Social anxiety disorder consists of experiencing excessive anxiety and avoidance about social situations. For example, talking to strangers, going on dates, speaking in public, talking to authority figures, and eating in front of others.

People with social anxiety are frequently concerned about acting in a way that will be perceived as embarrassing or humiliating. You might worry about others noticing your anxiety - which, in turn, of course, only increases your anxiety! You might worry about people not liking you or finding you inadequate. In some cases, you might also worry about receiving praise or positive feedback - that's right! Even positive attention can be the source of much anxiety. In these cases, you might tell yourself that the praise you received was not deserved and that others will realize and think of you as an “impostor.”

If you have social anxiety you likely: 1) avoid situations that make you anxious and/or 2) modify them or endure them with distress. For example, if you are anxious about making small talk with strangers you might avoid a birthday party altogether or attend, but drink excessively in an effort to reduce your anxiety.

This avoidance is problematic because, although it might relieve anxiety in the short-run, it certainly leads to more difficulties in the long run. If you avoid the party altogether, you don’t get a chance to realize that the anxiety was probably worse in your heads. So, next time there is a party, your anxiety will be higher and you might be even more tempted to avoid it. Plus, you might feel bad about yourself for having avoided.

If you do attend the party, but, for example, drink excessively to avoid anxiety, you might also not get a chance to test that your anxiety was likely worse in your head. Plus, while you are intoxicated, you might behave inappropriately, which might lead you to feel ashamed and be even more worried about attending future social events. Further, if you keep relying on excessive alcohol consumption, you might develop a substance abuse problem.

So, in both examples, avoiding the anxiety paradoxically makes it worse in the long run. This is the quintessential anxiety-avoidance vicious cycle that we see across the anxiety disorders. You get trapped in it and it can be hard to get unstuck.

Another important consideration about social anxiety disorder is that, regardless of how well you might do in a social situation, you might still second guess yourself. So, in the example above, let’s imagine that you do go to the party and make small talk with several people, perhaps even exchange contact info with a person or two. But then, once you get home (or as soon as you leave the party), you start berating yourself about your performance: "I can't believe I said that!" "Now everyone is going to think I'm stupid" "It sucks that she noticed how nervous I was!" and so on. This type of thinking is called post-event processing, and it tends to exacerbate the vicious cycle of anxiety and avoidance. That is, the more you worry about your past performance, the more anxious you will be about the next one!

Additionally, you people might be prone to stuttering or blushing, which also tend to exacerbate your anxiety. When you go into social situations worrying that you might stutter or blush, you increase your physiological stress, which makes it more likely that you will have one of these experiences. So, this becomes another vicious cycle that perpetuates your social anxiety.

One of the most challenging things about social anxiety disorder is how incredibly compartmentalized this condition can be. That is, many socially anxious people have paralyzing anxiety about one type of situations, but not others! For example, whereas the thought of public speaking might be incredibly anxiety provoking to one person, they might find talking to strangers to be a fairly pleasant experience. And vice versa. Someone else might be a fantastic public speaker, but fall to pieces when they have to make small talk at a party.

Because of this context-dependent nature of social anxiety disorder, many people who suffer from it still perform extremely well in a number of situations. This, in a way, can be problematic, as it might lead you to place even more pressure on yourself about performance in those situations that make you anxious. This of course, further increases your anxiety and exacerbates the vicious cycle of anxiety and avoidance. Moreover, this compartmentalization means that many people in your lives will be totally oblivious to your suffering. This can lead to feeling isolated and not understood, which once again, can fuel the vicious cycle of anxiety and avoidance.

Cognitive behavioral therapy (CBT) can help reverse this vicious cycle of anxiety and avoidance by teaching you a whole new toolkit of cognitive and behavioral skills to change your relationship to anxiety. In a nutshell, CBT entails learning how to think differently about anxiety-provoking situations. For example, “What evidence do you have that people don't like you?” “What is the worst that can happen if that presentation does not go well?” “Are others really paying that much attention?”

Further, CBT consists of conducting exposure exercises, where you might put yourself in those very situations that you find to be the most anxiety provoking. You would do this gradually, sometimes starting with your imaginations or role plays, and move into progressively more anxiety provoking situations.

I have spent most of my academic and clinical career working with clients with social anxiety. I received my Ph.D. in Clinical Psychology from Yale University, where I trained extensively on exposure therapy for social anxiety. I conducted further training at Weill Cornell Medical School / New York Presbyterian Hospital. I currently teach it to graduate students at Columbia University and Yeshiva University and psychiatry residents at Mount Sinai Hospital. I have also written over 60 peer-reviewed articles on anxiety and social anxiety (for the full list of my academic publications, please go here) I currently write articles for Psychology Today on social anxiety, including “5 Overlooked Signs of Social Anxiety Disorder” and “3 Ways of Lowering Your Social Anxiety”.

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