on the situation, staying until your anxiety has halved may not be possible, for example, if you called the hairdressing salon to book an appointment the conversation will probably not last long enough. However, you can still remember what went well and this should boost your confidence for similar future situations.
  • In a diary record your progress. Record:
    • The situation - what was the day, time and hierarchy step
    • Your level of fear at the start of the exposure
    • Your level of fear during the exposure
    • Your level of fear after the exposure
    • The outcome and if there were any problems think about how you will address these before repeating the step.
Situation Start During After Outcome
Monday 7pm - Give a presentation at home in front of my husband, maintaining eye contact. 20 10 0 I felt a bit embarrassed to begin with but once I got into it I felt much better and managed to maintain eye contact throughout.

5. Repeat the same step of the hierarchy until you no longer feel much anxiety in that situation. You should find that the situation becomes easier for you.

Try to engage in an exposure tasks every day as the anxiety will fade quicker.

6. Move on to the next step in the hierarchy.

Treating social anxiety disorder in adults

Research has shown that without treatment social anxiety is a chronic condition. But only around half the adults with it seek treatment and when they do it's usually after 15-20 years of experiencing the symptoms (Grant et al., 2005). It's likely this is because they:

  • Are scared of being judged by a professional
  • Believe that this cannot get better
  • Lack of information about treatments

However, there are a range of treatments available:

Virtual Reality (VR)

VR can be a great way to experience social situations in the safety of your own home. The technology immerses you in realistic environments where you can practice speaking to crowds, answering questions to panel members, standing on podiums in front of hundreds of people and many other situations.

There are some great VR apps out there, all you need is your mobile phone and a VR headset, such as Google Cardboard, which can cost as little as $15.

VirtualSpeech VR app can help you become more comfortable in social situations, such as meetings or speaking at conferences.

VirtualSpeech VR app for social anxiety

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy is one of the most effective treatments for social anxiety disorder.

Generally, CBT works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.

Cognitive behavioural therapy teaches new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.

Your therapy sessions may include learning about social anxiety, graduated exposure to feared social situations (which we have explained), examining and modifying your core beliefs and helping to prevent relapse.

CBT involves a considerable time commitment. The exact amount of time required can vary, depending on your specific condition and response to therapy. One example is 15 hourly sessions, plus one of 90 minutes. However, you may require fewer or more sessions, or you may need fewer sessions that last longer.

Supported self-help

If you wish to try a different psychological therapy, you may be offered supported self-help. This could be in the form of a CBT-based book or computer programme to try over three to four months.

One of the most widely-used self-help therapies for people with anxiety or phobias is FearFighter, which is available on the NHS in some areas. You can also pay to do the course privately.

Antidepressants

Some people may benefit from trying a type of antidepressant medication, usually a selective serotonin reuptake inhibitor (SSRI), either instead of or in combination with individual CBT. SSRIs increase the level of serotonin in your brain. They can be taken on a long-term basis.

As with all antidepressants, SSRIs can take several weeks to start working. You’ll usually be started on a low dose, which will gradually be increased as your body gets used to the medicine.

Escitalopram or sertraline are the two SSRIs often prescribed to treat social anxiety disorder. If you’re prescribed one of these, you’ll initially be asked to see your GP every few weeks to check on your progress and see if you’re responding well to it.

For further information on this, visit the NHS website.

Psychotherapy

If all of the above interventions aren’t right for you, for whatever reason, you may be offered interpersonal psychotherapy or short-term psychotherapy specifically designed for social anxiety disorder.

Psychotherapy generally involves talking to a trained therapist either one-to-one, in a group, or with your wife, husband or partner. It allows you to look deeper into your problems and worries, and deal with troublesome habits and a wide range of mental disorders.

Interpersonal psychotherapy aims to link social anxiety to relationship problem areas and address these. You’ll probably be offered 16-20 sessions over four to five months.

Short-term psychotherapy for social anxiety disorder aims to improve your social skills, and encourage you to face feared social situations outside therapy sessions. A course of treatment usually consists of 25-30 sessions that last 50 minutes, over a six-to-eight-month period.


Read more about Managing Anxiety and Stress in the Workplace

Glossophobia

Glossophobia is the technical term given to a severe fear of public speaking. People who suffer from glossophobia tend to freeze in front of an audience, unable to speak. Their mouth might dry up and they might start sweating, shaking or experiencing palpitations.

People who suffer from glossophobia will shy away from any opportunity to speak in public, no matter how beneficial to their career. They feel highly embarrassed speaking in front of people and are worried about what the audience will say and think about them.

Symptoms of glossophobia can be grouped under three primary categories: physical, verbal, and non-verbal. Physical symptoms consist of increased blood pressure and heart rate, an increased sweating tendency, stiffening of the neck and upper back muscles and dry mouth.

Some organisations, such as Toastmasters International, and training courses in public speaking may help to reduce the fear to manageable levels. Self-help materials that address public speaking are among the bestselling self-help topics.

Symptoms

  • Intense anxiety prior to, or simply at the thought of having to verbally communicate with any group
  • Avoidance of events which focus the group’s attention on individuals in attendance
  • Physical distress, nausea, or feelings of panic in such circumstances