Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
Social anxiety
The rehearsing, the replaying, the “they could tell.” Here’s what keeps social anxiety going and how CBT turns it around.
In short
- Social anxiety is a strong fear of being scrutinized, judged or embarrassed, so social situations get avoided or endured with dread.
- It’s common: 7.1% of U.S. adults in a given year.
- Safety behaviours and self-focus keep it going. In experiments, they made anxiety and even actual performance worse.
- Individual CBT built for social anxiety is the best-supported psychological treatment.
What it is
Paraphrased.
The fear
Marked fear or anxiety about situations where other people might scrutinize you: conversations, meeting new people, being watched eating or working, speaking up. The core fear is acting in a way, or showing anxiety in a way, that gets you judged negatively. (StatPearls SAD; NIMH)
The pattern
Those situations almost always trigger the fear, and get avoided or endured with intense distress. The fear is out of proportion, typically lasts 6 months or more, and gets in the way of work, school or relationships.
How common
7.1% of U.S. adults in the past year, 12.1% in a lifetime. Highest at ages 18–29 (9.1%). (NIMH)
Not just shyness
Shyness is a temperament. Social anxiety disorder is when the fear starts making choices for you: the job you don’t apply for, the friend you stop texting.
Safety behaviours
Your safety behaviours
Tap the ones you use in social situations.
The meters illustrate the idea; they aren’t a score.
What helps
Turn attention outward
Put your attention on the other person and the conversation, not on monitoring yourself. It’s a skill, and it gets easier with practice.
Drop one crutch at a time
Run it as an experiment: same situation, once with the safety behaviour and once without. Compare how anxious you felt and how it actually went.
Test the prediction
“My voice will shake and people will think I’m incompetent.” What did people actually do? Ask a trusted friend for honest feedback. Social example ladder →
Skip the post-mortem
Replaying every awkward moment afterwards is another way the fear keeps itself fed. Notice it, then move on to something else.
Evidence
Individual CBT leads
A network meta-analysis of 101 trials (13,164 adults) found individual CBT was the most effective psychological treatment (vs waitlist SMD −1.19), and the only kind that beat psychological placebo. (Mayo-Wilson 2014)
What NICE recommends
Individual CBT developed specifically for social anxiety, based on the Clark and Wells or Heimberg models. Clark and Wells’ version runs up to 14 sessions of 90 minutes over about four months, including video feedback and behavioural experiments. (NICE CG159)
Safety behaviours, tested
In an experiment, socially anxious people who used their safety behaviours and focused on themselves felt more anxious, held more negative beliefs, and performed worse, both in their own eyes and to observers. (McManus 2008)
Sources
All sources, linked5 references⌄
- StatPearls. Social Anxiety Disorder. NCBI Bookshelf NBK555890. www.ncbi.nlm.nih.gov/books/NBK555890/
- National Institute of Mental Health. Social Anxiety Disorder (NCS-R statistics). www.nimh.nih.gov/health/statistics/social-anxiety-disorder
- McManus F, Sacadura C, Clark DM (2008). Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor. J Behav Ther Exp Psychiatry, 39(2), 147–161. pubmed.ncbi.nlm.nih.gov/17433252/
- Mayo-Wilson E et al. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry, 1(5), 368–376. pmc.ncbi.nlm.nih.gov/articles/PMC4287862/
- NICE (2013). Social anxiety disorder: recognition, assessment and treatment (CG159). www.nice.org.uk/guidance/cg159/chapter/recommendations
Related on this site