Over my years of practice, I have noticed that a large percentage of my clients are those who struggle with social anxiety or chronic shyness. They come to therapy because of their ongoing difficulties with these issues at school, work, and/or in intimate relationships. This perception is consistent with findings from the Anxiety and Depression Association of America (ADAA, 2009), which reported that nearly “15 million American adults have social anxiety . . . and 36% of them report symptoms for 10 or more years before seeking help.”

Social anxiety usually starts early in life, between ages 11- 13, and it is equally problematic for men and woman, both in adolescence and adult life. A particular difference is that adults, for the most part, are able to recognize the source of their struggle with anxiety, while children and teens dealing with anxiety problems may not recognize the source of their fears; in fact they may experience their anxiety in the form of physical symptoms such as stomachaches and headaches, leaving the underlying problem unidentifiable. When symptoms of anxiety go unrecognized, anxiety problems can be exacerbated and perpetuated. Therefore, children and teens are actually at risk of being undiagnosed and not receiving effective treatments for anxiety.

Social phobia refers to the tendency to be nervous or uncomfortable in a social situation because of fears of being judged negatively by others. Social anxiety could result in avoidance of conversations, public speaking, attending social gatherings, being introduced to new people, and virtually any experience or challenge that requires a social exchange either with a single individual or a group. Social anxiety could be limited to particular type of social situation or occur across multiple settings. For instance, a client of mine used to experience extreme anxiety when giving a public presentation at her high school class; however, she felt comfortable introducing herself to others in casual situations like parties or when socializing with others (social phobia, specific type). Another client of mine struggled with severe social anxiety and as a result avoided all social encounters at school, work, family gatherings, and social/intimate relationships to the degree that she couldn’t even order food in a restaurant or register for her next class in her college, because both activities involved a social exchange with another individual (social phobia, generalized type).

What’s the difference between social anxiety, shyness, and introversion?
Shyness is an emotion that in extreme forms could evolve into social anxiety. Recent studies suggested that up to 80% of people report that they were shy at some point in their life; nevertheless, being shy doesn’t mean that you have a problem that requires professional help. Most shy people experience discomfort when approaching social situations; however, they manage to tolerate their discomfort without engaging in significant levels of avoidance or escape behaviors. For socio-cultural reasons, in recent years, and in particular after the 90s, shyness has been viewed as a personality defect. However, multiple studies have demonstrated that shy people are thoughtful about decisions they’re making mainly because they tend to be “prevention-focused.” In addition, they can be extremely effective when working in teams and have an extraordinary capacity to work independently and in a reflective manner.

Introversion is a personality trait characterized by simply having the personal preference for engaging in solitary activities (which is the opposite of extroversion). Although the majority of shy people may have introverted traits, there is also a group of shy people who may have extroverted characteristics, and while they can perform in social activities that are necessary, they would still rather be alone. Another difference is that shy people would like to connect with others, while introverted people may not have a strong desire to do so and feel comfortable spending time alone (Henderson, 2011). 

Popular wisdom suggests that extroverted leaders are more effective academically, professionally, and socially, but that’s not always the case according to a study conducted on leadership by A. Grant and two of his colleagues from the University of Pennsylvania (2010). The results of their study indicate that introverted leaders can be more effective when facilitating problem solving situations and are more likely to listen to suggestions and support others’ efforts to be proactive when compared to extroverted leaders. Grant’s study also shows that introverted and extroverted leadership styles can be equally effective, but with different groups of employees.

What causes social phobia?
Several variables influence the development of social phobia: (1) genetics, (2) prior learning experiences, and (3) the degree to which a person avoids social situations. It has long been recognized that the tendency to struggle with anxiety can run in families through generations, and this tendency is believed to be influenced by the interaction of several genes. In regard to genetics and social phobia, preliminary studies conducted by researchers from the Massachusetts General Hospital, University of California at San Diego, and Yale University suggest that there is a particular genetic variation linked to being inhibited or introverted; although this finding continues to be explored, it does not dismiss the overall consensus that there is a genetic predisposition for anxiety.

Regarding prior learning experiences and avoidance, most people with social phobia will recall single or multiple events in which they were embarrassed or humiliated in a social encounter; those experiences led them to be afraid that the same thing could happen again, and therefore they developed avoidance or escaping behaviors from social situations. This is a natural tendency in that at times we all may want to avoid a social situation because we don’t feel comfortable around new people or simply because we have exhausted our capacity to deal with others during the week. However, avoiding a social situation because we’re afraid of being misjudged is a different kind of avoidance. Later on, it’s the frequency and degree to which a person starts avoiding social gatherings that determines whether an individual develops social phobia or not. For instance, a former client of mine was first teased during middle school because he was wearing a t-shirt that had a family picture printed on it; days later he was called “gay” because he was wearing a gray sweater with pink stripes. He still recalled how embarrassed he was during those events and how he started avoiding walking in the hallways of the school where his classmates used to hangout; later on, he began avoiding giving presentations in the class and managed to schedule presentations with teachers individually during the breaks. He would only attend a social gathering if his sister went with him and if she stayed by his side during the whole event; if for any reason his sister started talking to other people for long periods of time, he would go hide in the bathroom and wait until the conversation was likely to be over. Within 2 years, he had organized a life based on avoidance of social situations; unfortunately, the degree of social isolation led him to experience significant levels of depression, which he tried to overcome by engaging in cutting behaviors.

What’s the most effective treatment for social phobia?
Cognitive Behavioral Therapy (CBT) has proven to be the most effective treatment for social anxiety (Albano & DiBartolo, 2007; David, 2003; Leichsenring et al., 2009). CBT includes cognitive and behavioral interventions that involve exposure to the social situations a person has been avoiding. Social skills or assertiveness training can be additional components to treatment in order to assure an effective outcome. The video below presents a teen undergoing CBT treatment for social anxiety.


Social phobia assessments
If you’re interested in figuring out if you or a relative of yours is struggling with social anxiety, click in the links below. The first two links are nonstandardized assessments developed by their respective organizations, the third one is a clinical validated and reliable assessment tool for social anxiety.

Written by:
Patricia E. Zurita Ona, Psy.D. is a psychologist at the East Bay Behavior Therapy Center. Dr. Zurita Ona can be contacted at
Antony, M. & Swinson, R. (2000). The shyness and social anxiety workbook. Oakland, CA: New Harbinger Publications.
Henderson, L. (2011). The compassionate-mind guide to building social confidence.. Oakland, CA: New Harbinger Publications.
Hoffman, S. & Otto, M. (2008). Cognitive Behavioral Therapy for Social Anxiety: Evidence-based and disorder-specific treatment techniques. Oakland, CA: New Harbinger Publications.
Analyzing Effective Leaders: Why Extraverts Are Not Always the Most Successful Bosses.Knowledge@Wharton (2010, November 23). Retrieved from
A better way to treat anxiety: for teens, exposure turns parents into coaches (May, 2013). Retrieved from


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