Social anxiety disorder is a persistent fear of being judged, embarrassed or negatively evaluated in social situations. It can make everyday activities—answering a phone call, speaking in a meeting, eating with other people or asking for help—feel intensely threatening.
It is more than ordinary shyness and does not mean someone lacks intelligence, social skills or the desire to connect. A person may want friendships, relationships or career opportunities but feel held back by anxiety.
Social anxiety is treatable. Cognitive behavioural therapy developed specifically for social anxiety is a recommended first treatment for adults. Medication and supported self-help can also have a role, depending on individual needs and preferences.
1. What is social anxiety disorder?
Social anxiety disorder, sometimes called social phobia, involves fear of situations in which other people might observe or evaluate you. The feared outcome is often humiliation, rejection or appearing anxious, awkward or incompetent.
For some people, the difficulty is concentrated around public speaking or performing. For others, it affects conversations, shopping, dating, work, education and healthcare appointments.
The important distinction is the impact: anxiety becomes a disorder when it is persistent and causes significant distress or interference with everyday life. Someone may avoid situations entirely or endure them while feeling extremely uncomfortable.
The condition often begins during adolescence, although people may seek help much later. The NHS overview of social anxiety explains why it deserves treatment rather than being dismissed as a personality trait.
2. What are the symptoms of social anxiety?
Symptoms can affect thoughts, emotions, the body and behaviour. They may begin long before an event and continue afterwards.
Thoughts and fears
- Expecting other people to think badly of you.
- Worrying that you will say something foolish or offensive.
- Fearing that blushing, sweating or trembling will be noticed.
- Assuming a pause or neutral expression means disapproval.
- Replaying conversations and searching for mistakes afterwards.
Physical symptoms
- A racing or pounding heart.
- Shaking, sweating or feeling hot.
- Blushing, nausea or a dry mouth.
- Muscle tension or a shaky voice.
- Feeling as though your mind has gone blank.
These bodily reactions are described in Homerton Healthcare’s social anxiety information.
Changes in behaviour
You might cancel plans, avoid calls, speak very little, rehearse every sentence or rely on another person to handle conversations. Some people appear confident externally while feeling highly anxious internally.
Panic attacks can occur, but they are not necessary for a diagnosis. Our guide to panic attack symptoms and what to do explains these episodes. New or severe physical symptoms should not automatically be attributed to anxiety.
3. How is it different from shyness, introversion or other anxiety?
Being quiet, enjoying time alone or feeling nervous before a presentation is not automatically a mental health problem.
| Experience | Main distinction |
|---|---|
| Shyness | Initial discomfort around people, which does not necessarily cause major distress or restrict life |
| Introversion | A preference for quieter settings or time alone, rather than necessarily fearing judgement |
| Social anxiety disorder | Persistent fear of scrutiny or negative evaluation that causes significant distress or interference |
| Generalised anxiety | Worry across several areas of life, rather than primarily social evaluation |
| Panic disorder | Recurrent unexpected panic attacks and concern about further attacks or their consequences |
These experiences can overlap. Someone can be outgoing and socially anxious, or introverted without anxiety.
Autistic people may also experience social anxiety, but autism is not another name for social phobia. Sensory needs, communication differences and experiences of exclusion require consideration in their own right. Assessment should explore what makes a situation difficult rather than assuming every social difficulty has the same explanation.
Our broader guide to anxiety disorders explains other patterns of anxiety.
4. What causes social anxiety, and what keeps it going?
There is no single cause. Research suggests a combination of inherited vulnerability, temperament, biological factors and life experiences. Stressful or humiliating experiences may contribute, but not everyone can identify a particular starting event.
The National Institute of Mental Health’s social anxiety guide describes the interaction between genetic and environmental influences. Having an affected relative does not make the condition inevitable.
Whatever started the problem, certain patterns can maintain it:
- You predict that a social situation will go badly.
- Your attention turns inward towards your appearance, voice or heartbeat.
- You avoid the situation or use strategies intended to prevent embarrassment.
- You get short-term relief but little opportunity to test your prediction.
- You later review the event critically, increasing fear about next time.
Therapists sometimes call these protective strategies safety behaviours. Examples include rehearsing every sentence or checking your phone to avoid interaction. Their function matters: the same action can be helpful in one context and anxiety-maintaining in another.
The Cumbria, Northumberland, Tyne and Wear NHS self-help guide explains this cycle.
Genuine bullying, harassment or discrimination should not be reframed as merely an anxious thought. Treatment should distinguish realistic threats from predictions that anxiety has exaggerated.
5. How is social anxiety diagnosed?
A GP or mental health professional will ask about the situations you fear, what you expect to happen, how you respond and the effect on your life.
Assessment may explore:
- how long symptoms have been present;
- situations you avoid or find difficult;
- effects on work, education, relationships and daily tasks;
- depression, other anxiety symptoms or substance use;
- physical health, medicines and developmental history;
- your goals and preferences for treatment.
Questionnaires can help measure symptoms and track progress, but an online score alone cannot establish a diagnosis. There is no blood test that confirms social anxiety disorder.
If anxiety makes seeking help difficult, write down what you want to say. You can hand over a note such as: “I avoid conversations and appointments because I am afraid of being judged. It is affecting my life, and I would like an assessment.”
You do not need to wait until you have stopped working or become completely isolated before asking for support.
6. How does CBT treat social anxiety?
NICE recommends individual CBT specifically developed for social anxiety as an initial treatment for adults. It is more targeted than general advice to become confident or think positively.
Depending on the treatment approach, you and the therapist may work on:
- understanding your particular anxiety cycle;
- testing predictions about how other people respond;
- shifting attention away from constant self-monitoring;
- gradually approaching situations you have avoided;
- reducing unhelpful safety behaviours;
- addressing harsh self-images and post-event rumination;
- planning how to maintain progress.
For example, you might predict that asking a question will make everyone think you are incompetent. A planned behavioural experiment lets you compare that prediction with what actually happens.
The aim is not to guarantee that nobody will ever judge you. It is to develop a more balanced view of social situations and confidence that you can cope with uncertainty.
Practice should be collaborative and manageable, not humiliating or forced. For adults, NICE does not recommend routinely choosing group CBT over individual CBT. See the NICE social anxiety treatment recommendations.
7. Can medication help?
Medication is an option for some adults, particularly when they prefer it to CBT or need further treatment after an initial approach has not helped enough.
SSRIs, a type of antidepressant, may be prescribed for social anxiety even when someone does not have depression. NICE identifies sertraline or escitalopram as options when an adult chooses medication. See its guide to treatments for adults.
These medicines are taken regularly rather than just before an event. Benefits develop over time, and the prescriber should review effectiveness and side effects.
Possible side effects include nausea, sleep disturbance, sexual difficulties and increased anxiety early in treatment. Some people develop suicidal thoughts or urges to self-harm, particularly when starting medication; seek medical help promptly if this happens. The NHS antidepressant guide explains risks and monitoring.
Do not stop antidepressants suddenly or change the dose without discussing it with the prescriber. Gradual reduction may be needed to minimise withdrawal symptoms.
What about propranolol?
Propranolol can reduce physical symptoms such as trembling and a racing heart, but it does not directly address the thoughts and avoidance patterns underlying social anxiety. It is not suitable for everyone.
Our guide to propranolol and anxiety symptoms explains its role. Do not borrow someone else’s medication or use alcohol as a substitute for treatment.
8. What can you try alongside treatment?
Self-help can be a useful starting point or complement to therapy. It is not a test of willpower, and needing professional support does not mean you have failed.
Choose one small, meaningful goal
Rather than deciding to “be more sociable”, choose something specific: asking a colleague one question, making a short enquiry or attending part of an activity you value.
Separate predictions from observations
Before the task, briefly note what you expect. Afterwards, record what you actually observed. “There was a pause” is an observation; “they thought I was boring” is an interpretation.
Practise without demanding perfect calm
You do not have to eliminate anxiety before participating. A useful goal is completing something meaningful while allowing some discomfort to be present.
Reduce one unhelpful protective habit at a time
For example, experiment with preparing a few talking points instead of scripting every sentence. Keep changes manageable and discuss difficult steps with your therapist.
Support your general wellbeing
Regular sleep, movement and meals can support your ability to cope. Notice whether caffeine worsens physical anxiety, and avoid relying on alcohol to get through social situations.
The NHS inform social anxiety self-help guide provides structured CBT-based exercises.
9. How do you access treatment in the UK?
You can speak to your GP, particularly if you are unsure about the diagnosis, have other health concerns or want to discuss medication.
In England, adults can usually self-refer to NHS Talking Therapies for anxiety and depression. You do not need an existing diagnosis. Services generally accept people aged 18 and over, with some accepting 16- and 17-year-olds.
Scotland, Wales and Northern Ireland have their own local pathways. Ask your GP or local health service how to access psychological therapy rather than assuming England’s referral system applies.
If making contact is difficult, ask whether an online referral, written information or an initial remote appointment is possible. Our guides explain self-referral routes and online therapy options.
If choosing private therapy, ask about the practitioner’s recognised registration or accreditation, experience treating social anxiety and use of disorder-specific CBT. Check fees, cancellation terms and progress-review arrangements. See our guide to private therapy costs.
10. What does social anxiety look like in children and teenagers?
Children may struggle to explain fears about judgement. Difficulties can appear as avoiding classmates, refusing to speak in certain situations, distress before school or reluctance to take part in activities.
Quietness alone is not a disorder. Assessment should consider the child’s development, communication needs, friendships, bullying and whether anxiety is preventing participation.
Parents and schools can help by:
- listening without describing the child as rude or difficult;
- asking privately what feels threatening;
- addressing bullying or exclusion directly;
- agreeing gradual, supported steps;
- avoiding surprise public performances intended to “build confidence”.
NICE recommends age-appropriate CBT for children and young people with social anxiety. Parents or carers may be involved, especially for younger children. Medication is not routinely recommended for treating social anxiety in this age group. See NICE’s treatment information for children and young people.
Speak to a GP, school mental health lead or local children’s mental health service if difficulties persist or significantly affect daily life.
11. What does recovery look like, and when is urgent help needed?
Recovery does not require becoming an extrovert or enjoying every social event. Meaningful progress may involve attending appointments, contributing at work, developing relationships or spending less time criticising yourself afterwards.
Progress can be uneven. An anxious week does not erase earlier gains. If treatment is not helping, discuss whether the approach is sufficiently focused on social anxiety, whether practical barriers are getting in the way, or whether another condition also needs attention.
Friends and family can help by acknowledging the difficulty, supporting agreed steps and avoiding both pressure and automatically taking over every interaction.
Social anxiety can occur alongside depression. Seek additional help if you become increasingly isolated, hopeless or reliant on alcohol or drugs. Our guide to depression symptoms and treatment explains related warning signs.
If you have seriously harmed yourself, taken an overdose or cannot keep yourself safe, call 999 or go to A&E. For urgent mental health support in England, call 111 and select the mental health option. Other UK nations have their own urgent-care arrangements.
You can also contact Samaritans on 116 123, free at any time, for confidential emotional support. You do not have to be suicidal to call.
12. Frequently asked questions
Is social anxiety just shyness?
No. Shyness does not necessarily restrict someone’s life. Social anxiety disorder involves persistent fear and significant distress or interference with everyday activities.
Can you have social anxiety and still seem confident?
Yes. Someone may speak fluently or perform well while feeling intensely anxious, preparing excessively or struggling afterwards.
Can social anxiety cause physical symptoms?
Yes. Sweating, trembling, blushing, nausea and a racing heart can occur. However, new or severe physical symptoms should not automatically be assumed to be anxiety.
Is social anxiety the same as autism?
No. They are different, although they can coexist. Assessment should explore the reason social situations are difficult and recognise communication or sensory needs.
What is the recommended treatment?
For adults, individual CBT specifically developed for social anxiety is a recommended first treatment. Supported self-help and medication may also be appropriate.
Will therapy force me into embarrassing situations?
It should not. Practice should be explained and agreed collaboratively, with tasks linked to your goals rather than humiliation or pressure.
How long does improvement take?
It varies. Treatment generally involves repeated practice over weeks or months, with progress reviewed along the way. No clinician can guarantee a fixed recovery date.
Can I get help if I am too anxious to make a phone call?
Yes. Online self-referral, written notes or help from a trusted person can make the first contact easier. Tell the service that communication itself is part of the difficulty.
Can social anxiety improve after many years?
Yes. Longstanding symptoms do not mean treatment cannot help. The aim is to reduce anxiety’s control over your choices, not change your personality.
