Social anxiety (social phobia)

Social anxiety disorder, also called social phobia, is a long-term and overwhelming fear of social situations.

It's a common problem that usually starts during the teenage years. It can be very distressing and have a big impact on your life.

For some people it gets better as they get older. But for many people it does not go away on its own without treatment.

It's important to get help if you are having symptoms. There are treatments that can help you manage it.

Social anxiety is more than shyness. It's a fear that does not 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:

• worry about 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 being criticised, avoid eye contact or have low self-esteem
• often have symptoms like 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 panic disorder.

When to get help for social anxiety

It's a good idea to see a 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 a GP will be aware that many people struggle with social anxiety and will try to put you at ease.

They'll 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 to an NHS psychological therapies service (IAPT) without a referral from a GP.

Self-help can help reduce social anxiety 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 – by thinking about or writing down what goes through your mind and how you behave in certain social situations, it can help to keep a diary
• try some relaxation techniques, such as breathing exercises for stress
• break down challenging situations into smaller parts and work on feeling more relaxed with each part
• try to focus on what people are saying rather than just assuming the worst

Read more about anxiety, fear and panic and how to manage them.

You can listen to the 6-minute anxiety control training audio guide. Dr Chris Williams talks about how to relax and beat your anxieties, today and in the long term.

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

You can find mental health, relaxation and mindfulness apps and tools in the NHS Apps Library.

A number of treatments are available for social anxiety.

The main options are:

• Cognitive behavioural therapy (CBT) with a therapist, which is therapy that helps you identify negative thought patterns and behaviours, and change them. This can be done with just you and a therapist, in a group or with your parents or carers.
• Guided self-help, which involves working through a CBT-based workbook or online course with regular support from a therapist.
• Antidepressant medicines, usually a type of medicine called a selective serotonin reuptake inhibitor (SSRI), such as escitalopram or sertraline. These are usually not used to treat people under the age of 15.

CBT is generally considered the best treatment, but other treatments may help if it does not work or you do not 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 or getting upset more often than usual
• getting angry a lot
• 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 a GP if you're worried about your child. They'll ask you about your child's behaviour and talk to them about how they feel.

Treatments for social anxiety in children are similar to those for teenagers and adults, although medicines are not 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.