Although it may feel like you’re the only one with this problem, social anxiety is actually quite common. Many people struggle with these fears. But the situations that trigger the symptoms of social anxiety disorder can be different.
Some people experience anxiety in most social situations. For others, anxiety is connected to specific social situations, such as speaking to strangers, mingling at parties, or performing in front of an audience. Common social anxiety triggers include:
Signs and symptoms of social anxiety disorder
Just because you occasionally get nervous in social situations doesn’t mean you have social anxiety disorder or social phobia. Many people feel shy or self-conscious on occasion, yet it doesn’t get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress.
For example, it’s perfectly normal to get the jitters before giving a speech. But if you have social anxiety, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak.
Emotional signs and symptoms of social anxiety disorder:
Physical signs and symptoms:
Behavioral signs and symptoms:
Social anxiety disorder in children:
There’s nothing abnormal about a child being shy, but children with social anxiety disorder experience extreme distress over everyday situations such as playing with other kids, reading in class, speaking to adults, or taking tests. Often, children with social phobia don’t even want to go to school.
How to overcome social anxiety disorder tip 1: Challenge negative thoughts
While it may seem like there’s nothing you can do about the symptoms of social anxiety disorder or social phobia, in reality, there are many things that can help. The first step is challenging your mentality.
Social anxiety sufferers have negative thoughts and beliefs that contribute to their fears and anxiety. These can include thoughts such as:
Tip 1: Identify the automatic negative thoughts that underlie your fear of social situations. For example, if you’re worried about an upcoming work presentation, the underlying negative thought might be: “I’m going to blow it. Everyone will think I’m completely incompetent.”
Analyze and challenge these thoughts. It helps to ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to blow the presentation?” or “Even if I’m nervous, will people necessarily think I’m incompetent?” Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety. It can be incredibly scary to think about why you feel and think the way you do, but understanding the reasons for your anxieties will help lessen their negative impact on your life.
Unhelpful thinking styles that fuel social anxiety.
Ask yourself if you’re engaging in any of the following unhelpful thinking styles:
Tip 2: Focus on others, not yourself
When we’re in a social situation that makes us nervous, many of us tend to get caught up in our anxious thoughts and feelings. You may be convinced that everyone is looking at you and judging you. Your focus is on your bodily sensations, hoping that by paying extra close attention you can better control them. But this excessive self-focus just makes you more aware of how nervous you’re feeling, triggering even more anxiety! It also prevents you from fully concentrating on the conversations around you or the performance you’re giving.
Switching from an internal to an external focus can go a long way toward reducing social anxiety. This is easier said than done, but you can’t pay attention to two things at once. The more you concentrate on what’s happening around you, the less you’ll be affected by anxiety.
Focus your attention on other people—but not on what they’re thinking of you! Instead, do your best to engage them and make a genuine connection.
Remember that anxiety isn’t as visible as you think. And even if someone notices that you’re nervous, that doesn’t mean they’ll think badly of you. Chances are other people are feeling just as nervous as you—or have done in the past.
Really listen to what is being said—not to your own negative thoughts.
Focus on the present moment, rather than worrying about what you’re going to say or beating yourself up for a flub that’s already passed.
Release the pressure to be perfect. Instead, focus on being genuine and attentive—qualities that other people will appreciate.
Tip 3: Learn to control your breathing
Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly.
Overbreathing (hyperventilation) throws off the balance of oxygen and carbon dioxide in your body—leading to more physical symptoms of anxiety, such as dizziness, a feeling of suffocation, increased heart rate, and muscle tension.
Learning to slow your breathing down can help bring your physical symptoms of anxiety back under control. Practicing the following breathing exercise will help you stay calm:
Tip 4: Face your fears
One of the most helpful things you can do to overcome social anxiety is to face the social situations you fear rather than avoid them. Avoidance keeps social anxiety disorder going. While avoiding nerve-wracking situations may help you feel better in the short term, it prevents you from becoming more comfortable in social situations and learning how to cope in the long term. In fact, the more you avoid a feared social situation, the more frightening it becomes.
Avoidance can also prevent you from doing things you’d like to do or reaching certain goals. For example, a fear of speaking up may prevent you from sharing your ideas at work, standing out in the classroom, or making new friends.
While it may seem impossible to overcome a feared social situation, you can do it by taking it one small step at a time. The key is to start with a situation that you can handle and gradually work your way up to more challenging situations, building your confidence and coping skills as you move up the “anxiety ladder.”
For example, if socializing with strangers makes you anxious, you might start by accompanying an outgoing friend to a party. Once you’re comfortable with that step, you might try introducing yourself to one new person, and so on.
To work your way up a social anxiety ladder:
Don’t try to face your biggest fear right away. It’s never a good idea to move too fast, take on too much, or force things. This may backfire and reinforce your anxiety.
Be patient. Overcoming social anxiety takes time and practice. It’s a gradual step-by-step progress.
Use the skills you’ve learned to stay calm, such as focusing on your breathing and challenging negative assumptions.
Socially interacting with co-workers: A sample anxiety ladder:
Step 1: Say “hi” to students and other students.
Step 2: Ask students questions about how to complete tasks at work.
Step 3: Ask a students what they did on the weekend.
Step 4: Sit in the staff room during coffee break.
Step 5: Eat lunch in the staff room.
Step 6: Eat lunch in the staff room and make small talk with coworkers (e.g., talk about the weather, sports, current events, etc.)
Step 7: Ask a co-worker to go for coffee after work.
Step 8: Go out for lunch with a group of co-workers.
Step 9: Share personal information about yourself with co-workers.
Step 10: Attend a staff party.
Tip 5: Make an effort to be more social:
Actively seeking out supportive social environments is another effective way of challenging your fears and overcoming social anxiety. The following suggestions are good ways to start interacting with others in positive ways:
Take a social skills class or an assertiveness training class:
These classes are often offered at local adult education centers or community colleges.
Volunteer doing something you enjoy:
Perhaps walking a dog in a shelter, or working at your local food bank—anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.
Work on your communication skills:
Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help. You can make friends even if you’re shy or socially awkward. No matter how awkward or nervous you feel in the company of others, you can learn to silence self-critical thoughts, boost your self-esteem, and become more confident and secure in your interactions with others. You don’t have to change your personality. By simply learning new skills and adopting a different outlook you can overcome your fears and anxiety and build rewarding friendships.
Tip 6: Adopt an anti-anxiety lifestyle
The mind and the body are intrinsically linked—and more and more evidence suggests that how you treat your body can have a significant effect on your anxiety levels, your ability to manage anxiety symptoms, and your overall self-confidence.
While lifestyle changes alone aren’t enough to overcome social phobia or social anxiety disorder, they can support your overall treatment progress. The following lifestyle tips will help you reduce your overall anxiety levels and set the stage for successful treatment.
Avoid or limit caffeine – Coffee, tea, soda, and energy drinks act as stimulants that increase anxiety symptoms. Consider cutting out caffeine entirely, or keeping your intake low and limited to the morning.
Get active – Make physical activity a priority—30 minutes per day if possible. If you hate to exercise, try pairing it with something you do enjoy, such as window shopping while walking laps around the mall or dancing to your favorite music.
Add more omega-3 fats to your diet – Omega-3 fatty acids support brain health and can improve your mood, outlook, and ability to handle anxiety. The best sources are fatty fish (salmon, herring, mackerel, anchovies, sardines), seaweed, flaxseed, and walnuts.
Drink only in moderation – You may be tempted to drink before a social situation to calm your nerves, but alcohol increases your risk of having an anxiety attack.
Quit smoking – Nicotine is a powerful stimulant. Contrary to popular belief, smoking leads to higher, not lower, levels of anxiety. If you need help kicking the habit, see: How to Quit Smoking.
Get enough quality sleep – When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations.
Social anxiety disorder treatment
If you’ve tried the self-help techniques above and you’re still struggling with disabling social anxiety, you may need professional help as well.
Therapy for social anxiety
Of all the professional treatments available, cognitive-behavioral therapy (CBT) has been shown to work best for treating social anxiety disorder. CBT is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.
CBT for social phobia may involve:
Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.
Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.
Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.
While you can learn and practice these exercises on your own, if you’ve had trouble with self-help, you may benefit from the extra support and guidance a therapist brings.
Role-playing, social skills training, and other CBT techniques, often as part of a therapy group. Group therapy uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable, and your anxiety will lessen.
Medication for social anxiety disorder
Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure. Medication is considered most helpful when used in addition to therapy and self-help techniques that address the root cause of your social anxiety disorder.
Three types of medication are used in the treatment of social anxiety:
Beta blockers are used for relieving performance anxiety. While they don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
Antidepressants: Zoloft may be helpful when social anxiety disorder is severe and debilitating.
Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so are typically prescribed only when other medications have not worked.
If you find you’re drinking more alcohol during the COVID-19 pandemic or starting to drink alone, you’re—well, not alone. Maybe you used to drink only occasionally, but now it feels like there’s permission to make drinking a daily ritual.
Working from home makes it even easier to turn to alcohol in the evening (or earlier). Why not have a drink (or three) every night when you don’t have to get up early to make yourself presentable and get to work on time? Pouring a drink can be especially appealing after a stressful day, which is pretty much every day now.
But what if you’re not entirely comfortable with your recent pattern of alcohol use, and part of you worries it might become a real issue? Even if you’ve never had a problem with drinking, you might be concerned about the long-term effects, and whether you’ll be able to step away from this higher level of consumption once the pandemic is behind us.
If you suspect your relationship with alcohol is moving in an unhealthy direction, don’t be hard on yourself. Turning to familiar ways of coping is a common and understandable response to this bewildering situation. As you’re assessing your relationship with alcohol, look for the following warning signs that your drinking may be going too far:
So how to avoid developing a serious problem with alcohol? The only surefire approach is to avoid drinking altogether, but the following recommendations can lower the risk. In general, these preventive measures are the flip side of the risk factors.
If you’re wondering whether to change your drinking behavior, take care to ask yourself the right question. Most commonly we’ll ask ourselves if we’re “addicted” or if we’re “an alcoholic,” but those questions are usually too black-or-white to offer meaningful answers. The better question is, "Is the way I’m drinking a net positive in my life?" If not, talk with a qualified substance abuse psychotherapist or someone you love and trust about the concerns you have. Explore with them whether it’s time to change your relationship with alcohol, and how they might support you along the way.
Fight-or-flight is the instinctive physiological response to an external threat. It is a reaction that no doubt has early evolutionary roots. When fight or flight kicks in, the brain does not take time to weigh the circumstances, because a very quick response can mean survival. Of course, this lack of reflection means that in many cases, the body is overreacting. With experience, most of us learn to quickly recover from the first flush of fight or flight and find an appropriate response. It is a balance.
Fight or flight, or something akin to it, can also come about when a person experiences sharp, chronic romantic trauma. Those who have had relationships in which they were emotionally abused, physically or sexually threatened, or assaulted understandably may have developed an acute sensitivity to the cues that preceded these events. Even if they have managed to extricate themselves from a bad relationship, they may retain the learned impulse to react without reflection to any hint of a repeat.
As a result, the distress they experienced in bad relationships now gets triggered, inappropriately, in new situations with other people. If this describes you, you may in the moment feel a dreadful sense of deja vu and react negatively. While it may feel like the exact same situation, as you reflect later, you recognize that it was not the same situation at all. This often makes people feel ashamed or guilty for mistreating a current, healthier partner.
Here are some ways to assess if your past romantic trauma is being triggered in your current relationship — and how to start processing the original trauma:
If you suffered a betrayal through cheating in your past romantic relationship you may find yourself thinking that your current boyfriend is fooling around behind your back, whether it is flirting or cheating. Do not allow yourself to engage in making assumptions. Ask yourself how well do you know this person and is this something he or she would do? Take a step back and work through the hurt you suffered in your last relationship. Consider talking to your new partner about how you were betrayed and what you need to feel safe in your current relationship. Talk with him/her about how you are working on not letting this old experience taint your new one.
If your past partner was controlling or domineering, you'll likely become triggered when a partner tells you what to do, how to feel, or how to act. Your new partner may not actually be trying to control you, but merely expressing an opinion. Nonetheless, the triggering may send you into flight or fight. You may tune out while they are talking, ignore them, or appear paralyzed. Instead, try to communicate with your partner about what you're noticing about yourself and how loaded the idea of control is for you.
Instead of blaming, see if you can understand where your partner is coming from and if they will consider ways to communicate opinions and desires that feel less threatening to you and are less likely to trigger an overreaction.
If you suffered emotional abuse in past relationships, it would not be unusual for conflict in a new relationship to trigger an overreaction. Your current partner may just be expressing normal feelings that need to get out, but for you, it feels as if the walls are caving in. You may panic or live in a state of fear about upsetting your partner. The possibility of an argument paralyzes you. Instead, work on noticing how your partner is communicating upset to you; instead of assuming it’s the same old thing, look for differences: Is he or she more sensitive to you, or are they still able to see the good in you even when upset with you? Remind yourself that all couples have conflict, and even if someone is upset, you can work things through without it becoming a crisis.
If you suffered physical or sexual abuse in past relationships, you may be susceptible to having negative emotions triggered by physical closeness or touch. If your past partner hurt you physically or made you feel as if you were physically disgusting or had no worth, then sexual interactions may become emotionally painful. Many in this situation leave an encounter by disconnecting and tuning out. Before entering a new romantic relationship, consider that your body and brain need time to heal to feel safe again. It is unrealistic to go from physical mistreatment to feeling safe while being physically vulnerable with a new partner. Take a break, talk to a therapist to help you work through the trauma. Do not force yourself to engage physically: If you are not fully on board, each new sexual experience will only add to that original trauma.
Neurofeedback is direct training typically provided by health professionals such as psychologists, family therapists, and counselors. We observe the brain in action from moment to moment and that information is brought back to the person by way of the sensors. Neurofeedback is also called EEG Biofeedback, because it is based on electrical brain activity, the electroencephalogram, or EEG. Neurofeedback is training in self-regulation. Self-regulation is a necessary part of optimal brain performance and function. Self-regulation training allows the nervous system to function better.
The LENS is a specific kind of Neurofeedback that operates much more rapidly than traditional Neurofeedback and has qualities that make it much easier to use with people who can’t sit still. With the LENS, the client doesn’t need to “do” anything, and there is nothing to learn. The typical session with the LENS lasts 3-4 minutes. This means that the LENS works well for people who either cannot or will not pay attention to a computer screen for longer time periods. Additionally, the LENS works much faster than traditional Neurofeedback with the number of sessions ranging from as few as 1 to an overall average number of sessions of 20.
The LENS works well with problems of the Central Nervous System, which can be numerous. These include symptoms of anxiety-depression spectrum, attention deficits, behavior disorders, various sleep disorders, headaches and migraines, PMS and emotional disturbances. It is also useful for organic brain conditions such as seizures, the autism spectrum, and cerebral palsy. These are all signs of Central Nervous System dysfunction which result in the body’s difficulty regulating itself.
How does the LENS work?
We apply sensors to the scalp to listen in on brainwave activity. We process the signal by computer, and extract information about certain key brainwave frequencies. Through a patented process, we then bring this information back to the client down the sensor wires to the person’s skin. The results are reduction and/or elimination of the symptoms which previously interfered with the client’s quality of life. The sessions are brief (usually 3-5 minutes), gentle (usually the client feels nothing during the session), and the changes are lasting with some exceptions: with symptoms of progressive conditions such as Parkinson’s and MS, the treatment needs to be ongoing to sustain the improvement.
What conditions does the LENS help with?
It works extremely well with the symptoms of Traumatic Brain Injury, no matter how long ago the incident occurred. The trauma can be from a physical blow, a concussive injury, a psychological incident (PTSD), or any other incident(s) which results in a decrease in cognitive ability.
Many children have sleep problems that can be helped such as bed wetting, sleep walking, sleep talking, teeth grinding, nightmares, and night terrors.
The LENS can also be helpful with many of the symptoms of adolescence including drug abuse, suicidal behavior, anxiety and depression. The LENS can also help in maintaining good brain function as people age.
Do the results of LENS last?
If the problem being addressed is one of brain dysregulation, then the answer is yes, and that covers a lot of ground. Neurofeedback involves learning by the brain and if that brings order out of disorder, the brain will continue to use its new capabilities, and thus reinforce them.
At times there are unknown issues such as early-stage degenerative disease, allergies, strong reactions to some foods or pollens, or spills and falls leading to bumps on the head. In these instances longer courses of the LENS may be needed. And it may also be that some direct medical help may be the best course of action. The LENS can’t do everything for everybody. But it can and has made a difference that other approaches have not provided, and in general, in a much shorter time. Matters are different when we are dealing with degenerative conditions like Parkinson's or the dementias, or when we are working against continuing insults to the system, as may be the case in the autism spectrum. In such cases, the LENS sessions may need to be continued at some level over time. Allergic susceptibilities and food intolerances may make it more difficult to maintain the gains. Poor digestive function will pose a problem, as does poor nutrition. A child living in a toxic environment (in either the physical or the psychological sense) may have more difficulty retaining good function.
What is the success rate with neurofeedback?
It turns out that among the vast majority of clients (>95% in one clinician's experience,) the actual outcome exceeds the prior expectations. Against such low expectations, the changes that can be produced with the LENS may even appear miraculous. One EEG Biofeedback office has a sign on its front desk: "We expect miracles." If none occur, something has gone wrong." What appears miraculous in all of this is really nothing more than the incredible capacity of the brain to recover function when given a chance.
Is neurofeedback a cure?
In the case of organic brain disorders, it can only be a matter of getting the brain to function better rather than of curing the condition. When it comes to problems of dysregulation, we would say that there is not a disease to be cured. Where dysregulation is the problem, self-regulation may very well be the remedy. But again, the word cure would not apply.
Thomas Kessler, LMFT, RAS
Imagine a train racing towards you at top speed, and there you are, stuck on the tracks, a human target. Your heart races, your muscles tense, your body starts shaking, and your breath becomes labored as worry consumes your mind and manifests throughout your body. Intense, right? For the nearly 20 percent of people in the U.S. affected by an anxiety disorder every year, this is what anxiety can feel like: Anxiety is a dreadful feeling of unease and worry, perpetuated by fear, that often comes with repetitive negative thinking.
As you’re experiencing it, you can have difficulty concentrating and making decisions. Even if you haven’t been diagnosed with an anxiety disorder, chances are you’ve felt the heart pound at some point and know the struggle is real.
What’s Going On In The Brain?
In states of anxiety, the brain is affected by stress hormones like cortisol and excitatory neurotransmitters, such as norepinephrine. These factors can lead to a decreased ability to regulate negative emotions, excessive negative thinking, and difficulty relaxing,” he says.
At the same time, the amygdala, or the emotion center of the brain, becomes overactive, which makes it harder for higher brain centers (those in charge of cognitive functions like learning and memory) to regulate emotional and physiologic states to calm down mentally and physically.
The amygdala decides what emotions to give you from moment to moment by providing a constant threat assessment about your environment. When it determines something isn’t dangerous, it does nothing and you feel calm. When it looks at something it perceives as dangerous, it rings an alarm to warn you about the danger and motivates you to do something about it—that’s what anxiety is, it’s the alarm system.
For someone with a fear of dogs, for example, when they see a dog, the amygdala rings the alarm and tells them the dog is dangerous, and the person becomes anxious. That motivates them to get away from the dog. When the danger is gone, the alarm shuts off and the anxiety goes from high to low.
As humans we are wired to repeat actions that make us feel good and stop actions that make us feel bad. Because the anxiety went from high to low by running away from the dog, this kind of avoidance behavior becomes reinforced and we’re more likely to repeat the same behavior the next time we see a dog. It’s an evolutionary response; the body says, ‘anxiety kept me safe, I better get anxious again.’”
Why Does Anxiety Keep Coming Back?
When the body experiences symptoms of anxiety, the brain interprets these signals from the body as cause for concern, worsening anxiety by creating a vicious cycle. The more anxious we get, the more nervous we feel; the more nervous we feel, the more anxious we get.
The important thing to know is not why you have anxiety in the first place, but what’s maintaining it now. The basic idea is short-term avoidance of anxiety leads to long-term maintenance of anxiety. When someone tries to make themselves feel better in the moment (avoiding a dog), it guarantees more anxiety the next time they’re in a similar situation.
How to Calm Anxiety When It Arises
By practicing a few helpful strategies on the regular, when a bout of anxiety strike, you’ll be more likely to get in the habit of doing them automatically—and dial down your angst.
If you or someone you know is experiencing anxiety there are many ways one can learn to overcome chronic anxiety.
Thomas Kessler, LMFT, RAS
Maybe sex is the last thing on your mind when you’re stressed out. But it might help lower your anxiety. Sex seems to lessen the amount of hormones your body releases in response to stress. And an active sex life can make you happier and healthier, which might also help keep anxiety at bay.
Research says people who have sex once a month or less get heart disease more often than those who have it twice a week or so. Part of the reason could be that you get a bit more exercise and are less likely to be anxious or depressed. But it could also be that if you have more sex, you’re physically and mentally healthier in the first place.
Sex typically burns about 5 calories a minute. That’s about equal to a brisk walk. And you use a bit more oxygen too -- about the same as digging in the garden or walking down the stairs.
That may not seem like much, but it starts to add up over the long term. And because sex can improve your mental health, you might be more likely to do other types of exercise like the neighborhood kickball team, hiking, or housework.
Well, not so much lose them as forget where you put them. That’s because regular sex seems be linked to improved memory, especially if you’re between ages 50 and 89. It’s not clear why.
Weekly sex seems to boost your immune system compared to those who have it less often. Part of the reason may be that it raises levels of a germ-fighting substance called immunoglobulin A, or IgA. But more is not always better here. People who had sex more than twice a week had lower levels of IgA than those who had no sex.
Sex bathes your brain in a chemical “afterglow” that lasts about 2 days and helps to bond you to your partner over the long term. Without it, you could lose some of the satisfaction of your relationship. A healthy, happy sexual relationship -- couples who do it at least once a week seem to be happiest -- can help build trust and understanding between you and your partner.
The reasons aren’t exactly clear, but in at least one study, men who ejaculated less than seven times a month were more likely to get prostate cancer compared to those who did it at least 21 times a month.
But unprotected anonymous sex and multiple partners can also raise your chances for the disease, so when you do have sex, take care.
Without sex, you’ll miss out on the hormones that promote restful sleep, like prolactin and oxytocin. Women get an estrogen boost that helps even more. The reverse is true, too: If you decide you want to start having sex again, a good night’s sleep is just the thing to keep you feeling frisky.
Sex can be a good way to take your mind off of any aches and pains you have. But it does more than that. Orgasm causes your body to release endorphins and other hormones that can help ease head, back, and leg aches. They may help arthritis pain and menstrual cramps, too.
It may seem odd, but “use it or lose it” may apply here. For women at menopause, vaginal tissue can get thin, shrink, and dry out without regular intercourse. That can make sex painful and weaken your desire. And some research says men who have sex less than once a week are twice as likely to have erectile dysfunction (ED) as those who have it weekly.
Sex seems to help keep your blood pressure down. That makes sense when you consider what it does: It adds a bit of aerobic and muscle-building exercise, and it can ease anxiety and make you feel better. Both of those can help keep your numbers where they need to be.
Thomas Kessler, LMFT, RAS
Marriage & Family Therapist and Registered Addiction Specialist