Shyness and Social Phobia
Health: have you been affected by the recession? We
would welcome your views.
This leaflet is for anyone who finds shyness a
problem, or who suffers from a social phobia. It may also be
helpful for friends or family who want to be able to understand and
What is a social phobia?
Shyness is a common sort of mild fear – if it's mild, it doesn't
really spoil life. Many of us get a bit worried before meeting new
people but find that, once we are with them, we can cope and even
enjoy the situation. A phobia is also a fear. We all have
fears about things such as heights and spiders but, for most of us,
they don't really stop us from doing what we want to do. A fear
becomes a phobia when it stops us from enjoying things or doing
If you have a social phobia, you get very anxious when you are
with other people, usually because you worry that:
- they may be critical of you;
- you may do something embarrassing.
This can be so bad that you can't enjoy being with people
or speaking in front of them. You avoid social situations
altogether. This leaflet describes what it is like to have a
social phobia, how you can help yourself and and some of the help
you can find for this.
There are two main sorts of social phobia.
General Social Phobia
- worry that other people are looking at you
and noticing what you are doing
- dislike being introduced to other people
- find it hard to go into shops or restaurants
- worry about eating or drinking in public
- feel embarrassed about undressing in public, so you can't face
going to the beach
- can't be assertive with other
people, even when you know you need to.
Parties can be particularly difficult.
Many of us hesitate slightly before going into a room full of
people, even if we have been looking forward to it. If you have a
social phobia, you may tend to hover around the entrance or outer
rooms - because you feel unable to 'go in'. This leads some
people to believe that they are claustrophobic. If you do
finally get into the room with other people, you feel as
though everybody is looking at you. You may have to have a drink
before you go to a pub or party, so that you can relax enough to
Specific Social Phobia
This affects people who have to be the centre
of attention as part of their way of life such as salesmen,
actors, musicians, teachers, or union representatives may all feel
like this. If you have a specific social phobia, you may find
that you can mix and socialise with other people without any
problems. However, when you have to get up and talk or perform in
front of others, you become very anxious, stammer or 'dry up'
completely. It can affect even people who are
experienced at speaking in public and do it regularly. At its
worst, it can make it impossible for to speak in public at all,
even to ask a question.
What does it feel like?
The feelings of anxiety are similar for both
types of social phobia. You find yourself:
- worrying a lot about making a fool of
yourself in front of other people
- feeling very anxious before going into any of
the social situations that worry you
- going through, in great detail, all the
embarrassing things that could happen to you
- unable to say, or do, the things you want
- after an event, worrying about how you handled the
situation. You may go over, again and again, how you might
have behaved differently or said different things.
People experiencing both of these types of
social phobia also have many of the same physical symptoms.You may
- a very dry mouth
- heart pounding
- palpitations (the feeling that your
heart is beating irregularly)
- wanting to pass water or open your
- feelings of numbness or pins and needles in the fingers and
toes (this happens because you breathe too fast).
Other people may be able to see some of the
signs of this anxiety - the blushing, stammering, shaking and
trembling. These symptoms can be quite alarming and make
your anxiety worse. It can become a self-fulfilling prophecy.
You worry so much about looking worried that you actually do look
worried. Your worry is your worst enemy.
With either sort of social phobia, these feelings
can end in a panic attack. This is a short period, usually only a
few minutes, during which you feel overwhelmingly anxious,
terrified of losing control. You may feel that
you are going mad or dying. You will usually try to get out of
the situation that has brought it on. These feelings reach a
peak and then pass off rapidly, leaving you feeling weak and
exhausted. Although these attacks are very alarming, they do stop
on their own and cannot harm you physically.
Does it affect the way you think about
It can be very wearing to suffer from a social
phobia - other people do things easily when you find them
impossible. You may worry that others will think you are boring.
You may be over-sensitive and reluctant to bother other
people. It's easy to see how this can make you feel depressed and
unhappy. This, in turn, can make the social phobia worse.
How can it affect people's lives?
Many sufferers cope by arranging their lives around their
symptoms. This means that they (and their families) have to miss
out on things they might otherwise enjoy. They can't visit their
children's school, can't do the shopping or go to the dentist. They
may even actively avoid promotion at work, even though they are
quite capable of doing a more demanding and more financially
rewarding job. About half of those with a severe phobia,
particularly men, will have difficulty in making long-term
How common is it?
About five in a hundred people have some
degree of social phobia, with women two or three times more likely
to be affected.
Are there any complications?
- Depression: Your may be so upset by
social phobia that you become depressed - to the extent that the
depression becomes a problem in its own right.
- Agoraphobia: If you
constantly avoid places where people meet, you may end up feeling
afraid of those places even when there is nobody there.
You may then find that you can't leave the house on your
own - this is called agoraphobia.
- Drug and
alcohol use: You may use alcohol, drugs or
tranquillisers to cope with your feelings - this runs the
risk that you may become addicted to them.
- Physical health: In spite of
their anxiety and panic attacks, people with social phobia don't
seem to have more heart attacks than anybody else.
What causes Social Phobia?
We really don't know. It seems to affect people who:
- have particularly high standards for their behaviour in
- who have stammered as a child.
Some experts think that it might be due to people getting stuck
at the normal stage of shyness that all children go through between
the ages of three and seven.
What keeps it going?
Thoughts: Certain thoughts tend to kick in when you enter a
social situation and will make you anxious. These include:
- rules for yourself - “I always have to look clever and in
- beliefs about yourself - “I'm boring”
- predictions about the future - “If someone gets to know me,
they will see how inadequate I am.”
They make you think about – and criticise -
your behaviour from moment to moment. Such thoughts are so
automatic that they feel true to you – although there is often no
evidence for them at all. They can make you imagine that you appear
to other people in a certain - usually rather unattractive
way. Ths is almost certainly very different from the way that
people actually do see you.
Safety behaviours: These are
things that you do to make yourself feel more in
control in a social situation. They include:
- drinking alcohol
- avoiding eye contact
- not saying anything personal about
- asking too many questions of the other
The problem with doing this is that
it doesn't allow you to experience the fact that dreadful things
don't happen if you stop trying to control your behaviour so
post-mortems: Thinking over and over about a social
situation, before or after, tends to make you focus on past
‘failures’. It strengthens your habit of over-scrutinising
your behaviour and criticising yourself.
Ways of helping
There are several ways of helping people with
social phobia. These may be used on their own or together,
depending on what you need.
- If you are naturally shy, you may find it
helpful to join a local self-confidence or assertiveness
- Learn some relaxation techniques – you can do
this from books, tapes, CDs or DVDs. When you do find yourself
getting anxious, you may be able to ‘nip it in the bud’ by using
one of these techniques.
- Write down the automatic thoughts you have
about yourself and the pictures of yourself these conjure up in
your mind. Once you have done this, it can be easier to start
- Try listening more to what other people are
saying, rather than what you are saying to yourself in your
- Start to stop using your ‘safety behaviours’,
beginning with the easiest.
- Break down a worrying situation into a number
of steps, right from the beginning. Then take the first step and
learn to feel relaxed while doing it – it may take some practice.
Then move on to the next step, and then the next.
It will be easier to do these things with one
of the many self-help books that deal with social phobia – see the
reading list at the end of this leaflet.
This can help you to feel more relaxed and
confident in company. It does this by teaching some of the simple
social skills that we tend to take for granted - like how to
start a conversation with a stranger. You can practice with
other people and do what is called 'feedback' - people watch
themselves practising on video to get an idea of what they are
doing and how they appear to other people.
We know that, even if you are very frightened
in a particular situation, your anxiety will start to go away after
a while. This approach helps you to do this for yourself, one step
at a time.
You make a list of all the situations that you
find frightening, and then put them in order, from the least
frightening to the most frightening. You start with the least
frightening situation and, with the support of your therapist, keep
yourself there until you stop feeling anxious. You then move
on to the next one and so tackle these frightening situations one
by one. It is done in stages, each time making the situation a
little more intense and frightening.
Social phobia is tied up very closely with the
thoughts that you have about yourself, the world and the people
around you - we can make ourselves anxious by the way that we think
about things. This treatment helps you to change the way that you
think about yourself and other people.
The therapist will help you to be aware
- any unhelpful rules, assumptions or
predictions (see above) that you regularly use – and the physical
sensations you get when they go through your mind;
- any safety behaviours (see above);
- the unhelpful impact on your behaviour of
thinking about these things all the time - and the
connections between these and your anxiety.
For example, take the situation when a
conversation dries up. If you have a social phobia, you will tend
to think it is your fault – you may have the automatic belief that
“I never have anything to say” - and so you will start to feel
anxious. In CBT, the therapist will try to help you to be aware
that it is just as likely that the other person has run out of
things to say. This is a more realistic and less worrying way of
thinking about the situation. The therapist will help you to test
these ideas out in your day to day life.
You can then start to focus on how other
people are actually reacting to you, rather than your imaginary
version of how they are. For instance, the therapist could ask you
to talk while thinking to yourself that you have to appear
very intelligent and amusing. After a few minutes you
would stop and try again, this time concentrating on how the
therapist is reacting to you rather than what you are thinking.
Other techniques focus on the conversation, or ‘task in hand’
rather than any physical symptoms of anxiety you may be aware of.
This sort of treatment is usually given by one therapist for each
client. If the problem is very severe, or if you are unable to get
out of the house, it can be given as an in-patient or as a day
patient in hospital.
Medication should be used if a psychological
approach has failed, if you do not want to try a psychological
approach, or if you are very depressed. The newer
antidepressants (SSRIs - Selective Serotonin Re-uptake Inhibitors)
have been found to be helpful in social phobia, but may sometimes
cause headaches and dizziness in the first few weeks. They
usually start to work within 6 weeks, but can take up to 12 weeks
to have their full effect. If the symptoms of social phobia
get better, the dose can be slowly reduced over several
months. About half of those who start taking
antidepressants will get worse again when they stop
If SSRIs do not help, Monoamine Oxidase
Inhibitors (MAOIs) can be tried. These have drawbacks.
They tend to lower the blood pressure which can make you feel
faint. Some foods, such as cheese and yeast extract, can
produce dangerous reactions with these drugs, so you have to
follow a special diet which leaves out these foods. Some cough
medicines that can be bought at the chemist also produce similar
reactions to these foods. There are now some new MAOI drugs called
RIMAs (Reversible Inhibitors of Monoamine Oxidase - A). These don't
seem to produce the above reactions, and so people taking them can
eat what they like. Other types of antidepressants don't seem to
work very well in social phobia.
These drugs are usually used to treat high blood pressure.
In a low dose, they control the physical shaking of anxiety - which
can be a symptom of social phobia - and can be taken shortly before
meeting people or before speaking in public.
Drugs like Valium were used in the past to
treat all sorts of anxiety. We now know that they are addictive and
that they do not help in the long run. They should usually not be
used to treat a social phobia.
How effective are treatments?
- Pure self-help, using books without a therapist, seems to help
some people a bit, but it doesn't reduce the impact of the social
phobia on their life. This may be a good choice if your
anxiety about social situations is troublesome, but doesn't stop
you from doing too many things
- Self-help with group meetings seems to work better, but is
- Graded self-exposure seems to work for about half the people
who finish the course - but quite a few people don't complete
- CBT seems to be better than SSRI medication and should be
provided before medication is tried.
Want to know more?
If you want to find out more about social phobia,
here is a list of self-help organisations, books,
websites and other materials that you may find
UK Helpline: 08444 775 774. Anxiety UK works to
relieve and support those living with anxiety disorders by
providing information, support and understanding via an extensive
range of services, including 1:1 therapy.
AlIiance Tel: 0845 123 23 20 Information, support
and understanding for people who suffer with depression and for
relatives who want to help. Self-help groups, information, and
awareness raising for depression.
Relaxation for Living Tel: 020 7439
8705 A free membership organisation that provides information
and advice on self-help methods and techniques to cope with all
kinds of stress.
- Shyness &
Social Anxiety Treatment Australia Information
about social anxiety, the treatment options, group therapy and
workshops, support groups, articles, resources and links to other
- Triumph Over
Phobia Tel: 0845 600 9601 firstname.lastname@example.org
Runs a national network of self-help groups to help people with
phobia or obsessive compulsive disorder (OCD) to overcome their
problems using graded self-exposure. This means learning how to
face up to your fears in a very gradual and structured way so that
eventually the anxiety should decrease.
- Aware - Helping to Defeat
Depression Tel: (00 353) 1890 303 302 A voluntary
organisation formed in 1985 by a group of interested patients,
relatives and mental health professionals whose aims are to assist
that section of the population who are directly affected by
- Shyness and Social Anxiety.
Northumberland Tyne and Wear NHS Trust: a short self-help workbook.
- Living with Fear by Isaac
Marks (McGraw Hill Education).
- Craig, A. & Tran, Y.(2006) Fear of speaking: chronic
anxiety and stammering. Advances in Psychiatric Treatment, 12:
- Rapee et al. (2007) Treatment of social phobia through pure
self-help and therapist-augmented self-help. Br J Psychiatry.2007;
- Veale, D. (2003) Treatment of Social Phobia. Advances in
Psychiatric Treatment, 9: 258-264.
This leaflet was produced by the Royal
College of Psychiatrists' Public Education Editorial Board. Series
editor: Dr Philip Timms. Expert Review: Dr Cosmo Hallstrom
Illustration: Lo Cole: www.locole.co.uk
© May 2008 Royal College of Psychiatrists. This leaflet may be
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