In short
Social anxiety disorder is an intense, lasting fear of being judged or embarrassed in social situations, strong enough to make you avoid them. It is the most common anxiety disorder in Australia, affecting about 7 per cent of adults in a year, and it usually starts in childhood or the teenage years. Cognitive behavioural therapy is the best first treatment, and online versions work about as well as face to face.
On this page
What is social anxiety?
Social anxiety disorder, also called social phobia, is an excessive fear and avoidance of social situations. People with it fear being judged, criticised or embarrassed in front of others.1
Feeling shy or nervous before a speech or when meeting new people is normal.1 Social anxiety disorder is more than that. The fear is out of proportion, it lasts, and it gets in the way of things you want to do. A diagnosis is made when symptoms have caused distress for at least 6 months.1
How common is it?
It is the most common anxiety disorder.3 In the Australian Bureau of Statistics national study, 7.3 per cent of people aged 16 to 85 had social phobia in the previous 12 months.2
It starts young. About half of people who develop it have it by age 11, and about 80 per cent by age 20.3 It often goes untreated. In a large United States survey, social anxiety was the focus of care in only about half of the people with it who received any treatment.4
Want to talk it through?
Talk it through with an Australian doctor online. No referral needed.
Symptoms
The fear can attach to one situation, such as speaking in public, or to most social contact. Common signs include:1
- Dreading social events for days or weeks beforehand, or avoiding them
- Worrying that you will embarrass yourself in everyday situations
- Avoiding speaking in groups, in meetings or to people you do not know
- Only going to social events if alcohol is available
The body joins in. Sweating, trembling, blushing and stammering are common, and worrying that other people will notice them adds to the fear.1
Social anxiety or shyness?
| Shyness | Social anxiety disorder | |
|---|---|---|
| How strong | Nerves that ease once you settle in | Intense fear that can start well before the event |
| Effect on life | Uncomfortable, but you still go | You avoid situations, or endure them with distress |
| How long | Comes and goes | Lasts 6 months or more1 |
What causes it?
There is no single cause. Being very shy as a child raises the likelihood.1 Brain imaging studies show more activity in the regions that process threat, and genetic studies point to an inherited tendency.3
Avoidance keeps it going. Each situation you skip brings relief in the moment and removes the chance to find out that it would have gone better than you feared.
Why it is worth treating
Untreated social anxiety tends to be long-lasting, and it raises the risk of later depression and of problems with alcohol or other drugs.1,3 It affects study, work and relationships, and the more situations a person fears, the greater the impact.4
Treatment
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) helps you notice and test the thoughts that drive the fear, and to face feared situations step by step. It usually takes 8 to 12 sessions.1
It has the strongest evidence. An analysis of 101 trials involving 13,164 people compared psychological treatments and medicines for social anxiety disorder. Individual CBT had the largest effect, and the authors concluded it should be regarded as the best first treatment.5
Online CBT
You do not have to sit in a room with a therapist. In a pooled analysis of 31 studies, CBT delivered online or by app produced large improvements, and was at least as effective as face-to-face CBT.6 Self-help with or without support also beat no treatment in the larger analysis.5
MindSpot offers free mental health assessment and support online and by phone.1
Medicines
Antidepressant medicines may help when social anxiety is severe.1 For people who decline psychological treatment, the type of antidepressant that acts on serotonin has the most consistent evidence of benefit.5
When treatment does not work straight away
Treatment does not work for about 30 to 40 per cent of people the first time.3 That is a reason to try a different approach, not a reason to give up.
What you can do yourself
- Go easy on alcohol, and avoid using it or other drugs to get through social situations.1
- Take small steps towards the situations you avoid, starting with the easiest.
- Tell someone you trust. A friend or family member can help you book an appointment or come with you.1
- If the thought of a waiting room is the barrier, ask whether the appointment can be done by telehealth.1
When to see a doctor
- Fear of social situations is stopping you from working, studying or seeing people
- You are drinking to cope
- You feel low or hopeless as well as anxious
If you are having thoughts of suicide or self-harm, call Lifeline on 13 11 14. In an emergency, call 000.
See also our guides to anxiety symptoms, generalised anxiety disorder and how to calm anxiety.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- healthdirect. Social anxiety disorder.
- Australian Bureau of Statistics. National Study of Mental Health and Wellbeing, 2020–2022.
- Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008;371(9618):1115-25.
- Ruscio AM, Brown TA, Chiu WT, et al. Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychol Med. 2008;38(1):15-28.
- Mayo-Wilson E, Dias S, Mavranezouli I, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2014;1(5):368-76.
- Winter HR, Norton AR, Burley JL, et al. Remote cognitive behaviour therapy for social anxiety disorder: A meta-analysis. J Anxiety Disord. 2023;100:102787.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.