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For adults
Social anxiety
Social anxiety is not shyness and it is not a personality you are stuck with. It is a specific, well-understood pattern, and there is a specific treatment that dismantles it.
What social anxiety is
At its core, social anxiety is the fear of being evaluated and found wanting — of doing something that reveals you to be awkward, boring, stupid, or visibly anxious. The fear is not really of people. It is of exposure.
What makes it so persistent is that it is self-sealing. In a feared situation you turn your attention inwards and monitor how you are coming across, which makes you a worse conversationalist and gives you a vivid impression of how badly it is going. You deploy safety behaviours to get through — rehearsing sentences, gripping a glass, keeping the topic on the other person, saying less. It goes acceptably. And you conclude that it went acceptably because of the safety behaviours, so you keep them. The belief is never tested.
What it actually looks like
- Preparing for a meeting by scripting what you will say, then not saying it.
- Letting a phone call go to voicemail and texting instead, or rehearsing a two-line call before making it.
- Not eating in front of colleagues, in case your hands shake.
- Arriving early so you do not have to walk into a room where people are already seated, or arriving late so nobody talks to you before it starts.
- Going to the party and spending most of it in the kitchen, on your phone, or with the one person you know.
- Drinking two before you leave the house so the first hour is survivable.
- Turning down a promotion because it involves presenting, and telling yourself it was not the right role.
- Lying awake after a social event doing a forensic review of everything you said, landing on the one clumsy sentence and replaying it.
- Blushing, sweating or shaking, and then panicking about whether it showed.
That final review — the post-mortem — deserves its own mention. It runs on your internal impression of how you looked, which is generated by anxiety, not by anything anybody actually saw. In my experience this is the habit that keeps social anxiety topped up between events, and stopping it is often an early and unexpectedly powerful change.
Safety behaviours are the problem, not the solution
Everyone with social anxiety has a set of manoeuvres that get them through: the drink, the script, the phone, the tight grip on the glass, the deliberate avoidance of eye contact, the standing near the door. They feel like coping. They are the reason nothing improves.
As long as you get through the dinner party by hiding, your brain records a near miss rather than a success. Dropping the safety behaviours — deliberately, one at a time, while staying in the situation — is what allows the belief to finally be tested. It is also, reliably, the part people most want to negotiate their way out of.
What treatment involves
Cognitive behavioural therapy for social anxiety is one of the better-developed treatments in the field, and NICE recommends CBT as a first-line psychological treatment for social anxiety disorder. Done properly, it has a recognisable shape.
We start by working out what you actually predict will happen, in concrete terms — not “it will go badly” but “I will go blank for ten seconds and they will look at each other”. Vague fears cannot be tested; specific ones can. Then we shift your attention outwards. Most of the exercises early on involve deliberately dropping self-monitoring and putting your attention on the other person and the room, which consistently makes conversation easier and, more importantly, gives you real information instead of your internal reconstruction.
From there, behavioural experiments. You go into the feared situation, drop a safety behaviour, and find out whether the predicted disaster occurs. Sometimes we go further and deliberately do the feared thing — ask an obvious question, spill something, let a silence run — to discover what actually happens when you are less than perfect. It is almost always less than you expected, and there is no argument as persuasive as having done it. Video feedback is useful here too, because most people are genuinely surprised by the gap between how they felt and how they looked.
Social anxiety in teenagers
Adolescence is where social anxiety usually starts, and it is where it is easiest to miss. A teenager who is quiet, agreeable and no trouble at school does not get referred. The signs are more often practical than emotional.
- Refusing to order their own food, ask a teacher a question, or phone the dentist.
- Chronic stomach aches on days with presentations, PE, or a new class.
- Friendship groups that shrink rather than change, and weekends spent entirely at home.
- Missing lessons or whole days — see also school refusal.
- Contact that stays online, where it can be edited, and never becomes face to face.
Treatment for teenagers is recognisably the same therapy, adapted: shorter sessions, more concrete experiments, and parents involved deliberately. Parents almost always accommodate — ordering for them, making the calls, accepting the party invitation on their behalf — because it spares an obviously distressed child. It also removes every opportunity to learn. Where a young person refuses to attend at all, SPACE is a parent-based route that works through changing those responses instead. There is more on adolescent presentations in anxiety in children and teenagers and on the for parents pages.
What recovery actually looks like
Not becoming an extrovert. If you are naturally quiet, you will still be naturally quiet, and that was never the problem. What changes is that the decision stops being made by the anxiety — you go or you do not go because you want to, you speak in the meeting when you have something to say, and the review afterwards stops running.
Working with me
I am a clinical psychologist, HCPC-registered and chartered with the British Psychological Society, and board certified in Behavioral and Cognitive Psychology by the American Board of Professional Psychology. I trained at the University of Washington, a leading clinical research programme, and completed a postdoctoral fellowship at the Evidence-Based Treatment Centers of Seattle, where I was Director of Training and Education and later Assistant Director of the Child Anxiety Center. I have been working in psychology since 2008 and qualified as a clinical psychologist over a decade ago.
I see adults and teenagers online across the UK and in person near Ravenshead, Nottingham and Mansfield, weekdays from 9am to 9pm. Fees, insurance and session numbers are set out on the fees page.
The first step is a free 30-minute call, which — I am aware — is itself a phone call to a stranger. If that is the hard part, email me instead and we will start there.
Common questions
Is social anxiety just extreme shyness?
No. Shyness is a temperament — plenty of shy people are perfectly content and unimpaired. Social anxiety disorder is defined by fear of being judged, and by the cost of that fear: opportunities declined, careers capped, friendships that stay at arm’s length, evenings spent replaying what you said. Many people with social anxiety are not shy at all; they are outwardly confident and privately exhausted by the effort of appearing so. The question is not how quiet you are, it is what the fear is costing you.
Will therapy make me do public speaking?
Only if that is one of your goals, and only at a point you have chosen. Treatment works from a list you build, starting with situations that are uncomfortable rather than unbearable, and the difficulty rises as your confidence does. Some people want to give a best man’s speech. Others want to be able to eat lunch with colleagues or make a phone call without rehearsing it. The aim is your life, not a standardised set of challenges.
Does alcohol make it worse?
Usually, yes, though not in an obvious way. Alcohol functions as a safety behaviour: it makes the event survivable, so your brain never learns that you could have survived it unaided, and the belief that you need it grows. Many people with social anxiety drink specifically to manage social situations and do not think of it as a problem because the amounts are unremarkable. It is worth being honest about in assessment — reducing it is often one of the more significant early changes.
Can this be treated online, when the problem is being around people?
Yes, and the evidence for online CBT is good. The therapy room was never where the change happened anyway — the work is what you do between sessions, in your actual workplace, shop, classroom and social life. Online sessions can even make things easier at the start, when coming to an unfamiliar building to talk about being judged is itself a barrier. Where in-person sessions are useful for particular exercises, I can offer them near Nottingham and Mansfield.
How long does treatment usually take?
A typical course for social anxiety runs to roughly 12 to 20 sessions after the initial assessment, weekly at first and then spaced as you take over. Social anxiety often has a long history — many people date it to childhood or early adolescence — but a long history does not mean slow treatment. What predicts progress is willingness to do the between-session work, particularly dropping the safety behaviours, which is the part people find hardest and which does most of the work.
My teenager will not talk to me about it. What can I do?
You are not stuck. Parent-based work such as SPACE was developed for exactly this: parents attend, the young person does not have to, and the focus is on changing how the family responds to the anxiety rather than persuading a reluctant teenager into a therapy room. Accommodation — ordering for them, making their calls, letting them skip the party — is well-meant and keeps the fear intact. Changing those responses reliably shifts symptoms, even when the young person never engages directly.
Related pages
Not sure whether this is the right fit?
Start with a free 30-minute call. We will talk through what is going on, I will tell you honestly whether I think I can help, and if I cannot I will try to point you to someone who can. There is no obligation and no charge.