What is social anxiety?

Emotional and behavioral symptoms change the way you interact with the world around you. They often look like this:

• Intense worry about upcoming events. You might dread social situations for days or weeks beforehand.
• Avoiding places where there are other people. This includes skipping parties, avoiding crowded stores, or finding excuses to stay home.
• A deep fear of judgment. You might constantly worry that others are scrutinizing your actions or noticing your flaws.
• High self-consciousness in interactions. You may experience intense difficulty making eye contact or feel overly awkward during simple conversations.

The physiological response to social situations is driven by your body’s fight-or-flight system. You might experience:

• A rapid heart rate. Your heart might pound so hard you can feel it in your chest or throat.
• Noticeable blushing. You might feel a sudden flush of heat in your face that you cannot hide.
• Excessive sweating. Your palms, underarms, or forehead might sweat heavily even when you are not hot.
• Trembling or shaking. Your hands, legs, or voice might quiver uncontrollably.
• Nausea and stomach upset. You might feel intense butterflies or a genuine need to use the restroom.
• Your mind going completely blank. Panic can make it impossible to focus or find the right words to say.

Anxiety disorders frequently run in families, which points to a strong hereditary link. In fact, research from twin studies indicates that if one twin has social anxiety, the other is 30 to 50 percent more likely to develop it. Your brain structure also plays a major role in how you process fear.

People with anxiety often have an overactive amygdala, which is the brain area responsible for their fear response. This can make you highly sensitive to perceived social threats. Additionally, imbalances in brain chemicals like serotonin may contribute to the severity of your symptoms.

Social anxiety can also develop as a learned behavior. Observing anxious parents during your childhood can teach you to view social interactions as dangerous or threatening. Negative life experiences are also major factors that may contribute. Having a history of severe bullying, experiencing family conflict, or surviving childhood trauma can leave lasting emotional scars. Even growing up with a highly controlling or overprotective parenting style can hinder your ability to build healthy social coping skills.

Living in a constant state of fear also severely damages your self-esteem. As you isolate yourself further, the risk of comorbidity increases significantly. Comorbidity means having more than one mental health condition at the same time.

Studies suggest that up to 66 percent of those with social anxiety also struggle with an additional mental health disorder. There is an especially high correlation with clinical depression and avoidant personality disorder.

To cope with this overwhelming distress, some people turn to alcohol or drugs to numb their feelings. This significantly increases the risk of developing a substance abuse problem. Seeking proper support is the best way to prevent these long-term impacts and protect your overall well-being.

Cognitive behavioral therapy (CBT) is the most well-researched form of talk therapy for treating social anxiety disorder, consistently supported by clinical trials and endorsed by the American Psychiatric Association as a first-line approach for social phobia and other anxiety disorders. Cognitive behavioral therapy CBT helps people with social anxiety identify and challenge negative thoughts that fuel extreme fear in social situations, replacing distorted beliefs about judgment and humiliation with more accurate, balanced thinking patterns.

Through structured exposure exercises and coping skills practice, CBT gives patients the tools to gradually overcome social anxiety, engage more confidently in social interactions, and reduce the avoidance behaviors that have been limiting their daily life and personal life.

DBT therapy (dialectical behavior therapy) adds a layer of structured skills training to the social anxiety treatment process, focusing on emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness, which are areas where people with social anxiety disorder commonly struggle. DBT’s interpersonal effectiveness module is especially valuable for patients whose anxiety symptoms extend into personal relationships and who feel self-conscious or experience intense fear across a wide range of social settings, not just formal performance situations.

Our mental health programs use DBT alongside cognitive behavioral therapy for patients whose social anxiety disorder co-occurs with other mental health problems, such as depression treatment, borderline personality disorder treatment needs, or body dysmorphic disorder.

Group therapy is a particularly meaningful component of social anxiety disorder treatment because it provides a structured, supportive environment in which patients can practice social skills, make eye contact, speak in front of others, and experience social interactions with the guidance of a mental health specialist present. Participation in support groups and therapist-led group sessions helps people with social anxiety see that their symptoms are shared by others, reducing isolation and gradually building the self-confidence needed to engage more fully in social events and personal relationships outside of treatment.

Family therapy is also available to help family members learn how to support a loved one in treating social anxiety disorder without reinforcing avoidance or accommodation patterns that can worsen anxiety over time.