Social anxiety disorder, also known as social phobia, is a psychological condition in which certain social situations become the cause of significant anxiety. Typical examples of these social situations include speaking with an authority figure, with a potential romantic partner, with strangers, or in front of an audience.
Some people with social anxiety think of themselves as being “just shy,” and surely for some people that’s true. However, shyness, when it becomes more pronounced, can develop features of an anxiety disorder that represents a real problem.
A fear of public speaking is a common problem for those with this disorder. Many people feel uncomfortable or anxious in certain social or interpersonal situations — this is normal. However, a person with social anxiety disorder will experience certain social situations to be so anxiety-provoking that they either avoid them or endure them with significant distress. This avoidance or distress becomes a significant issue in that person’s life.
Social anxiety treatment
The primary psychotherapy treatment for social anxiety is cognitive-behavioral therapy (CBT). CBT for social anxiety involves two components: 1) reducing the number of situations that are avoided and 2) changing the anxious thinking that typically occurs in these situations.
Reducing the number of situations are avoided is a key part of what it takes to overcome social anxiety. How does CBT help people do that? In part, it accomplishes that by using a technique called situational exposure. Exposure typically involves working with your CBT therapist to find a social situation that is challenging for you, but not overwhelming. You are then encouraged to willingly enter this situation using some of the skills you have learned in treatment. These skills will help you manage the anxiety in a healthy way. Over time, exposure lowers the anxiety people experience in the previously avoided situations. The situations become less and less anxiety-provoking.
Changing anxious thinking
Social anxiety is largely driven by beliefs and thought patterns about how one will be perceived by others. As long as this thinking persists, the anxiety will continue to be a problem.
The most common thought pattern found in sufferers of social anxiety is when we make assumptions about how others are thinking and feeling. For example, if you ask someone which way 39th street is, and assume he/she thinks you’re an idiot for asking, you will likely experience some anxiety. Typically for those with this disorder, making that type of assumption is not a conscious choice. Rather, it’s an implicit assumption about how they think about other people. These assumptions are hard to change unless you learn to examine them and evaluate them. CBT strives to help people do just that. This is part of what makes CBT effective in this type of anxiety.
CBT is the treatment of choice for social anxiety disorder. Some medications can also be helpful, but CBT is the preferred first treatment for social anxiety because:
- it is highly effective for this disorder and
- it has no risk of side effects like SSRIs. (Common side effects of SSRIs include nausea, weight gain, and sexual difficulties)
- CBT teaches you skills that last beyond the end of the treatment. This represents an advantage over medications, which only help while you’re taking them.
Last updated: May 15, 2020