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Social Anxiety Disorder Counseling

“What if I say something stupid?”

“I don’t know what to say and I may look stupid if I talk.”

“What if I say too much? OR not enough?”

“I shouldn’t have done anything at all, they probably think I am so stupid now.”

“I shouldn’t have said that… what if they think less of me?”

Social anxiety disorder is often known as SAD. It is a type of anxiety disorder that can be–and is– experienced across different ages, cultures, genders, and socioeconomic classes. Social anxiety disorder is usually characterized by a fear, often irrational, of being judged, watched, or embarrassed. 

Key Factor of Social Anxiety Disorder

One of the key factors of SAD is that it is something that impacts and interferes with your daily life. It is not a one-off nervous feeling during social situations. It is recurrent and for some it can be debilitating. The fear that people with social anxiety disorder have in social situations is so strong that they feel it is beyond their ability to control.

It may be common that those struggling with SAD may be commonly avoiding conversations, class discussions, and may seem isolated. It is important to remember that social anxiety is more than just being shy or uncomfortable in social situations.

Unlike shyness, SAD will cause an intense fear, usually derived from the possibility of humiliating oneself. Doing everyday things in front of people—such as eating or drinking in front of others or using a public restroom—also causes anxiety or fear.

Social anxiety disorder usually starts during childhood. It can be seen in young people and children who are extremely shy. Actually, an estimated 9.1% of adolescents had social anxiety disorder, and an estimated 1.3% had severe impairment.

SAD is not uncommon in adults either; in fact, some research suggests that about 7% of Americans are affected. Some studies even suggest that of the adults diagnosed with social anxiety disorder in the past year, an estimated 29.9% had serious impairment, 38.8% had moderate impairment, and 31.3% had mild impairment.

Is There a Difference Between Social Phobia and Social Anxiety?

In the world of behavioral health, social anxiety disorder is often classified as a social phobia. This makes sense as phobias are often classified as another type of anxiety disorder. So, the terms can be used in the place of one another in the world of behavioral health.

Therefore, it is possible that you may hear some refer to Social Anxiety Disorder as social phobia. The Anxiety and Depression Association of America suggests that over 15 million American adults struggle with social phobia. This would make it the second most common anxiety disorder in the country.

The most common would be specific phobias. One of the most well-known being an anxiety disorder with agoraphobia. Agoraphobia is commonly thought of as “the fear of leaving one’s house or comfort zone”.  While this can be true in some cases, it is really the fear that is derived when someone perceives their environment as unsafe.

Now we know that social phobia, or Social Anxiety Disorder, is common and there is still more research to be done on causes, the next question is: “how do we treat it?”

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What are Social Anxiety Symptoms?

As with any mental illness or disorder, people with anxiety disorders experience their symptoms differently. Generally, anxiety changes day-to-day function. Some of the thoughts we listed above are common signs of SAD.

The other signs and symptoms of SAD are pretty similar to other anxiety disordersThese symptoms include but are not limited to:

  • Fearing situations where you don't know other people
  • Worrying that you will be judged
  • Fear of becoming embarrassed or being humiliated
  • Thinking that others will notice your anxiety
  • Dreading upcoming events weeks in advance

These symptoms can cause responses that are both physical and mental. For example, it may be common for someone struggling with Social Anxiety Disorder to:

  • Blush
  • Sweat Profusely
  • Have muscle tension
  • Have a racing heart
  • Avoid social activities
  • Use safety behaviors


Know Your Health - What Causes Social Anxiety

By this point, most of us would be wondering what causes social anxiety disorder. In general, all anxiety disorders are typically thought to be caused by a combination of genetics and experiences. This is also known as “nature and nurture” in the world of behavioral health.

Social Anxiety Disorder in particular has no 100% evidenced-backed cause and therefore most professionals and scientists believe it is a combination of nature and nurture like other anxiety disorders. SAD is unique though, because it is often thought to begin during teen years. 

It also has some links to chemical imbalances in the brain like Generalized Anxiety Disorder (GAD) and depression. An imbalance in the neurotransmitter serotonin, a brain chemical that regulates mood and emotions, may play a role in social anxiety disorder.

woman covering face with hands
woman on phone looking at laptop

Some specific reasons that scientists have found a potential link with SAD are:

  • Being bullied or teased as a child
  • Family conflict or sexual abuse
  • A shy, timid, or withdrawn temperament as a child
  • Having an overly critical, controlling, or protective parent
  • Having an overactive amygdala

Most of these are also commonly related to other mental health struggles. One from that list that may stand out to you is the “overactive amygdala”.

What does that even mean?

The amygdala is an almond-shaped piece of the brain that is partially responsible for emotions, instincts, and memory (also known as the limbic system).

When the amygdala goes into overdrive and is overactive, it may be associating emotions or instincts abnormally which can lead a person to feel fear or anxiety around a situation that they otherwise would not.

Also, sometimes we misread people which comes down to the brain making a mistake. For example, you may think that people are staring at you when they are not. Some researchers think that misreading of others’ behavior plays a significant role in worsening social anxiety.

Treatment for Social Anxiety Disorder

Make a Doctor Appointment to Get Support for Social Anxiety with SUN Behavioral


Common Treatment of Social Anxiety

Like any other type of illness or injury, treatment begins with diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes social anxiety disorder as a specific diagnosable mental illness. The DSM-5 is one of the leading diagnostic manuals for mental illness in the world., It is very commonly used by professionals that treat mental illness in the United States.

When it comes to diagnosing SAD, it is most often diagnosed with a clinical interview. This is when a mental health professional will go through a series of questions, especially those related to the symptoms that are discussed prior to the visit.

Much like other illnesses such as a flu or even something more serious, a person needs to meet a specific number of symptoms and diagnostic criteria to be diagnosed with SAD. This includes fear that is so severe that it interferes with daily life such as work or school, as we discussed above. Some will be diagnosed with SAD as a result of the interview process and others will potentially be diagnosed with Generalized Anxiety Disorder (GAD).

That is why it is important if you think that you may meet the criteria for any mental illness or disorder that you seek professional care via making an appointment with a therapist or mental health professional.

After diagnosis is when a full treatment program will begin.

The most commonly used evidence-based treatments for social anxiety disorder are medication and cognitive behavioral therapy (CBT). It is important to remember though, that these treatments are most effective when used together.

The most common medications used to treat social phobia or SAD are:

  • Benzodiazepines
  • Beta-blockers
  • Monoamine oxidase inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)2
  • Selective serotonin-norepinephrine reuptake inhibitors (SNRIs)

Of course, like all treatment plans and medication regimens, it is crucial to speak to both your mental health professional and your family doctor when starting or stopping a medication. All of these medications and medication types are specially designed. Also, since everyone is unique, what works best for one person may not work well for another so it is important to go through the process properly while in the care of medical teams to be sure the medication is working correctly for you.

Types of therapies used in the treatment of SAD and social phobia:

Cognitive behavioral therapy (CBT)

An example of one type of therapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. It can also help people learn or practice social skills, which is important for treating social anxiety disorder.


Also known as “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be tailored to each person’s needs.

Other Types of Therapy

  • Interpersonal therapy (IPT)
  • Rational emotive behavior therapy (REBT)
  • Acceptance and commitment therapy (ACT)

At SUN Behavioral, we recognize that each individual has their own experiences and much like medicines, what works for one person may not work best for another. We keep this in mind during the planning process of our treatment programs.

Frequently Asked Questions

What triggers social anxiety?

Social anxiety is most frequently triggered by social interactions. This can be as minor as ordering a meal, talking on the phone to make a doctors appointment, or checking out at the grocery store. Or the trigger can be something larger like parties, long conversations, presentations, performances, or conferences. Everyone is different and so are their triggers for anxious responses.

How do you cure social anxiety?

There is no “cure” for social anxiety, or any anxiety disorder. There are ways to effectively treat and manage anxiety. These methods include medication, therapies, support groups and more. The most effective treatment is a combination of evidence-based strategies such as medication and therapies like cognitive behavioral therapy.

How do you know you have social anxiety?

Social anxiety can seem obvious to some but it can be tricky for those dealing with it. Often, it may be hard to recognize that you have social anxiety because what you consider normal may actually be the sign of an issue.

For example, many with social anxiety will experience extreme nervousness or fear around being social and they may ultimately find methods to avoid social situations that seem natural or normal. Perhaps they mask the disorder with “shyness” or other types of safety habits. Another way to recognize that you may be facing social anxiety is to take time to consider if it is impacting your life in work, school, relationships or other ways. This is usually a telltale sign of an anxiety disorder.

Who is most affected by social anxiety disorder?

In general, most anxiety disorders start in the teen years. Studies show that an estimated 40 million adults in the U.S. have an anxiety disorder. 15 million of those are said to suffer from a form of social anxiety. Other data shows that females ages 18-29 are the most impacted population when it comes to social anxiety disorder.

Treatment for Social Anxiety Disorder

The capable team at SUN Delaware has been serving our community for years. Reach out to begin your journey to recovery.


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