Social anxiety (social phobia)

Symptoms of social anxiety

Social anxiety is more than shyness. It's an intense fear that doesn't go away and affects everyday activities, self-confidence, relationships and work or school life.

Many people occasionally worry about social situations, but someone with social anxiety feels overly worried before, during and after them.

You may have social anxiety if you:

• dread everyday activities, such as meeting strangers, starting conversations, speaking on the phone, working or shopping 
• avoid or worry a lot about social activities, such as group conversations, eating with company, and parties
• always worry about doing something you think is embarrassing, such as blushing, sweating or appearing incompetent
• find it difficult to do things when others are watching – you may feel like you're being watched and judged all the time
• fear criticism, avoid eye contact or have low self-esteem
• often have symptoms such as feeling sick, sweating, trembling or a pounding heartbeat (palpitations)
• have panic attacks (where you have an overwhelming sense of fear and anxiety, usually only for a few minutes)

Many people with social anxiety also have other mental health issues, such as depression, generalised anxiety disorder or body dysmorphic disorder.

When to get help for social anxiety

It's a good idea to see your GP if you think you have social anxiety, especially if it's having a big impact on your life.

It's a common problem and there are treatments that can help.

Asking for help can be difficult, but your GP will be aware that many people struggle with social anxiety and will try to put you at ease.

Your GP will ask you about your feelings, behaviours and symptoms to find out about your anxiety in social situations.

If they think you could have social anxiety, you'll be referred to a mental health specialist to have a full assessment and talk about treatments.

You can also refer yourself directly for psychological (talking) therapies on the NHS without seeing your GP.

How you can overcome social anxiety

Social anxiety can be difficult to deal with, but there are things you can try yourself, as well as several effective treatments and support groups that can help you.

Things you can try

Self-help probably won't cure your social anxiety, but it may reduce it and you might find it a useful first step before trying other treatments.

The following tips may help:

• try to understand more about your anxiety – think about what goes through your mind and how you behave in certain social situations to help you get a clearer idea of the problems you want to tackle
• replace your unrealistic beliefs with more rational ones – for example, if you feel a social situation went badly, think if there are any facts to support this or if you're just assuming the worst
• don't think too much about how others see you – pay attention to other people instead and remember that your anxiety symptoms aren't as obvious as you might think
• start to do activities that you'd normally avoid – this can be tough at first, so start with small targets and work towards more feared activities gradually

You may find it useful to read an NHS self-help guide for social anxiety for more detail.

You can listen to a helpful podcast about controlling anxiety from a leading anxiety specialist.

You can also find mental health apps and tools in the NHS apps library.

Treatments for social anxiety

A number of treatments are also available for social anxiety.

The main options are:

• cognitive behavioural therapy (CBT) with a therapist – therapy that helps you identify negative thought patterns and behaviours, and change them
• guided self-help – this involves working through a CBT-based workbook or online course with regular support from a therapist
• antidepressant medication – usually a type of medicine called a selective serotonin reuptake inhibitor (SSRI), such as escitalopram or sertraline

CBT is generally considered the best treatment, but other treatments may help if it doesn't work or you don't want to try it. Some people need to try a combination of treatments.

Support groups

There are several charities, support groups and online forums for people with social anxiety and other anxiety disorders, including:

• Anxiety UK
• a HealthUnlocked anxiety forum run by Anxiety Support
• Mind and YoungMinds
• Social Anxiety UK, who also have an online forum
• Triumph Over Phobia (TOP UK)

Social anxiety in children

Social anxiety can also affect children.

Signs of social anxiety in a child include:

• crying more than usual
• having frequent tantrums
• avoiding interaction with other children and adults
• fear of going to school or taking part in classroom activities, school performances and social events
• not asking for help at school
• being very reliant on their parents or carer

Speak to your GP if you're worried about your child. Your GP will ask you about your child's problems and talk to them about how they feel.

Treatments for social anxiety in children are similar to those for teenagers and adults, although medication isn't normally used.

Therapy will be tailored to your child's age and will often involve help from you (you may be given training and self-help materials to use between sessions). It may also take place in a small group.