Primary Care in Rochester and Kasson

Scared to speak up? The cause and cure for social anxiety

9/21/2020 by Olivia Bogucki, PhD, MA, and Craig Sawchuk, PhD, LP


Social anxiety disorder is one of the most common anxiety disorders. An estimated 12 percent of the population experiences it at some point in their lifetime. A person who has social anxiety feels significant fear or anxiety in everyday social situations like:

  • Meeting strangers
  • Interacting with groups of people
  • Engaging in a one-on-one conversation
  • Using a public restroom
  • Doing something in front of other people like speaking, writing or eating

Overall, people with social anxiety feel fearful about being judged critically and negatively evaluated by others. They often think that they will humiliate or embarrass themselves or that others will laugh at, make fun of, be offended by, or not like them. 

The fear of being negatively evaluated by others often leads people with social anxiety to avoid social situations or experience significant anxiety in them. Passive avoidance, such as avoiding eye contact or trying to look busy while in social situations, can also be common ways to try to cope with their anxiety. As you may expect, social anxiety makes it harder to engage in social situations and can cause problems at home, school, and work. 

Rates of depression and substance use tend to be higher in people with social anxiety relative to those with other anxiety-related disorders. Unfortunately, it often takes a long time for socially-anxious people to seek treatment. The Anxiety and Depression Association of America found that less than five percent of people seek treatment within a year of first experiencing social anxiety and 36 percent wait 10 years or longer. 

What causes social anxiety disorder?

There are many factors that contribute to the development of social anxiety disorder. Negative social experiences, like being bullied or doing something embarrassing, can lead to social anxiety. You are also much more likely to develop social anxiety if you have a naturally shy personality style or have an immediate family member with similar struggles. 

Social anxiety tends to develop earlier in life. The majority of people who are diagnosed with social anxiety disorder begin to experience symptoms in childhood or adolescence, and many continue to experience significant difficulties from their anxiety well into adulthood.

What types of treatments are available for social anxiety disorder?

Cognitive behavioral therapy (CBT) has the strongest evidence for treating social anxiety disorder. CBT is a skill-building intervention that helps people learn how to identify and manage thoughts and behaviors that contribute to maintaining social anxiety. Common features of CBT for social anxiety include: 

  • Challenging thoughts: It's good to keep in mind that the anticipation of bad things happening in social situations tends to be worse than the actual outcomes. Most people are quite forgiving and tend not to notice our mistakes and struggles. Socially-anxious individuals tend to be their own worst critic; they often perform better in social situations than they think. 
  • Avoiding the avoidance: While avoidance makes sense when we feel uncomfortable, learning how to approach and tolerate social situations is extremely important. Gradual and repetitive exposures to progressively more challenging social situations often helps individuals feel more comfortable over time. 
  • Practicing social skills: Learning how to do small talk, ask for help, and maintain eye contact takes practice. Setting small social goals every day, such as saying hello to three people you are less familiar with, can help build confidence in these situations. 

Joining social groups or participating in Toastmasters may help individuals gain comfort in social situations. Self-help books, such as The Shyness and Social Anxiety Workbook, can help introduce CBT skills and practical strategies that can be worked on over time. Some individuals may benefit from working with a CBT therapist to learn and strengthen skills to conquer their fears. 

For more information on social anxiety disorder, check out:

Dr. Olivia Bogucki is a clinical health psychology fellow in Primary Care in Rochester and Kasson. 

Dr. Craig Sawchuk is a clinical psychologist in Primary Care in Rochester and Kasson and co-chairs the Division of Integrated and Behavioral Health.