Some people feel intense dread about social situations to the point that it can be difficult to meet or interact with other people. In these cases, you might be living with social anxiety. Many people with social anxiety may be skeptical that mental health treatment could be necessary or effective for what they may perceive as “shyness”. Still, research indicates that therapy for social anxiety can be beneficial.
The nature of social anxiety can make it difficult to seek treatment. After all, talking with a therapist is also a type of social interaction. Some people living with anxiety find that online counseling makes it easier to get over this hurdle. This article reviews the evidence on internet-based therapy and explains how talking with a counselor may help.
Taking social anxiety seriously
The difficulties of extreme anxiety can be made worse if the people in your life don’t see it as a serious problem. You may have been frustrated in the past by suggestions that you’re “just a little shy” or recommendations to simply “put yourself out there.” This advice may be intended to help, but it can come across as dismissive. It may also compound your anxiety with feelings of embarrassment and self-recrimination.
The American Psychological Association recognizes social anxiety disorders (also called social phobia) as mental health conditions that can severely impact one’s life. It’s different than just shyness or introversion, and social anxiety can be characterized by symptoms such as:
- Intense worry about being watched, judged, or humiliated
- Disproportionate feelings of fear about social interaction, manifesting in the form of a social phobia
- Avoidance of situations where you’ll have to meet or talk to people
- Having specific social anxiety leading up to an event where you will be around people
- Difficulty speaking or performing in front of other people
- Physical symptoms of panic in the company of others such as sweating, shaking, muscle tension, rapid heartbeat, or nausea
- Trouble focusing and concentrating when talking to people in social settings
- Negative impact on your social, personal, or professional life
When having social anxiety treated, seeing a mental health professional can help you work through personal relationships with a friend or family member, persistent fear surrounding social interactions, and any significant anxiety or extreme shyness you might be experiencing as a result. It's important to note that there are many different ways to treat social anxiety disorder symptoms, and treatment options may vary based on the level of fear or anxiety you are experiencing.
If you feel like you may be developing social anxiety disorder, it can be beneficial to learn about how the disorder is treated, and how it differs between shyness or self-consciousness. The ADAA (Anxiety and Depression Association of America) can be a great resource when learning more about coping skills, how to treat depression, how to navigate being self conscious, and anything else that may trigger symptoms.
Impacting your every day life
The intense fear and anxiety surrounding a social situation might impact your daily life in the form of panic attacks, and when left untreated social anxiety disorder may feel like it's taking over your life. If your persistent feelings of social anxiety are disrupting your life, there’s a chance you could be dealing with social phobia.
Some anxiety disorders may manifest in the form of wanting to avoid eye contact, having a fear of public speaking or giving a speech, or having poor social skills when starting conversations. Often, people may be judged negatively in work or school when giving a presentation or receive criticism poor social skills in teenage years, however, there are many treatments for social anxiety and support groups to help navigate these situations.
This anxiety might also manifest in avoiding eating in front of people or avoiding meeting new people. This disorder often has symptoms that overlap with other mental disorders in the Diagnostic and Statistical Manual Of Mental Disorders (DSM), such as avoiding unfamiliar people, rigid body posture during a complex interaction, or avoiding eye contact. Major depressive disorder and generalized anxiety disorder might have symptoms similar to signs of social anxiety. However, like other mental disorders and mental health conditions, it can be treated through therapy and possibly even anxiety medications.
Even if your challenges with social situations don’t quite meet the criteria for a diagnosable mental health condition, there’s no reason you can’t talk with a therapist about them. It’s common for people to find value in therapy even when they’re not living with mental illness. Therapy can also help you get a formal diagnosis for social anxiety disorder and other anxiety disorders, allowing you to work through negative thoughts and symptoms such as blushing, sweating, trembling, or nausea. Knowing the signs and symptoms (especially specific anxiety symptoms) of anxiety disorder in adults may help you overcome social anxiety and panic disorder symptoms.
Can therapy really help?
Perhaps you’re convinced that your social anxiety is worth addressing, but you’re still unsure if talk therapy can make a difference. You may have already tried without success to talk yourself out of feeling anxious. You might wonder if talking with a counselor about your social anxiety would be any different.
Consider that sessions with a trained psychotherapist are different from the kind of self-talk you may engage in when you’re in the grip of social anxiety. Therapists can provide you with clinically tested strategies for reframing your thoughts and processing your emotions in social situations.
The National Institute of Mental Health outlines various risk factors when treating social anxiety, noting it can be important to find a doctor or licensed therapist near you to help navigate signs of social anxiety or overwhelming fear in social situations. Typical in-person therapy appointments often cost around $100-$200 per session. Online treatment may cost about $65 to $90 per week, depending on the platform. Each platform might have various insurance acceptance policies and rights reserved.
Two different ways to treat social anxiety disorder
A randomized controlled trial looked at the outcomes of 108 patients after undergoing psychotherapy for social anxiety disorder. The study compared two different treatment approaches: group therapy sessions led by a cognitive-behavioral therapist versus a mindfulness-based technique for stress reduction related to social anxiety. Both groups receiving treatment showed measurable social improvements in factors such as:
- Symptoms of social anxiety
- Cognitive distortions
- Rumination (thinking obsessively about negative outcomes)
Long-lasting effectiveness of therapy
These researchers in clinical trials wanted to see whether people with social anxiety could benefit from therapy in the long run or if they only felt better temporarily, and the social phobia remained post-treatment. The authors conducted follow-up assessments on former patients who had received treatment five years previously. Results indicated that the positive effects of therapy on anxiety continued long after the treatment concluded.
Environmental factors, family history, substance abuse history, and previous mental health conditions can all play a role in how social anxiety might manifest. The American Psychiatric Association also outlines the benefits of breathing exercises to help calm nervous systems and lower high blood pressure in anxiety-inducing scenarios for any condition that draws attention or may have uncontrollable side effects.
Even self-directed therapy can help with this social anxiety disorders
Adapting some of the strategies used in cognitive-behavioral therapy may help even when people use them on their own. One study adapted a specific CBT treatment protocol into a workbook that individuals could use to manage their own anxiety. The results indicated that even this self-directed approach to treatment improved participants’ mental health, helping them navigate their social anxiety and social phobia.
What kind of therapy works best in treating social anxiety disorder?
Mental health professionals are constantly testing and refining their approaches to treatment for social anxiety. As a result, there are many different types of therapy available for those seeking help on a variety of social challenges in both old and young adults. For example, what works for young people having a panic attack in a public restroom might not work for someone at work with a deep fear of public speaking. The following have shown promise for treating social anxiety:
Mindfulness-based interventions (MBI)
Adapted from mindfulness meditation, these techniques encourage patients to focus non-judgmental attention on their body, their thoughts, and their emotions to defuse feelings of social anxiety. A meta-analysis of prior research concluded that this type of therapy can have a robust effect on social anxiety.
Cognitive-behavioral therapy (CBT)
One of the best-studied treatments for anxiety, CBT therapy uses a variety of therapist-guided methods to help patients identify what may trigger social anxiety, and modify their thoughts and emotional reactions to stressors like social situations. Researchers reviewing the scientific literature found that “all forms of CBT appear likely to provide some benefit for adults”.
Acceptance and commitment therapy (ACT)
Through various mindfulness techniques, individuals learn to detach from their anxiety, allowing them to engage more fully in the present moment. ACT guides individuals to identify their core values and commit to behaviors aligned with those values, even in the face of social discomfort. This process helps individuals break free from the cycle of avoidance and gain a sense of purpose and fulfillment in social interactions.
Psychodynamic therapy (PDT)
In this approach, the therapist works together with the patient to gain insight into the emotional roots of unhealthy attitudes, beliefs, and behaviors. A comprehensive meta-analysis published in 2022 indicated that PDT “could produce significant SAD [social anxiety disorder] symptoms reduction”.
Exposure therapy
Based on the idea that avoiding the things we fear tends to reinforce anxiety, exposure therapy encourages patients to encounter the sources of their anxieties in a controlled, deliberate way. Research has shown that it can be effective for a wide range of phobias, including social phobia.
Does medication help?
Under the guidance of a licensed psychiatrist, some types of anti-anxiety or other medications may provide relief from symptoms of social anxiety disorder:
Antidepressants
Despite the name, antidepressants (including selective serotonin reuptake inhibitors) can often alleviate the symptoms of both social anxiety and depression.
Beta-blockers
These medications may temporarily suppress some of the physical symptoms of social anxiety, including sweating, irregular pulse, and dizziness, though most psychiatrists don’t recommend them for long-term anxiety treatment.
Benzodiazepines
This class of sedatives can be a short-term way to reduce anxiety, but due to the potential for abuse, they’re not usually prescribed long-term.
Moreover, some medications may come with unwanted side effects.
If you develop social anxiety disorder, you might not get a physical exam like you would with other psychiatric disorders. If you are interested in support without medication (such as serotonin-norepinephrine reuptake inhibitors), you might attend a therapy support group to address your fear response, performance anxiety in your personal life, and other personality traits to help you gain confidence in these areas.
Why online therapy may be helpful
For people experiencing social anxiety, the prospect of undergoing therapy may seem intimidating. Simply locating a provider for treatment may involve significant social interaction with healthcare professionals. Moreover, therapy itself involves discussing personal insecurities with a stranger. Still, a number of options for engaging in therapy over the internet have emerged in recent years, which may make the process easier.
It may also be possible to choose the mode of communication that feels most comfortable to you. Those who prefer a greater sense of discretion may prefer the option to talk with their therapists via text message or online chat. Others can schedule voice-only sessions or use a video chat service. All of these options are available from the familiar setting of your own home, which may feel more comfortable than traveling to a therapist’s office.
Although internet-enabled therapy is a more novel method than in-person visits, the evidence suggests that it can be just as effective. Large-scale meta-analyses have demonstrated that internet cognitive-behavioral therapy works as well as in-person therapeutic sessions. Some patients with anxiety even find that they’re better able to connect with their therapists due to the increased sense of control that the remote messaging platforms provide, separate from the anxiety of any social interactions.