A woman hates to stand in line in the grocery store because she’s afraid that everyone is watching her. She knows that it’s not really true, but she can’t shake the feeling. While she is shopping, she is conscious of the fact that people might be staring at her from the big mirrors on the inside front of the ceiling. Now, she has to talk to the person who’s checking out her groceries. She tries to smile, but her voice comes out weakly. She’s sure she’s making a fool of herself. Her self-consciousness and anxiety rise to the roof…

Another person sits in front of the telephone and agonizes because she’s afraid to pick up the receiver and make a call. She’s even afraid to call an unknown person in a business office about the electric bill because she’s afraid she’ll be “putting someone out” and they will be upset with her. It’s very hard for her to take rejection, even over the phone, even from someone she doesn’t know. She’s especially afraid to call people she does know because she feels that she’ll be calling at the wrong time — the other person will be busy — and they won’t want to talk with her. She feels rejected even before she makes the call. Once the call is made and over, she sits, analyzes, and ruminates about what was said, what tone it was said in, and how she was perceived by the other person….her anxiety and racing thoughts concerning the call prove to her that she “goofed” this conversation up, too, just like she always does. Sometimes she gets embarrassed just thinking about the call.

A man finds it difficult to walk down the street because he’s self-conscious and feels that people are watching him from their windows.Worse, he may run into a person on the sidewalk and be forced to say hello to them. He’s not sure he can do that. His voice will catch, his “hello” will sound weak, and the other person will know he’s frightened. More than anything else, he doesn’t want anyone to know that he’s afraid. He keeps his eyes safely away from anyone else’s gaze and prays he can make it home without having to talk to anyone.

A man hates to go to work because a meeting is scheduled the next day. He knows that these meetings always involve co-workers talking with each other about their current projects. Just the thought of speaking in front of co-workers raises his anxiety. Sometimes he can’t sleep the night before because of the anticipatory anxiety that builds up. Finally, the meeting is over. A big wave of relief spills over him as he begins to relax. But the memory of the meeting is still uppermost in his mind. He is convinced he made a fool of himself and that everyone in the room saw how afraid he was when he spoke, and how stupid he acted in their presence. At next week’s meeting, the boss is going to be there. Even though this meeting is seven days away, his stomach turns raw with anxiety and fear floods over him again. He knows that in front of the boss he’ll stammer, hesitate, his face will turn red, he won’t remember what to say, and everyone will witness his embarrassment and humiliation. He has seven miserable days of anxiety ahead of him — to think about it, ruminate over it, worry about it, over-exaggerate it in his mind…….again and again and again…..

A student won’t attend her university classes on the first day because she knows that in some classes the professor will instruct them to go around the room and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a roomful of strangers who will be staring at her makes her feel nauseous. She knows she won’t be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details. Her voice might even quiver and she will sound scared and tentative. The anxiety is just too much to bear—so she skips the first day of class to avoid the possibility of having to introduce herself in class.

Another young man wants to go to parties and other social events—indeed, he is very, very lonely—but he never goes anywhere because he’s very nervous about meeting new people. Too many people will be there and crowds only make things worse for him. The thought of meeting new people scares him—will he know what to say? Will they stare at him and make him feel even more insignificant? Will they reject him outright? Even if they seem nice, they’re sure to notice his frozen look and his inability to fully smile. They’ll sense his discomfort and tenseness and they won’t like him — there’s just no way to win — “I’m always going to be an outcast,” he predicts. And he spends the night alone, at home, watching television again. He feels comfortable at home. In fact, home is the only place he does feel completely comfortable. He hasn’t gone anywhere else in twelve years.

In public places, such as work, meetings, or shopping, people with social anxiety feel that everyone is watching, staring, and judging them (even though rationally they know this isn’t true). The socially anxious person can’t relax, “take it easy”, and enjoy themselves in public. In fact, they can never fully relax when other people are around. It always feels like others are evaluating them, being critical of them, or “judging” them in some way. The person with social anxiety knows that people don’t do this openly, of course, but they still feel the self-consciousness and judgment while they are in the other person’s presence. It’s sometimes impossible to let go, relax, and focus on anything else except the anxiety and fear. Because the anxiety is so very painful, it’s much easier just to stay away from social situations and avoid other people altogether.

Many times people with social anxiety simply must be alone—closeted—with the door closed behind them. Even when they’re around familiar people, a person with social anxiety may feel overwhelmed and have the feeling that others are noticing their every movement and critiquing their every thought. They feel like they are being observed critically and that other people are making negative judgments about them.

One of the worst circumstances, though, is meeting people who are “authority figures”. Especially people such as bosses and supervisors at work, but including almost anyone who is seen as being “better” than they are in some respect. People with social anxiety may get a lump in their throat and their facial muscles may freeze up when they meet this person. The anxiety level is very high and they’re so focused on “not failing” and “giving themselves away” that they don’t even remember what was said in the conversation. But later on, they’re sure they must have said the wrong thing…..because they always do.

How is it ever possible to feel “comfortable” or “natural” under these circumstances?

To the person with social anxiety, going to a job interview is pure torture: you know your excessive anxiety will give you away. You’ll look funny, you’ll be hesitant, maybe you’ll even blush, and you won’t be able to find the right words to answer the questions coherently. Maybe this is the worst part of all: You know that you are going to say the wrong thing. You just know it. It is especially frustrating because you know you could do the job well if you could just get past this terrifying and intimidating interview.

Welcome to the world of the socially anxious.

Social anxiety is the third largest psychological problem in the United States today. This type of anxiety affects 15 million Americans in any given year. Unlike some other psychological problems, social anxiety is not well understood by the general public or by medical and mental health care professionals, such as doctors, psychiatrists, psychologists, therapists, social workers, and counselors. In fact, people with social anxiety are misdiagnosed almost 90% of the time. People with social phobia come to our anxiety clinic labeled as “schizophrenic”, “manic-depressive”, “clinically depressed”, “panic disordered”, and “personality disordered”, among other damaging misdiagnoses.

Because few socially-anxious people have heard of their own problem, and have never seen it discussed on any media, such as the television talk shows, they think they are the only ones in the whole world who have these terrible symptoms. Therefore, they must keep quiet about them. It would be awful if everyone realized how much anxiety they experienced in daily life. Then what would people think about them? Unfortunately, without some kind of education, knowledge, and appropriate treatment, social phobia/social anxiety continues to wreak havoc throughout their lives. Adding to the dilemma, when a person with social anxiety finally gets up the nerve to seek help, the chances that they can find it are very, very slim.

Making the situation more difficult is that social anxiety does not come and go like some other physical and psychological problems. If you have social anxiety one day……you have it every day for the rest of your life…..

The feelings I described to you at the beginning of the article are those of people with social anxiety disorder. That is, their symptoms apply to most social events and functions in almost every area of life. I suffered from social anxiety myself for twenty years before I ever saw the term or read about its symptoms in a book. (The first book that specifically dealt with social phobia was not published until the 1990’s.)

As with all problems, everyone with social anxiety has slightly different secondary symptoms. Some people, for example, cannot write in public because they fear people are watching and their hand will shake. Others are very introverted and they find it too difficult to hold down a job. Still others have severe anxiety about eating or drinking in the presence of other people. Some people with social anxiety feel that a certain part of their body (such as the face or neck) are particularly “strange looking” and vulnerable to being stared at. Others experience a muscle spasm (usually around the neck and shoulders) and it becomes the center of their focus —“it’s so embarrassing that if someone sees it I will be humiliated forever!”

One thing that all socially anxious people share is the knowledge that their thoughts and fears are basically irrational. That is, people with social anxiety know that others are really not critically judging or evaluating them all the time. They understand that people are not trying to embarrass or humiliate them. They realize that their thoughts and feelings are somewhat exaggerated and irrational. Yet, despite this rational knowledge, they still continue to feel differently.

It is these automatic “feelings” and thoughts that occur around social situations that must be met and conquered in therapy. Usually these anxious feelings are tied to thoughts that are entwined in a vicious cycle of negative expectations and negative appraisals. It is a catch-22 situation: there is no way out without the appropriate therapy.

Here comes the good part.

How can social anxiety be treated? Many therapeutic methods have been studied, but cognitive-behavioral therapy is the only modality that has been shown to work effectively. In fact, treatment of social anxiety through cognitive-behavioral methods has the capacity to produce long-lasting, permanent relief from the anxiety-laden world of social anxiety.

Social anxiety responds to relatively short-term therapy, depending on the severity of the condition. I have seen significant progress in just twelve individual sessions, although most people respond better with sixteen to twenty-four meetings. To overcome social anxiety, completion of a behavioral therapy group is also essential (when people feel ready for this and not before). 

What socially anxious people do not need is years and years of therapy or counseling. You can’t be “counseled” out of social phobia. In fact, socially anxious people who are taught to “analyze” and “ruminate” over their problems usually make their social anxiety and fears much worse, which in turn leads to depression, which just reinforces the fact that “I will never get better”. (Shudder…this statement does NOT have to be true.)

THERE IS A BETTER LIFE FOR ALL PEOPLE WITH SOCIAL ANXIETY. Without treatment, social anxiety is a torturous and horrible emotional problem; with treatment, its bark is worse than its bite. Add to this that current research is clear that cognitive-behavioral therapy is highly successful in the treatment of social anxiety. In fact, the people who are unsuccessful are the ones who are not persistent in their practice and who won’t stick with simple methods and techniques at home. They are the ones who give up. 

If a person is motivated to end the years and years of crippling anxiety, then cognitive-behavioral treatment provides the methods, techniques, and strategies that come together to lessen the anxiety and make the world a much more enjoyable place. 

Many of us have been through the crippling fears and constant anxiety that social phobia produces — and have come out healthier and happier on the other side. You can too.

—Thomas A. Richards, Ph.D.
Psychologist