This is a common problem but it effects people differently. As a therapist I have worked with people who have a specific fear such as public speaking, and people who have generalised fears and live very restricted lifestyles in that they will avoid restaurants, buses, indeed anywhere where others can view them.

While all have different presentations, the central characteristic is the same in that all are extremely sensitive to their perception of being negatively evaluated by others.

Normally those with Social Anxiety recognise that the fear is disproportionate or irrational in the situation but overcoming it is still very difficult.

How is it diagnosed?

Social Anxiety is defined as “a marked and persistent fear of social or performance situations in which embarrassment may occur”. The situation must almost always provoke immediate anxiety on exposure and the fear must interfere with daily routines, occupational functioning or social life or the person must be markedly distressed about having the disturbance. Situations that induce social anxiety are normally avoided or else endured with distress.

Where and when can social
anxiety arise?

The answer is everywhere. If people are present the potential exists for social anxiety. Some situations which are in reality neutral get turned into risky situations by the activation of beliefs. For instance, being on a bus where no one has any interest in you gets turned into “everyone is looking at my big nose” or sitting in a cafe on your own gets turned into “everyone thinks I am a loser because I am here on my own”. Social anxiety typically has its onset in adolescence and often results from one critical incident such as being given out to in front of the class or bullying.

Other disorders associated with Social Anxiety

Some people with social anxiety can have panic attacks, others develop depression. Social anxiety is particularly related to substance abuse disorder..


It is very difficult to solve this yourself. Because people recognise the fear as irrational they often will push themselves into social situations with the belief that, with exposure, they will get used to it and the problem will lessen. Unfortunately, what tends to happen is that people are anxious in advance of the situation, invoke multiple safety behaviours (which are counterproductive), still experience the social situation as a failure and then think about all the negative elements afterwards thus reinforcing the belief system that caused the problem in the first place.

Good news

The good news is that CBT has very effective protocols for the treatment of Social Anxiety and within this practice very high success rates are achieved. At Cork Cognitive Therapy we also move out of the therapy room into the community. This is beneficial as it is real world testing of beliefs and often these situations need the support of the therapist due to the anxiety level present.

What to do

Don’t try and solve this yourself! You are setting yourself up for failure and that will ultimately worsen the problem. Find a good CBT therapist, who operates to evidence based protocols. Do it as soon as possible as the longer you leave it the more work it will require.