People with this disorder find it difficult to establish new relationships, and their avoidance of other people puts them at risk for feeling lonely, having fewer friendships, and being unable to take advantage of the enjoyment of being with people who share their hobbies and interests. If they should become involved in a long-term, committed relationship, individuals with social anxiety disorder are less likely to be able to express their emotions. As a result, any relationships they do manage to forge will be less satisfying, both to themselves and their partners.
Research on social anxiety disorder tends to approach the understanding of its causes and treatments from the standpoint of the individual’s extreme aversion to other people. However, as pointed out by University of British Columbia’s Lynn Alden and colleagues (2018), there is not enough attention paid in the literature to the ability to function in close relationships as a component of this disorder.
The authors note that “the importance of addressing this issue is underscored by work indicating that social avoidance and social approach behavior are guided by partially independent neurocircuits.” In other words, it’s not just social avoidance that contributes to the disorder. This is because “adaptive relational functioning depends in large part on the social approach system” (p. 506). Treating the avoidance isn’t sufficient to helping people with this disorder improve, because in this view, individuals with this disorder need to learn how to interpret social cues from others and to be able to derive joy from their interactions with other people.
Some typical social situations feared by people with social phobia include:
- Speaking in a group
- Giving a presentation or speech
- Meeting new people
- Being introduced
- Talking to someone in authority
- Being observed doing an activity
- Eating or drinking in public
- Using the telephone
- Going to a party
- Expressing your opinion
- Returning faulty goods
- Using public toilets
- Being the centre of attention
- Speaking to someone you’re attracted to
Cognitive Behaviour Therapy
Cognitive-behaviour therapy (CBT) is the treatment of choice for social phobia. It involves changing the way you think, feel and behave in social situations. CBT is offered either face to face, or through internet CBT providers, such as our shyness course.
A course of CBT should include:
- Ongoing assessment of a person’s levels of anxiety in relation to their social phobia.
- Education about anxiety, tailored to each individual’s needs. For more information about anxiety, please see the anxiety fact sheet
- Training in strategies, such as mindfulness, to manage anxiety symptoms, and encouragement in practicing these techniques regularly.
- Behavioral interventions
- CBT should focus on graded exposure to feared situations. For example, if a person is fearful of eating in front of others and would like to be able to eat a meal in a local cafe, the following hierarchy could be adapted according to how difficult they find each step.
1) Have a soft drink at the cafe early in the morning when there are not many people around.
2) Have a soft drink at lunchtime when the cafe is busy.
3) Have a cup of tea and a sandwich early in the morning.
4) Have a cup of tea and a sandwich at lunchtime.
5) Have a full meal (using cutlery) and stay for twenty minutes even if you do not eat the whole meal.
6) Have a full meal (using cutlery) and stay until you’ve eaten the whole meal.
- The steps can be adapted to include the presence or absence of friends, or to accommodate slightly different goals or problems (e.g., to be able to sign a form, or use a telephone, while people are watching). The last step on the hierarchy represents the situation or activity the individual fears most.
- CBT may also include “social mishap” exposure, with people putting themselves in situations where they embarrass themselves in public. During these exposures, people with social phobia are able to confront very uncomfortable situations, thereby increasing the power of the exposure, and challenge common thoughts (i.e., “What’s the worst that could happen?”).
- People with social phobia should also be encouraged to identify and let go of safety behaviors. These behaviours include avoiding other peoples’ eyes, sitting alone in a corner, mumbling or speaking very softly, and pre-planning all social encounters. People with social phobia often rely on these safety behaviors, and believe that they cannot cope without them.
- CBT helps people with social phobia to identify and challenge their fears. A person should monitor their thoughts, and label their thinking distortions during specific situations throughout the day.
Once a person has identified and challenged their maladaptive thoughts, they should be encouraged to focus on the present, and to think realistically about the present situation rather than feared future outcomes. Mindfulness-based interventions can also help individuals practice remaining present-focused.
Some people with social phobia may need to learn basic conversational and interpersonal skills and practice these in minimally aversive social situations.
A person with any kind of anxiety should avoid the use of alcohol or sedative medication to control their anxiety, as this can often lead to complications with dependency.
Referral or specialist consultation will be necessary if social anxiety or avoidance persists despite the above measures.