Social anxiety and shyness

Maybe your heart races before a phone call. Maybe you rehearse what to say, then say nothing. Maybe you skip the party, then feel lonely at home. If so, you are not strange or broken. Social fear is very human, and it can get smaller.

Shyness or social anxiety?

Shyness is a personality trait. Shy people may feel awkward at first and warm up slowly. Many shy people have good friends and full lives. Shyness is not a problem to fix.

Social anxiety disorder is stronger and lasts longer. The fear of being judged, embarrassed or rejected is so intense that it shapes your life. You might:

• Avoid parties, meetings, classes, phone calls or eating in front of others
• Worry for days or weeks before an event
• Blush, sweat, shake, feel sick, or have your mind go blank
• Replay conversations afterward and criticize yourself
• Turn down jobs, dates or friendships because of fear

It is common. About 12.1%U.S. adults who have social anxiety disorder at some point in their livesAs of December 31, 2003.From a large national survey done in 2001–2003; about 1 in 8 adults.Source: National Institute of Mental Health: Social Anxiety Disorder statistics (National Comorbidity Survey Replication) of U.S. adults have social anxiety disorder at some point in their lives. It usually starts in childhood or the teen years.

Being an introvert is different again. Introverts may simply prefer quiet and small groups. See Introverts, extraverts and everyone between.

The avoidance trap

Avoiding what scares you brings quick relief. That relief teaches your brain "that was dangerous, good thing I escaped." So next time, the fear is a bit bigger.

Over time, avoidance can shrink your world. Fewer people, fewer places, fewer chances to learn that things usually go better than you fear. That is one way social anxiety leads to loneliness.

People with social anxiety also often use safety behaviors: staying on the phone, avoiding eye contact, rehearsing every sentence, having a drink first, or leaving early. They feel protective, but they can keep the fear going and make you seem distant.

Research on loneliness itself points the same way. A review of loneliness programs found that the ones that worked best helped people change unhelpful thoughts about how others see them. See The loneliness trap.

What helps

Changing thoughts

Cognitive behavioral therapy (CBT) is one of the best-studied treatments for social anxiety. Part of it is noticing anxious thoughts and testing them, like a scientist.

• Thought: "Everyone will see I'm nervous and think I'm weird."
• Questions to ask: What is the evidence? Do I notice other people's small signs of nerves? What would I tell a friend who said this?
• More balanced thought: "Some people might notice. Most are thinking about themselves. Even if someone does, it isn't a disaster."

Facing fears step by step (exposure)

The other key part is gradually facing what you fear, on purpose, and staying long enough for the fear to drop. This is often called exposure.

1. Make a list of situations that scare you.
2. Rate each from 0 (no fear) to 10 (terror).
3. Start with something around a 3. Repeat it until it feels easier.
4. Then move up one step.

A sample ladder:

• Make eye contact and nod at a cashier
• Ask a store worker where something is
• Say "good morning" to a neighbor
• Ask a coworker or classmate a question about their weekend
• Join an online group and post one comment
• Go to a class or club for 20 minutes
• Invite someone for coffee

Try dropping one safety behavior at a time, too. For example, keep your phone in your pocket while you wait.

Calming your body

Slow breathing (breathe in for about 4 seconds, out for about 6) can take the edge off. Regular exercise and enough sleep help too. These are helpers, not a replacement for facing fears.

Shift your attention outward

Anxiety turns attention inward: "How do I look? What do I say?" Try turning it outward. Get curious about the other person. Ask a question and really listen. See Conversation and listening skills.

Free self-help

• Stepping out of Social Anxiety is a free CBT-based workbook from the Centre for Clinical Interventions, part of the Government of Western Australia's Department of Health. It has ten modules with worksheets, including a step-by-step guide to facing feared situations. cci.health.wa.gov.au (opens in a new tab)
• Your local library may have CBT self-help books on social anxiety. Ask a librarian; you don't have to say why.
• Practice-friendly places. Groups built around an activity, like a walking group, a class or volunteering, give you something to do besides talk. See Groups, hobbies, classes and clubs and Volunteering.

Self-help works best when you do the exercises, not just read about them. Go slowly, and count every step.

When to get help

Consider talking to a doctor, counselor or therapist if:

• Fear keeps you from work, school, friendships or getting basic needs met
• You have tried self-help and feel stuck
• You feel low most days, or are drinking or using drugs to get through social situations
• You have panic attacks

CBT with a therapist, alone or in a group, helps many people. Some medicines can help too; talk with your doctor about whether they are right for you. See Getting help for low-cost options, including online therapy, which some people with social anxiety find easier to start.

If you also feel very low or hopeless, see Depression and loneliness.