Social Anxiety; Test, symptoms, self-help and treatment

Dr Elaine Ryan

What is social anxiety?

Social anxiety is an anxiety disorder where you have a disabling fear of being judged or humiliated in all interactions with other people. These interactions include, and are not limited to, speaking, eating, walking, indeed anything you do that another person can witness.

The condition can start in early adolescence (1) and stay with you in adulthood unless treated. 

Table of Contents

In trying to understand social anxiety, I find it helpful to use the cognitive model in terms of breaking apart the condition into a;

  • subjective experience
  • physiological responses, and
  • behavioural responses

The subjective experience is how you experience the interaction, e.g. trying to pay attention to what others are saying while judging every word you say.

The physiological response goes on in your body; feeling anxious, dry mouth, palpitations.

Behavioural Response is what you do ( or don’t do). Maybe you excuse yourself early, try not to say too much, or avoid the social interaction altogether.

Understanding these three responses can explain most aspects of social anxiety, including what maintains it. According to the cognitive model, the maintenance of social anxiety can be understood in terms of interpretation biases, safety-seeking behaviours, and pre and post-event processing(2).

Interpretation bias is when the person negatively interprets social invents.
Safety seeking behaviours are, for example, avoiding eye contact or over preparation. Pre and post-processing refer to the worry before and analysis and rumination of the event afterwards.

How do I know if I have social anxiety?

Someone like myself, a psychologist or other mental health professional will undertake an assessment. The assessment consists of asking questions, and you may be asked to complete some forms to help with diagnosis.

Social anxiety has typical signs and symptoms that might initially alert you to the idea that you have the condition. If you are waiting to be seen by a mental health professional, you are welcome to take my online test for social anxiety.

Please note this test is for information purposes only and does not replace assessment by a mental health professional.

Social anxiety test

Symptoms of social anxiety

Cognitive Symptoms 

Faulty belief systems; you may have some or all of the following negative beliefs about yourself.

  • I’m not good enough
  • I’m worthless
  • I’m a failure
  • Other people believe that I am worthless, stupid, and not good enough.

Behavioural symptoms
Avoidance of, for example 

  • Shopping
    Presentations
    Social interactions
    Meeting new people or going/trying something new
    Eye contact

Physical symptoms of social anxiety are similar to the symptoms of anxiety, and you can read about these in full here, but include

  • palpitations
  • sweating
  • tummy pains
  • shaking
  • dry mouth

How does social anxiety affect the person?

Social anxiety can severely limit your day to day life and reduce your opportunities, as you will probably be avoiding or limiting your social and work interactions.

I updated part of this post in the middle of Covid-19 and want to highlight the social anxiety experienced during home working.

Zoom meetings remind me of the anxiety experienced during round robin’ (pre coronavirus) when everyone in the forum introduces themselves. I dreaded round robins and mentally rehearsed, my name is Elaine, and I’m a psychologist!

Virtual meetings are capable of producing anxiety for those of you who have social anxiety—
feeling apprehensive before the meeting, not knowing when to speak, finding it more difficult in the absence of clear body language and dealing with the millisecond delay in a virtual environment will exist.

How to overcome social anxiety?

If you have been diagnosed with social anxiety, there are recommended treatment options to help you recover.

Cognitive Behavioural Therapy (CBT) is the recommended treatment to help you to overcome social anxiety.

What is having social anxiety like?

To explain this, I will give a few examples from my personal life.

Being in a friend’s home on Christmas Day.
I arrived after my hosts opened the presents. After dinner, my friend gave me a present to me. “This is for you, from my mum.” To which I replied,
Oh, was it a gift she didn’t like and wrapped it up for me?

I imagine I appeared rude. Indeed, inside my head for the rest of the day (and a day or two after), no matter what way I looked at it, I couldn’t believe that I had said that.
Those reading this with social anxiety will recognize how it played out in my head.
“Why did I say that? What must they think of me? Did they notice? How did they react?

These thoughts kept the feelings of embarrassment, shame and anxiety alive. I tried to enjoy the day, but my head kept going back to how I responded after being given a gift.

Years later, and now working as a psychologist 😉 I know I didn’t mean to be rude, but I can forgive myself and let it go.

Let’s look at it again regarding the cognitive model of social anxiety I introduced above.

When I was given the gift, you can identify the negative interpretation bias when I thought, was it a joke? Are they going to make fun of me if I take it? This can’t be right, someone’s mum would not give me a gift, it’s a joke.

When I received an invitation to someone’s house for dinner.
I did not know the people very well. The man was well educated, and his wife was a stay-at-home mum. They had just bought a large house. I had been feeling anxious in the lead up to the dinner. I had wanted to see their new house and wanted to make new friends, but I was nervous. On dinner day, I went out and bought a newspaper selection. It seems innocent enough, except I did not read newspapers.

The reason I bought them was fuelled by fear. Fear that

  • I was not smart enough. 
  • I would say something stupid and let myself down. 
  • They would laugh at me.
 

School-aged 13
I was asked how many centimetres are in this; the teacher pointed at 1m. I felt acute embarrassment as I could not answer. I could not answer because I needed glasses and did not want to wear them! I never said this in class when I could not answer the question, as the pain and embarrassment were excruciating.

Post university.
I eventually made it through school. Before becoming a psychologist, my first degree was in Finance. I worked in a series of jobs that I was more than qualified to do, as I did not have the confidence to apply for jobs in my area.

Maybe some of this is familiar to you. Sitting at a meeting or course and watching everyone introduce themselves. “Hello, my name is ” and feel the anxiety build up as it gets closer to your turn. All you have to say is “Hello” and give your name, but you feel anxiety levels that belong to a dangerous event.

I spoke with a friend who had social anxiety when growing up. He had been accepted into a new school and described himself as extremely shy, thinking. As correctly put by the NHS, social anxiety is more than shyness and can limit a person’s life in many ways.

He felt,

  • I don’t belong here
    I’m out of my depth
  • All the other kids are middle class and have money and education that I don’t have.
  • Everyone knew my name, and that terrified me.

He used to sit alone with a juice drink at break times, and his hand always shook as he took a sip.

You might find that you are in company, having, what looks like a normal conversation, but inside your head, not only are you chatting to the other person, but you are having another entirely different conversation inside your head, with yourself.

They think I am stupid and boring. They can see that I am anxious,I have nothing to say,
everyone else seems to be normal.

Anxious When Not In Social Situations

Many people think that if you have Social Anxiety, you only feel anxious in the company of others.


However, the privacy of your own home is a great place to mull over what happened when you were talking to someone or worry about the next time you have to meet up with people. This is an example of pre and post-processing introduced above, producing secondary anxiety.


This means that the first anxiety was experienced, as it was happening when you were in the company of others. Once you leave and return home, the secondary anxiety is what we do to ourselves by replaying the event like an old movie in our head.

Outlook

Social anxiety can be debilitating but breaking it down into smaller components exposes how it works. Using treatment models such as CBT helps the person to overcome social anxiety.

  1. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry,62(6), 617–627. https://doi.org/10.1001/archpsyc.62.6.617.
  2. Chapman, J., Halldorsson, B. & Creswell, C. Mental Imagery in Social Anxiety in Children and Young People: A Systematic Review. Clin Child Fam Psychol Rev 23, 379–392 (2020). https://doi.org/10.1007/s10567-020-00316-2

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