Therapy for Social Anxiety

We all feel anxious in front of others from time to time. However, if you often feel afraid of being judged by others or highly self-conscious when you meet people, you might have social anxiety disorder. 

Social anxiety disorder — or social phobia — is a common mental health condition that can affect people of all ages and backgrounds, and can vary in severity.

One of the most effective ways to treat social anxiety disorder is through psychotherapy, or talk therapy. 

Below, you’ll find information on what social anxiety disorder is, as well as the symptoms you may have if you’re affected by social anxiety disorder.

You’ll also find details on how different forms of therapy can treat social anxiety disorder, either on their own or in combination with medication.

Social anxiety disorder is an anxiety disorder in which a person feels persistent fear and anxiety before or during social situations.

If you have social anxiety disorder, you may experience symptoms when you meet new people, when you need to speak or perform in front of others or when you’re in a situation with strangers who could make judgments or assumptions about you.

Social anxiety disorder is a common anxiety disorder. According to data from the National Comorbidity Survey Replication (NCS-R), an estimated 12.1 percent of all American adults have social anxiety disorder at some point in their lives.

Like other forms of anxiety, social anxiety disorder is more common in women than in men, with eight percent of women experiencing social anxiety at some point in the year leading up to the data mentioned above.

It’s normal to feel nervous before a presentation, a performance, a job interview or any event in which you need to make a good impression on people.

And experiencing occasional anxiety doesn’t mean that you have social anxiety disorder.  

However, if you almost always feel scared, nervous or anxious when meeting people or taking part in social events, it could be a sign you should talk to a mental health service provider. 

If you have social anxiety disorder, you may experience the following symptoms when you need to spend time around other people:

• Fear of talking to others. You may feel scared about talking to other people, especially if you don’t know them. And when you do talk to others, you might find it hard to think of what to say or how to continue a conversation.

• Blushing, sweating and a rapid heart rate. When you talk to other people or perform in front of an audience, you may start to experience physical symptoms of anxiety, such as a rapid heart rate or sweating.

• A soft voice and little or no eye contact. You might notice that you talk in a soft voice, even without meaning to. It might feel difficult or impossible to maintain eye contact with the people you’re talking to, and/or your posture may become more upright and rigid.

• Nausea and a feeling of sickness in your stomach. When you’re in a social situation, you might begin to feel nauseous and uncomfortable, with a “butterflies in your stomach” sensation.

• Fear that other people will judge you. You might worry that people will find something you say strange or awkward. When you meet other people, you may assume that they’ll always make negative assumptions or judgments about you.

• Extreme embarrassment or self-consciousness. You might feel very self-conscious in social situations. Even when you do nothing wrong, you might still feel embarrassed and awkward about your behavior. 

Unlike the everyday nervousness that can occur before a job interview or other important event, for a person with social anxiety disorder, these symptoms might develop during just about every interpersonal interaction. 

And when the symptoms of social anxiety disorder are severe, they can cause you to avoid crowded parties, events and other situations in which you need to meet and talk with other people.

If you think you might have social anxiety disorder, it’s important to reach out to a mental health professional for help. 

Like other anxiety disorders, social anxiety disorder is treatable. You can start by talking to your primary care provider about your concerns, or by reaching out to a licensed psychiatry provider for anxiety treatment online.

Cognitive Behavioral Therapy

Most of the time, social anxiety disorder is treated with a form of psychotherapy called cognitive behavioral therapy, or CBT.

Cognitive behavioral therapy involves identifying the false and distressing thought patterns that can cause you to develop anxiety in social environments, then taking steps to change the ways you think and behave.

For example, your therapist might help you identify reactions you have in social settings that affect your feelings and behavior. 

This could be something as basic as interpreting neutral comments from other people as a form of criticism. 

You may work with your therapy provider to recognize distorted thinking, and then reevaluate it to view people’s comments in a more neutral, realistic way. 

Your therapist may also help you develop problem-solving skills that allow you to better handle anxiety symptoms without panicking. 

This could involve role-playing situations that might trigger your anxiety, for example, or techniques to calm your mind in tough situations.

More than anything else, CBT is about helping you to make real progress for the future, rather than focusing on your past. 

When taken seriously, it’s an effective treatment that can produce real, noticeable improvements in your thoughts and actions.

Many different licensed mental health providers offer CBT, including therapists, counselors and psychologists, and it’s something that can be carried out in a private setting as individual online therapy or as part of online group therapy. 

Exposure Therapy

Another form of therapy that’s used to treat social anxiety disorder is exposure therapy. This is a specific type of cognitive behavior therapy that involves exposing yourself to situations or activities that trigger your anxiety, all in a safe, controlled environment.

The theory behind exposure therapy is that exposure to something in a safe environment allows you to gain control over your fear and increase your level of comfort. 

Research suggests that it’s an effective therapy and often the treatment of choice for anxiety.

Several different variations of exposure therapy can be used to treat social anxiety, as well as other anxiety disorders. 

These include in vivo exposure, in which you directly confront your fears in a real-life setting. If you feel anxious in a crowded social environment, for example, in vivo exposure therapy may involve visiting a meetup or other group social event to confront your fears head-on.

Another form of exposure therapy is imaginal exposure, which involves picturing a scenario that makes you feel anxious. 

By returning to this scenario and describing it, you may be able to gain more control over your feelings and responses to anxiety.

Sometimes, you and your therapist might act out a scene that you fear, such as giving a speech or introducing yourself to someone new.

Exposure therapy is often graded, meaning you might start with a situation that only causes mild anxiety before moving on to something more challenging.

Therapy and Medication

While therapy is often effective on its own, your healthcare provider may prescribe medication to help you control your anxiety and make faster, more substantial progress.

Mental health specialists prescribe several types of medication to treat and manage anxiety. The most common are anti-anxiety medications, antidepressants and beta-blockers. 

Anti-anxiety medications work by treating anxiety directly. They’re fast-acting and provide instant relief from most anxiety symptoms. 

However, they can be habit-forming and often become less effective when they’re used for long periods of time.

Your healthcare provider may prescribe this type of medication to treat social anxiety in the short term.

Antidepressants, which are typically used to treat depression, are also used for several common anxiety disorders. 

They’re much more suitable for long-term use, but can sometimes take weeks to start improving your anxiety symptoms.

Beta-blockers work by stopping some physical anxiety symptoms — such as tremors, sweating or a fast heartbeat. 

Beta-blockers are often used to treat performance anxiety, such as the specific type of anxiety you might feel before a public speaking event or party. 

This full guide to anti-anxiety medications goes into more detail about how common medications for anxiety work, their potential side effects and more. 

If you’re prescribed medication for anxiety, make sure to closely follow the instructions provided by your healthcare provider. 

If you have social anxiety disorder, it’s important to talk to a mental health specialist to determine your best treatment options. 

Like other anxiety disorders, social anxiety usually improves with cognitive behavioral therapy, exposure therapy and other forms of talk therapy. 

To improve your results, your mental health service provider might also prescribe anti-anxiety medication for you to use during treatment. 

If you prefer to treat social anxiety from home, you can connect with a licensed mental health provider online for support, therapy and ongoing help using these accessible online mental health services.

For more information on dealing with anxiety and managing your mental health, check out these free mental health resources.