Social Anxiety Disorder

Social Anxiety Disorder (also known as Social Phobia) is the chronic fear of social or public situations due to an excessive concern over possible humiliation, embarrassment or rejection by others. Intense anxiety and stress can cause avoidance of social situations for the sufferer and manifest symptoms listed below.


SAD tends to be more prevalent in females than in males and is estimated to affect around 7% of the US population. Most people diagnosed with SAD report that their symptoms of social anxiety began during their childhood or early teenage years.

Cognitive Symptoms :

Social anxiety is associated with negative thoughts & beliefs, self-doubt, dysfunctional thought patterns or feelings of inadequacy that can lead to a diminished sense of well -being and make it harder to function in daily life. Some common concerns for individuals with SAD include being negatively judged by others as stupid, boring, or unlikeable.  Other common thoughts include negative predictions about doing something embarrassing or offensive.

Physical Symptoms:

The overwhelming fear of social situations can instigate physical symptoms, such as: blushing, chest pain, chills, dizziness, dry mouth, feelings of derealization, palpitations, lump in the throat, difficulty speaking, shaking, shortness of breath, sweating, tremor, or trembling voice.

Behavioral Symptoms:

In SAD, the high level of fear experienced is recognized to be out of proportion to the actual level of risk posed by the social situation.  Individuals with SAD may find that they rely on strategies of avoidance, isolation, or escape to manage this overwhelming feeling of fear.  Relying on avoidance to manage anxiety can further contribute to a sense of isolation and loneliness that can ultimately limit a person’s social, academic, or occupational success.


Diagnosis of SAD can only made by a qualified Mental Health Professional using the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM 5 TR) diagnostic criteria.


Cognitive Behavioral Therapy: SAD can be successfully treated with Cognitive Behavioral Therapy (CBT).  CBT is an evidenced-based treatment where therapist and patient work in collaboration to identify and solve problems as well as build new skills to manage problematic thoughts, emotions, and physical symptoms. CBT is an effective treatment for SAD and will often include: psychoeducation, cognitive restructuring (identifying and challenging irrational beliefs), exposure therapy, behavioral experiments, social skills training, and relaxation techniques (including mindful imagery, breathing techniques, and biofeedback).

Exposure Therapy: Exposure therapy is a highly effective evidence-based treatment for SAD.  Participation in exposure therapy involves the patient and therapist working as a team to identify events that trigger anxiety and discomfort.  Patient and therapist will then gradually face those triggering situations in a controlled and structured way while using coping techniques learned during the treatment process.

We are proud to be a regional clinic for The National Social Anxiety Center, which is the national organization dedicated to providing and fostering evidence-based services for those struggling with social anxiety.


Social Anxiety Picture

Social Anxiety:

Janine was a freshman in high school. She had difficulty eating in front of friends at school, walking into a room where everyone else was already seated, initiating conversations, and being called on by the teacher in class (even when certain of the correct answer).  She felt flushed, lightheaded, and her heart pounded in her chest.

She worried, “Others will notice how anxious I am and think I’m weird”, “I won’t be able to talk with them”, “They will think I am a really boring person and not want to be friends with me.”  Because of her anxiety, she avoided social gatherings, phone calls and text with friends. All of this had a negative effect on her socialization and academics.  After discussing the problem with her parents, and finding out about CBT, Janine was willing to take the steps to help herself and to learn the tools to overcome her fears.

Test Anxiety Picture

Test Anxiety:

Ms. Johnston worked for many years on her graduate degree program, and it was now time for her licensing exam.   She had heightened anxiety at the thought that she would fail the exam, and she found herself dwelling and overthinking negative outcomes. She experienced lack of concentration during study sessions, irritability with others asking about study progress, and avoidance of group study sessions. She put off scheduling the appointment to take the exam.

She felt “charged up” or “on edge” and had chest tightness and increased heart rate whenever she attempted to look at the testing website or when researching internship and job opportunities requiring licensure.  She thought, “I am certain to fail”, “If I fail this, I will never make a future for myself”, “If I fail, I will be a disappointment to my family”.  Ms. Johnston had worked so hard for many years and now felt stuck. She researched treatments for test anxiety and decided to begin a course of CBT.

Fear of Public Speaking Picture

Fear of Public Speaking:

Salvatore had a history of anxiety as a child, but he was able to overcome much of it due to his drive to succeed. Recently he accepted of an offer of a “dream job”, but he began to experience anxiety, inability to concentrate during work, and difficulty sleeping.  He said this new position could be “life changing”, but on the negative side it would involve frequent experiences of public speaking in front of colleagues, superiors, and large groups at conventions and trade shows. Salvatore thought about quitting, but that made him even further upset. He decided to seek help instead.