African american male sitting alone in office

Social Anxiety

October 30, 2024

Lucy Robinson

About the Author: Lucy is a low-intensity cognitive behavioural practitioner who treats and assesses adults who experience common mental health difficulties within the NHS.

Team Mindsum

About the Editor: Our team of researchers and writers edited this article. Our content is published after careful review and approval by the editorial board.

What is social anxiety?
Symptoms of social anxiety in children and young people
Treatment options
What types of professionals are involved?
The recovery journey
How to support your child with social anxiety
Useful resources

What is social anxiety?

Social anxiety is when someone finds social situations to trigger anxiety. This can result in numerous symptoms and can come from beliefs about themselves or others.

Social anxiety can be mild, moderate, or severe. It may be that the child or young person is anxious in social situations but does not avoid them and can function well. However, issues arise when the child or young person starts to avoid social situations and feels unable to function when forced into them, risking social isolation.

Social anxiety in children and young people has always been common as it is a time of a lot of change socially where friendships can be built and broken very quickly. The COVID pandemic has increased the prevalence of social anxiety in children and young people, potentially due to a lack of socialising where important social development was missed.

Symptoms of social anxiety in children and young people

Social Anxiety can be mistaken for shyness, the main difference between the two is that social anxiety is a mental health difficulty and a type of phobia whereas shyness is a personality trait. Below are the symptoms of social anxiety highlighted in bold are the ones that usually occur in social anxiety and not shyness.

The symptoms of social anxiety include:

Physical

Feeling hot and sweating
Blushing
Heart racing
Feeling nauseous

Behavioural

Avoiding social situations
Preplanning conversations before they occur
Going back over conversations that have occurred looking for errors in the way they handled it
Going to the loo often in social situations
Not looking people in the eyes

Cognitive

A fear of being judged or embarrassed
Negative beliefs about themselves
Negative beliefs about how others will perceive them

“Katie has started to withdraw from social situations as she feels scared that other people are going to think that she is boring. She plans conversations in her head when she knows she is going to interact with other people and then will pick apart her response after the conversation. Katie’s parents have noticed that she feels sick before going to school and will avoid school activities as she says that people will think she is boring. As a result, Katie doesn’t have many friends. Katie’s parents decided it was time to contact a professional.”

Treatment

Medication

Medication is not routinely offered for children with social anxiety. The treatment approach that is outlined in the clinical guidelines for England is Cognitive Behavioural Therapy.

Cognitive Behavioural Therapy (CBT)

This is an effective type of talk therapy that focuses on learning tools and techniques to break down the cycle of social anxiety that can be completed in a group or individual setting.

You will start by learning to understand your triggers and different symptoms that are a part of social anxiety and how these symptoms can maintain your anxiety levels.

For example, you may discover that behaviours that you do to manage the anxiety (safety behaviours) actually worsen it. E.g. your behaviour of pre-planning the conversation may mean that you struggle to know what to do when the topic of conversation is unexpected making you more anxious.

Or you may discover an underlying belief about yourself that triggers the anxiety. If you believe that people find you to be boring so before social situations you will feel anxious about coming across as boring.

Once there is an understanding of how the anxiety is created and maintained, you will work to try and break the vicious cycle. This may involve techniques such as challenging specific thoughts and patterns and making positive behaviour changes.

This can feel tricky as these may have been beliefs and behaviours that you have done for years. However, your therapist will support you to slowly gain confidence in tackling them.

What types of mental health professionals are involved?

Different professionals may or may not be involved throughout the treatment process of social anxiety for children and young people. These might include cognitive behavioural therapists and doctors/psychiatrists, mental health nurses, support workers and social workers.

Cognitive Behavioural Therapists

These are therapists who have been trained in Cognitive Behavioural Therapy using this model to form an idea of a patient’s mental health difficulties and to treat them. When working with social anxiety the therapists would have been trained in how to help the child/young person manage their symptoms to improve wellbeing.

There are also doctors and psychiatrists that can be involved in the treatment of social anxiety for children and young people. There are more obvious differences between these two professional terms.

Doctors

These are professionals who are trained in medicine. This will likely be the family GP, they may provide signposting and referrals to appropriate services to help with social anxiety.

Psychiatrists

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. So they are able to provide consultation and medication for a wide range of mental disorders such as anxiety, social anxiety, schizophrenia, psychosis, bipolar disorder and so on.

Mental Health Nurses

Nurses trained in mental health might also be involved with the child or young person. If the child or young person is in a hospital setting or is seen by a crisis team due to self-harm or suicide, a mental health nurse might help to give treatment by administering medication.

Support Workers

‍Workers trained in helping vulnerable people to live better lives might also be involved with the child or young person. This might be within a community setting or a crisis. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, and making child-care arrangements).

Social Workers

Workers trained in protecting vulnerable individuals might also be involved with the child or young person. This might also be within a community or a crisis. Social workers will problem-solve and organise the right support for the child or the young person to ensure their protection.

The Recovery Journey

The journey of recovery from social anxiety can look different for each child or young person depending on the approach that the therapist uses. However, some things are expected when going through therapy for social anxiety.

Assessment

This is an important phase, where the therapist will get a feel of what is going on with the child or young person. The therapist might try to identify the severity of the social anxiety, along with other important background information. The therapist will ask some questions, including certain questions about the possibility of self-harm or suicide. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

These sessions will take place at a time and regularity that suits the child or young person and their parents. An important aspect of the therapy session is the relationship that the therapist will build with the child or young person. This will create a safe space that will encourage them to talk about their feelings. The child will be able to develop a better understanding of their feelings and learn helpful ways to tackle social anxiety.

Homework

This can be an important part of treatment for social anxiety when having CBT. This is because social anxiety affects everyday situations in the child or young person’s life. So, homework tasks will really help the child or young person to develop a sense of achievement and mastery over social anxiety. It is the best place to put the tools and techniques into practice.

Progress and setbacks

When having treatment for social anxiety, there will be progress and there may be setbacks. For example, because of the social anxiety itself, a child or a young person might find some of the tasks to be quite scary. It is important not to feel discouraged when this happens, as these types of setbacks can be quite normal when dealing with social anxiety. These situations provide opportunities to discover new ways to move forward together with the therapist.

Ending therapy

The therapist will eventually prepare the child, young person and parents for the end of therapy. This is a very important phase because the child or young person needs to become confident in coping with difficult feelings without relying too much on the professional. The end of therapy will take place once the child or young person has made a lot of progress or has completely recovered from social anxiety. The child or young person will leave therapy with many skills that they can use without the help of the therapist.

Follow up

There might be an agreement with the therapist to have a follow-up meeting. This is to check how the child or young person is coping. If they are doing well, there will be no need for more support. But if they continue to have challenges with social anxiety or any other issues, this will be an opportunity to have extra support.

How to support your child with social anxiety

Managing social anxiety can be very challenging but there are a few things that you can do to help support someone you care about manage their social anxiety

Understand social anxiety

Having a read about social anxiety is a great start, as it will give you some insight into what someone goes through when experiencing social anxiety. It can be very lonely to experience social anxiety and can cause withdrawal from people. Having someone who understands social anxiety and a safe space is crucial.

Show empathy

It can be very difficult when a loved one is incredibly anxious about something that you may not understand or feel frustrated by. For example, you may want your child to go out with people their age as you want them to have friends. However, try to be empathetic when your child is feeling anxious and not get frustrated. By showing kindness you can generate a supportive conversation encouraging your child to attend, perhaps using techniques they have learnt in therapy.

Support them with home practice

Home practice within therapy sessions can be quite daunting. It will involve placing your child in anxiety-provoking situations, therefore there may be some pushback as they may not want to do it. Support your loved one to engage in their home practice e.g. setting time aside to go through it with them and/or gentle reminders can be a great way to keep them on track and show your care.

If you notice your child is especially resistant to the home practice this may be worth raising with their therapist to brainstorm ways to overcome any barriers.

Take part in mindfulness with them

When someone is feeling anxious and overwhelmed at the moment, mindfulness is a great way to help with this. There are numerous types of mindfulness that you can do with each other.

One great technique is called rectangular breathing and helps when your child feels panicked at the moment. This is where you find a rectangular-shaped object e.g. a door or window. You follow the edges of the shape breathing in as you go along the short edge and breathing out as you go along the long edge.

Encourage them to do fun activities

Help them to do more uplifting activities. For example, you might put on a funny movie or take them out to their favourite activity. This will allow them to experience positive feelings that will refocus them from the anxiety to the present.

Monitor their activity levels

Encourage them to stay physically active within a healthy range. Exercise shows promising results in helping to manage symptoms of anxiety in children. In terms of social anxiety, it is also a great way to introduce the child to another peer group, as they may be so distracted by the sport that they are not as focused on their anxiety. This can be a fine balance though as some children may feel embarrassed about their sporting ability. If this is a goal your child wants to work up to, encourage them to tell their therapist so the sessions can incorporate this.

Help them find the right support

Encourage them to find support through a GP or therapist. If this involves your young child under the age of 16, you can contact these services, however, it is best to involve your child as much as possible within this process.

You might:

Help them search for a therapist, you can check registrations of private therapists here
Help them to book an appointment with a GP or therapist
Advocate for your child if they feel unable to do so within appointments

Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)

Encourage them to keep attending sessions and to not give up

‍

Know when to get urgent support

When your loved one is dealing with social anxiety, it is good to keep an eye out for signs of self-harm or suicide. Sometimes the frustration the child experiences and the hopelessness they feel about their anxiety can lead to self-harming behaviours and/or suicidal thoughts.

If you notice these symptoms you should contact a GP or the NHS urgent helpline.

Know what NOT to do

When a loved one is dealing with social anxiety, it is good to be mindful of the things we say and the way we react, as this can have a big impact.

For example, be mindful of:

Don’t reassure them too much

When someone is struggling with social anxiety it is a symptom that they will seek reassurance from people they consider to be safe e.g. not leaving your side when around other children. This will maintain the anxiety as they are depending on others for comfort rather than being able to self-soothe. Talk to their therapist or a professional about how is best to respond to this reassurance seeking as they may suggest helpful phrases that you and your loved one can agree on.

For example, “I can see you are feeling anxious about this now, shall we talk through the technique you spoke about in therapy?”

Don’t tell them to “They are just being silly”

This can make people feel very isolated when they are experiencing social anxiety. Children and young people experiencing social anxiety can also feel as if their anxiety is silly and can be very ashamed of it. If they could stop the anxiety then they would. If you feel as if you cannot understand what is causing them anxiety ask them to talk you through it. A good question to ask is:

What is your worst fear in this situation?

If your child has been able to identify thoughts about themselves that fuel the anxiety in the past you can check in if these are causing the anxiety.

For example, “I know sometimes you can feel like people will think you are boring, do you think that is what is scary about this?”

‍

Look after yourself too

You need to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too.

For urgent support

To get urgent help, you or your loved one should contact the NHS urgent helpline or the Samaritans.