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Understanding Social Anxiety Disorder

Updated: Nov 12, 2022

Social anxiety and severe shyness make us worry, in an abysmal and painful way, about what other people think of us. Consulting with people who we may feel comfortable with may often lead to various suggestions and advise, to stop "overthinking" about what other people think or say about us, or as Dr Seuss phrased it - "Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind".

However, a slightly more honest and mature discussion may include a slightly different view, as other factors are taken into consideration – such as "reputation", or social standing. Confusingly enough, though it may stand in contradiction to ‘just being who we are’ approach, maintaining a good impression is often perceived as a highly valuable thing: "Your reputation can lift you up and bring you down"; "While building a good impression requires time, effort and patience, creating a bad impression only requires one wrong step". At the end of it all, we may be left puzzled, conflicted, and still without a real answer to the question: "Why do we care what other people think?".


The social world is a dangerous place and we all care what people think of us. As explained by the evolutionary perspective, since there are not many lions around, and on the other hand overly available pizzas and chocolates, it is the people (or social status) - and not predators or hunger - that are often perceived as the main danger in modern life. New acquaintances may be hostile or abusive; Potential partners may reject us and ignore our needs; Friends may think we are not polite or smart enough; An audience may mock us during a lecture; Our boss may torpedo our efforts to move up the job ladder in the company. It is no wonder that in modern society, fear of speaking in front of an audience is a more common fear than that of snakes and spiders.

The fear of what other people think of us permeates many aspects of our lives, even if we are not aware of it. In fact, the need for approval and respect from others is inevitable, since we have been accustomed to doing so for thousands of years of evolutionary pressures - ensuring we are affiliated and valued members of a group means we can gain access to significant resources. Simply put, we were all ‘programmed’ to develop as social beings, through generations that relied on their social status within their group, which had a direct impact on their ability to survive, as living in a group brought with it many important advantages: protection, shelter, food and improved mating possibilities. Thus, worrying about what others think of us is part of our innate nature by now, and there are specific subsystems in the brain whose job it is to monitor our social status. These bio-behavioral systems, which include brain structures, hormone secretions and of course - behavior, affect our social ranking and shape our social behaviors.

Why are people with social anxiety so preoccupied with what other people think of them?

Basically, it is usually a combination of several factors: First, people with social anxiety wish to leave a good social impression, while at the same time being extremely aware of their negative qualities (or what they perceive as flaws) – such as believing they have little charisma, are unattractive, or that once their anxiety is revealed - they will be rejected and ridiculed. Second, people with social anxiety often believe that other people are very critical and judgmental. Therefore, often assuming that in public others are scrutinizing them.

It is the bilateral effect of these two factors that can make every social engagement, be it an important or insignificant meeting, into no less than a particularly stressful interview - an event where one wants to show off their most positive sides, but during which expect being scrutinized to uncover their flaws and abilities. Expecting rejection and ridicule leads to a high level of self-awareness, and feelings of shame and embarrassment, which further heightens the sense of one’s flaws and perceived weaknesses.

How does it feel when you experience clinical anxiety?

How many times have you heard the phrase "it's all in your head"? Well - that's simply untrue. Anxiety is felt in the body, and people with social anxiety disorder can experience a wide variety of unpleasant anxiety symptoms. These include muscle contractions, increased heart rate, dizziness, dry mouth, shortness of breath and even nausea. At the same time, the most worrying anxiety symptoms for them in social situations are those that are visible to the eye, such as blushing, sweating, trembling

hands and feet and stammering. People with social anxiety fear that other people will notice these visible symptoms of anxiety, and criticize them - that they are strange, weak-willed or just plain ridiculous. Hence, unfortunately the physical anxiety symptoms themselves further increase one’s already existing insecurities, assumptions they will be judged and rejected, and further encourages their motivation to avoid social engagements.

As we all know from experience, the fear of embarrassment makes us want to "disappear" - and thus avoidance becomes the preferred escape route. Often, people with social anxiety never attend in the first place, and if they do, they find ways to avoid the increase of their anxiety (in hope of hiding the physical symptoms that follow, to prevent judgement and rejection): they avoid making eye contact and look at the tips of their shoes instead of the person in front of them, they speak quietly, distract themselves by suddenly looking at their mobile phone, wear scarves to hide their faces or tuck their hands in their pockets to hide the shakes, or wear extra layers makeup to hide blushing. Imagine that you are striking up a conversation with a person you met by chance a few weeks ago, and they barely reply, look at their mobile phone and then over your shoulder. Unfortunately, this may be perceived like your new friend isn't very interested in continuing the conversation with you; in other words, shyness or social anxiety behaviours may be perceived by others as a lack of interest and even arrogance.

How does CBT treatment help with Social Anxiety?

Cognitive behavioural threrapy helps people to recognise their own unique and individual patterns of thoughts (cognitions), the corresponding emotions of anxiety and shyness that arise in social situations, the associated physical symptoms of anxiety, and their avoidant behaviour. Therapy then aims to build the person’s confidence is social settings, challenging some of the basic assumptions about themselves and others’ critical nature, and develop alternative behaviours of social engagement and exposure-based CBT, to gradually work up to facing the situations that are feared most. By the end of a successful treatment, the person would have a far better understanding of their own anxiety, will be able to recognise its symptoms and circular nature, will have challenged some basic assumptions and learn to engage in social settings, and feel comfortable and confident in whatever they are aiming for, whether to make a speech, have a job interview, go on dates or just spending time with friends or colleagues without worrying about potential repercussions.


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