Social anxiety disorder is marked fear of situations where you might be scrutinised and judged negatively. Not disliking parties. A conviction that you’re being evaluated, that you’ll be found wanting, and that the consequences of that matter.
It typically begins in adolescence, lasts for years untreated, and is frequently mistaken by the person themselves for who they are.
The three things that maintain it
This is the Clark and Wells model, and it’s the most useful thing to understand about the disorder.
Self-focused attention. In a feared situation, attention turns inward. You monitor your own voice, face, hands, and how you’re coming across — and you build an image of yourself from the inside that’s far worse than what anyone sees. That internal image, not the room, is what you react to. It also means you miss most of the actual social information, which makes you seem distracted and confirms the fear.
Safety behaviours. Rehearsing sentences, gripping a glass, standing where you can’t be approached, keeping to questions so you never have to speak about yourself, drinking. Each makes an occasion survivable and prevents you learning that it would have been survivable anyway — and several of them, especially rehearsing, make you come across worse.
Post-event processing. The two-hour replay afterwards, in which you review everything you said and construct a case against yourself from the internal image rather than from what happened.
Why the treatment isn’t exposure alone
Simply attending more events doesn’t fix social anxiety, which is why people who force themselves to socialise for years get no better. If you attend while self-monitoring and running safety behaviours, you haven’t tested anything.
Effective treatment adds two things. Attention training — deliberately putting attention outward, onto the other person, the room, the actual conversation. And behavioural experiments without safety behaviours, where you drop the precautions and find out.
Video feedback is often used and is startling: people watch themselves and discover the sweating, trembling and awkwardness they were certain was obvious is largely invisible.
What actually works well
Group CBT for social anxiety, where available, is often the better format — the group supplies the feared situation, and the experiments can be run in the room rather than described afterwards. It has good evidence, and the irony of being asked to join a group isn’t lost on anyone.
This is also the one anxiety disorder where in-person has a genuine edge, because video lets you angle away and watch your own face — both of which are the safety behaviours you’re meant to be dropping.
The thing worth knowing early
Social anxiety and introversion are different. Introverts find socialising tiring and aren’t afraid of it. Plenty of people with social anxiety badly want the company and can’t get to it — which is a much sadder situation and a much more treatable one.