"If I have to speak in front of people, I get so anxious I can't stand it. I won't sign up for a class if an oral presentation is involved. It's just not worth it."

"I'm afraid to start conversations with people I don't know. What if I say something stupid? What if they think I'm stupid?"

What is social anxiety disorder?
Social anxiety disorder involves an intense and persistent fear of one or more social or performance situations. Individuals with social anxiety disorder:

• fear, when exposed to unfamiliar people or possible scrutiny by others, that they will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing,
• experience anxiety, which may take the form of a panic attack, whenever they are in a feared social situation,
• avoid feared social situations or endure them with intense distress, and
• find that their avoidance, anxious anticipation, or distress in feared social situations significantly interferes with their life

Situations in which individuals experience social anxiety can be divided into two types: 1) performance-based situations (e.g., giving a speech or presentation, speaking in a group setting) and 2) interaction-based situations (e.g., initiating conversations, dating). Some individuals' fears are limited to one or a few situations like public speaking. Others experience anxiety in many or most social situations.

• Social situations that people fear or avoid include:
• Public speaking
• Initiating or maintaining conversations
• Speaking to individuals in authority
• Dating
• Going to parties
• Eating or drinking in public
• Writing in public
• Using public restrooms

Cognitive-behavioral Model of Social Anxiety Disorder
One core feature of the cognitive-behavioral model of social anxiety disorder is self-focused attention. When people become self-focused, they become highly attuned to what they are thinking or feeling and how they are acting, and pay little attention to what is actually happening around them. Being so highly self-focused is particularly problematic for individuals with social anxiety. First, high self-focus makes negative or fearful thoughts about how one appears to others (e.g., I look really stupid), and physiological symptoms of anxiety (such as sweating, trembling, and blushing) extremely prominent, and leads people to erroneously believe that these symptoms are just as noticeable and real to those around them as they are to the socially anxious person. Second, when people are highly self-focused, they do not observe whether people are reacting as negatively as they believe and if their anxiety symptoms are as noticeable as they think. All this can lead to increased anxiety, decreased performance, avoidance of feared situations, negative beliefs about themselves and others, and anticipatory anxiety about future situations. People with social anxiety may also adopt safety behaviors that help them feel safe in social situations, such as speaking softly or avoiding eye contact; however, these behaviors often cause them to appear awkward or aloof and can cause the very negative reactions from others that they fear. The result of all these elements working together is a negative cycle of anxiety, negative self-evaluation, fearful anticipation, and avoidance behaviors that prevent people from overcoming their anxiety in social situations.

Cognitive-behavior therapy for social anxiety disorder

Cognitive-behavior therapy for social anxiety involves several types of interventions, including:

• Education and monitoring: Learn about the specific cognitive, behavioral, and physiological components that contribute to your social anxiety.
• Cognitive: Identify the negative thoughts and beliefs that contribute to your social anxiety, and work with your therapist to test out these beliefs and develop more realistic and grounded ways of thinking.
• Behavioral: To overcome social anxiety, it is important to test your beliefs about social situations by exposing yourself to situations that trigger your fears. Your therapist will help you gradually expose yourself to feared social situations (starting with easy ones and working up to harder ones), both in imagination and in real life and set realistic goals for your performance in those situations. Your therapist will help you identify and drop safety behaviors that actually contribute to the problem. You and your therapist may also work on increasing your social skills so that you can feel more confident and be more effective in social situations.
• Attention: Learn and practice skills to reduce self-focused attention, and be more engaged with the environment and what is happening in the present moment. These skills work in combination with the behavioral exercises that test out your negative beliefs about how others are perceiving or judging you.