Social anxiety (social phobia)

Symptoms of social anxiety include worrying about speaking to people, dreading social events, avoiding eye contact and low self esteem.

There are things you can do to help with social anxiety, such as relaxation techniques and breaking down challenging situations into smaller parts.

Talking therapies are the main treatment for social anxiety. Self-help courses and antidepressants can also help some people.

Social anxiety is more than shyness. It's a fear that does not go away and affects everyday activities, self confidence, relationships and work or school life.

Many people occasionally worry about social situations, but someone with social anxiety feels overly worried before, during and after them.

You may have social anxiety if you:

• worry about everyday activities, such as meeting strangers, starting conversations, speaking on the phone, working or shopping
• avoid or worry a lot about social activities, such as group conversations, eating with company and parties
• always worry about doing something you think is embarrassing, such as blushing, sweating or appearing incompetent
• find it difficult to do things when others are watching – you may feel like you're being watched and judged all the time
• fear being criticised, avoid eye contact or have low self-esteem
• often have symptoms like feeling sick, sweating, trembling or a pounding heartbeat (palpitations)
• have panic attacks, where you have an overwhelming sense of fear and anxiety, usually only for a few minutes

Many people with social anxiety also have other mental health issues, such as depression, generalised anxiety disorder or panic disorder.

Self-help can help reduce social anxiety and you might find it a useful first step before trying other treatments.

The following tips may help:

• try to understand more about your anxiety – by thinking about or writing down what goes through your mind and how you behave in certain social situations, it can help to keep a diary
• try some relaxation techniques, such as breathing exercises for stress
• break down challenging situations into smaller parts and work on feeling more relaxed with each part
• try to focus on what people are saying rather than just assuming the worst

A number of treatments are available for social anxiety.

The main options are:

• cognitive behavioural therapy (CBT) with a therapist, which is therapy that helps you identify negative thought patterns and behaviours, and change them; this can be done with just you and a therapist, in a group or with your parents or carers
• guided self-help, which involves working through a CBT-based workbook or online course with regular support from a therapist
• antidepressant medicines, usually a type called a selective serotonin reuptake inhibitor (SSRI), such as escitalopram or sertraline; these are usually not used to treat children and young people

CBT is generally considered the best treatment, but other treatments may help if it does not work or you do not want to try it.

Some people need to try a combination of treatments.