Social Anxiety

Social anxiety is the fear of being judged: of doing something that will be noticed and thought badly of. The older name for it is social phobia, and both refer to the same thing.

It is not the same as shyness, though it often gets described that way. Shyness is a temperament, and plenty of shy people are perfectly content. Social anxiety is a fear that starts reorganizing your life around avoiding situations, and it becomes a diagnosis at the point where it costs you things: friendships not made, work not applied for, classes not taken because they involve speaking.

For some people it is confined to one situation, such as public speaking, eating in front of others, or making phone calls where someone might overhear. For others it covers most encounters involving other people. It usually begins in adolescence, and many people describe having had it as long as they can remember.

The physical symptoms are part of the problem rather than a side effect of it. Blushing, trembling, sweating, a voice that will not stay level: each becomes further evidence that you are visibly failing, which raises the anxiety, which worsens the symptom.

People with social anxiety may know intellectually that the danger is being overestimated. That knowledge often changes very little, which is one of the more demoralizing features of it.

The three-part event

One of the more useful things to notice is that a social event is not one experience. It is three, and for most people two of them are worse than the one everyone assumes.

Before. The rehearsal. Drafting what you will say, predicting how it will land, deciding what to wear against an imagined audience. This can start weeks out and it tends to make the event harder, because you arrive having already failed at it several times in advance.

During. The part almost nobody describes accurately until asked: your attention turns inward. Instead of watching the conversation, you are monitoring yourself in it, how you sound, whether your face is doing the right thing, whether the pause has gone on too long. You are effectively watching a live feed of yourself from the outside, and the picture is far harsher than anything anyone else can see. That monitoring uses the attention you would otherwise be using to follow what is being said, which is why people come away unable to remember the conversation.

After. The post-mortem. Reviewing the evening for errors, landing on the one clumsy remark, and replaying it. It can run for days, and it does not weigh the ninety minutes that went perfectly well against the four seconds that didn't.

The safety behaviors that keep it going

Almost everyone develops a set of tactics for getting through, and they are worth taking seriously because they are a major part of what maintains the problem.

Rehearsing sentences. Holding a drink so your hands have a job. Arriving late so you don't have to do unstructured mingling, or early so you can settle before the room fills. Asking questions continuously so you never have to talk about yourself. Standing where you can leave.

Each one helps in the moment, and each one prevents the thing that would actually change matters, which is finding out what happens without it. It also means that when an evening goes fine, the credit goes to the tactic rather than to you, so the underlying belief never gets updated.

Alcohol can be remarkably effective at reducing social anxiety in the moment, which is precisely why relying on it can become a problem.

What treatment involves

Social anxiety responds well to treatment, and CBT specifically adapted for social anxiety has the strongest evidence. It works on three fronts, and the second is the one most often left out.

Testing the predictions, through exposure: going to the thing, and going without the safety behaviors, which is the harder and more important half. Dropping the attention-monitoring, deliberately turning your focus outward onto the actual conversation, which is a trainable skill and often produces a noticeable shift on its own. And examining the beliefs underneath: that you are being evaluated continuously, that visible anxiety is obvious to everyone, that one awkward remark is remembered by anyone but you.

A specific and useful piece of the work is finding out how visible your anxiety actually is. Most people with social anxiety substantially overestimate it. The blush that feels like a flare is usually far less noticeable than it feels, and the trembling hand is often missed entirely. That is not reassurance; it is something to be tested rather than taken on trust.

Group therapy suits this problem unusually well, and is unusually unappealing for obvious reasons. Practising in a room with other people who have the same difficulty is closer to the real thing than describing it one-to-one. Individual therapy also works well, so this is not a reason to wait for a group to become available.

Medication is a reasonable option too, usually an SSRI, and often combined with therapy. That is a conversation for a doctor rather than a therapist.

What to look for in a therapist

Ask whether treatment will involve doing things outside the session. Social anxiety does not change much from discussion alone.

Ask whether they will address safety behaviors specifically. A therapist who helps you attend the event while keeping every tactic in place has helped you survive it rather than treat it.

If a specific situation is the issue, such as public speaking, eating in front of people, or being on camera, say so early. Treatment can be aimed narrowly and finish quickly, and does not have to become a general project about your confidence.

Reading

Two books on the recommended reading list cover this directly: Gillian Butler's *Overcoming Social Anxiety and Shyness* and Martin Antony and Richard Swinson's *The Shyness and Social Anxiety Workbook*.