Social anxiety is far more than shyness. It is a persistent fear of being judged, embarrassed or seen as inadequate by other people. It can make meetings, presentations, conversations with colleagues, dates or even ordering in a restaurant feel like tests you might fail. Many people with social anxiety function well, and nobody around them would guess how much effort it takes. That is part of why it so often goes untreated for years.
It is also one of the anxiety problems that responds best to CBT. There is a specific, well-tested cognitive therapy for social anxiety, and it is the approach recommended in the NICE guidelines.
What social anxiety feels like from the inside
Typical experiences include:
- Dreading social or work situations days in advance, and mentally rehearsing what to say
- Being intensely aware of yourself during conversations: your voice, your face, whether you are blushing, sweating or making sense
- Worrying that other people can see your anxiety and will think less of you
- Using small strategies to get through, such as avoiding eye contact, gripping a glass to hide shaking, staying in the background, or over-preparing what to say
- Replaying the conversation afterwards, focusing on what went wrong
- Avoiding situations altogether, or leaving early
Why it keeps going
The cognitive model of social anxiety explains why it persists even when nothing bad actually happens.
Attention turns inward. In social situations, attention shifts to monitoring yourself. That makes you more aware of anxious sensations and less aware of how other people are actually responding, so you miss the evidence that would reassure you.
You picture yourself from the outside. People with social anxiety often have a vivid image of how they appear: red-faced, awkward, visibly nervous. This image feels accurate but is usually far more exaggerated than what others actually see.
Safety behaviours backfire. The strategies used to avoid embarrassment, such as rehearsing, holding back or avoiding eye contact, often make you seem more distant or awkward, and they stop you discovering that you would have been fine without them.
Before and after. Anticipatory worry primes you for failure, and the post-mortem afterwards rewrites the event as worse than it was.
Social anxiety, perfectionism and self-esteem
Social anxiety often comes with demanding standards for how you should come across: always fluent, always interesting, never visibly nervous. Those standards are a form of perfectionism, and they make ordinary social imperfection, such as a pause, a stumble or a joke that doesn't land, feel like failure.
Underneath, there is often a more general belief about yourself, such as being boring, inadequate or unlikeable. Social situations feel dangerous because they seem likely to expose it. When that belief extends well beyond social situations, it is worth reading about low self-esteem as well, because treatment may need to address both.
What CBT for social anxiety involves
Treatment begins with a personal formulation: your particular fears, the image you have of how you come across, the safety behaviours you rely on, and what happens before and after social situations. From there, the work is active and practical. We plan ways of testing your predictions in real situations, look at what happens to your attention when you are anxious, and work on the post-mortem that so often follows.
Social anxiety is one of the most treatable anxiety problems. Much of what keeps it going is invisible from the inside, which is why working with someone who understands the mechanism makes such a difference.
In my practice
Social anxiety is common among the professionals I work with, especially those whose roles involve presenting, leading or networking. Often it has been managed for years through careful preparation and a great deal of effort, and it only becomes a problem when the demands increase. Treatment is active and practical. Much of the work happens in real situations between sessions, and it can be done just as effectively online as in person.
Social anxiety is one of several anxiety problems I treat. You can read more about the others on my page about CBT for anxiety in London and online.
If any of this sounds familiar, you may find it useful to talk it through. I offer an initial assessment, online or in person in Queen's Park, and can tell you honestly whether I think treatment with me is the right fit.
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BABCP-accredited CBT therapist and EMDR Europe accredited practitioner, in clinical practice since 2015. Guy works with adults online and in Queen's Park, North West London, with a particular focus on OCD, anxiety and trauma. More about Guy
