What is Social Anxiety?

Some of it yells. Some whispers. Some hide behind a to-do list or a tight chest. But whatever form it takes, anxiety disconnects relationships and prevents people from living life to the fullest. Although Social anxiety disorder affects 12.1% of U.S. adults at some point in their lives, few people understand this common condition.

But here's the good news: with specialized treatment, you can transform your relationship with social situations and start living the connected life you deserve. 

What Is Social Anxiety and How Does It Affect Your Life? 

Beyond Shyness: Understanding Social Anxiety 

Social anxiety disorder, also called social phobia, involves intense fear of social situations where you might be judged, embarrassed, or humiliated.

Unlike normal nervousness before a big presentation, social anxiety is persistent, overwhelming, and interferes with daily life. 

Clinical definition: According to recent research, social anxiety disorder is characterized by marked fear or anxiety about one or more social situations lasting six months or more.

The fear is disproportionate to the actual threat posed by the social situation. 

Spectrum of severity: Social anxiety exists on a continuum: 

• Mild: Discomfort in specific situations but able to push through 

• Moderate: Avoiding some situations, significant distress in others 

• Severe: Extensive avoidance impacting work, school, and relationships 

Physical symptoms include: 

• Blushing, sweating, or trembling 

• Rapid heartbeat 

• Nausea or upset stomach 

• Muscle tension 

• Difficulty making eye contact 

• Mind going blank 

• Speaking very softly or mumbling 

Cognitive symptoms involve: 

• Intense fear of judgment 

• Negative self-talk ("Everyone thinks I'm stupid") 

• Overthinking past interactions 

• Catastrophizing future social situations 

• Believing others can see your anxiety 

Common Social Anxiety Triggers 

Understanding your specific triggers helps target treatment: 

Performance situations: 

• Public speaking or presentations 

• Job interviews 

• Being called on in class 

• Performing music or sports with audience 

Interpersonal interactions: 

• Meeting new people 

• Dating and romantic situations 

• Small talk at parties 

• One-on-one conversations 

• Phone calls or video chats 

Authority figures: 

• Speaking to bosses or supervisors 

• Interacting with professors 

• Dealing with doctors or other professionals 

• Asking for help or clarification 

Dating and intimacy: 

• Initiating romantic interest 

• Physical intimacy 

• Emotional vulnerability 

• Fear of rejection 

Group settings: 

• Parties or social gatherings 

• Work meetings 

• Classroom discussions 

• Eating in front of others 

The Hidden Cost of Social Anxiety 

Social anxiety's impact extends far beyond momentary discomfort: 

Career limitations: Studies show people with social anxiety earn 10% less on average and are more likely to be unemployed or underemployed⁹. Promotions requiring presentations or leadership roles feel impossible. 

Relationship challenges: Difficulty forming friendships, romantic relationships suffering from lack of communication, and isolation leading to loneliness and secondary depression. 

Academic impact: Class participation grades suffer, group projects become nightmares, and many drop out rather than face presentation requirements. 

Quality of life reduction: Missing out on life's joys—weddings, parties, travel, new experiences—all sacrificed to avoid anxiety. 

Secondary depression: Up to 70% of people with social anxiety develop depression, often from the isolation and missed opportunities. 

Specialized Therapy Approaches for Social Anxiety 

Cognitive Behavioral Therapy Adaptations 

CBT for social anxiety includes specific modifications targeting social fears: 

Thought challenging specific to social fears: We identify and challenge thoughts like: 

• "Everyone will notice I'm nervous" (mind reading) 

• "If I blush, people will think I'm weird" (catastrophizing) 

• "I made one mistake, so everyone thinks I'm incompetent" (all-or-nothing thinking) 

Attention training: Social anxiety involves excessive self-focused attention. We teach techniques to shift attention outward, reducing self-consciousness and improving social performance. 

Post-event processing: Breaking the habit of endless rumination after social interactions. We help you evaluate situations realistically rather than through an anxiety-distorted lens. 

Video feedback techniques: Recording practice conversations or presentations, then reviewing them together. Patients consistently discover they appear much less anxious than they felt. 

Exposure Therapy for Social Situations 

Gradual, systematic exposure remains the most powerful treatment component: 

Hierarchy development: Creating a personalized list from least to most anxiety-provoking: 

• Saying hello to cashier (easier) 

• Asking stranger for directions 

• Making small talk with coworker 

• Attending social gathering 

• Giving presentation (harder) 

In-session exposures: Role-playing social situations in therapy provides safe practice with immediate feedback and coaching. 

Real-world practice: Homework assignments to practice skills in actual situations, starting small and building confidence. 

Virtual reality options: Our VR system allows exposure to crowds, presentations, and social situations in a controlled environment. 

Cognitive Behavioral Group Therapy (CBGT) 

Group therapy offers unique benefits for social anxiety: 

Benefits of group format: 

• Real-time practice with peers who understand 

• Multiple perspectives on social situations 

• Normalizing the experience of social anxiety 

• Built-in exposure to group social situations 

Peer support: Discovering others share your fears reduces shame and isolation. 

Real-time practice: Conversations, presentations, and assertiveness exercises with supportive feedback. 

Normalized experience: Seeing others' progress inspires hope and motivation. 

How Social Prescribing Can Help Social Anxiety

Social prescribing can be a powerful tool for managing social anxiety by gently reconnecting people with their communities in low-pressure, supportive ways. Instead of relying solely on medication or therapy, social prescribing links individuals to non-clinical activities like art classes, support groups, volunteering, or walking clubs that help build confidence, reduce isolation, and create meaningful social connections. For someone with social anxiety, this kind of structured, purpose-driven engagement can feel less intimidating than traditional social settings, offering a safe path to rebuild trust in themselves and others, one small step at a time.

Virtual Therapy: A Comfortable Start for Social Anxiety 

Advantages of Starting Online 

For many with social anxiety, walking into a therapist's office feels overwhelming. Telehealth provides a gentler entry: 

1. Reduced initial anxiety: Starting from your safe space at home removes transportation stress and waiting room anxiety. 
2. Home comfort zone: Familiar surroundings help you feel more in control and less vulnerable. 
3. Gradual exposure: Begin with camera off if needed, progressing to video as comfort grows. 
4. Camera on/off flexibility: We meet you where you are—no pressure to show your face until you're ready. 
5. Building to In-Person Sessions 
6. Virtual therapy can be a stepping stone: 
7. Transitioning when ready: Many patients start online then add in-person sessions as confidence builds. 
8. Hybrid approaches: Alternating between virtual and in-person based on anxiety levels and session content. 
9. Using virtual as practice: Online sessions become rehearsal for real-world interactions. 
10. Maintaining progress: Option to return to virtual during challenging periods without losing momentum. 
11. Online Group Therapy Options 

Local Resources and Support 

Denver Resources 

• Denver Social Anxiety Meetup: Practice groups meeting weekly 

• Toastmasters Downtown Denver: Public speaking practice in supportive environment 

• Denver Public Library: Quiet spaces for gradual social exposure 

Boulder Resources 

• CU Boulder Social Anxiety Research: Cutting-edge treatment studies 

• Boulder Shambhala Center: Meditation classes for anxiety 

• Boulder Creek Path: Walking meetings for exposure practice 

Westminster Resources 

• Westminster Recreation Center: Classes and activities for gradual social exposure 

• Front Range Community College: Continuing education with disability services 
• Butterfly Pavilion: Peaceful environment for social practice

Social anxiety may have kept you on the sidelines of your own life, but that chapter can end today.

At Axis Integrated Mental Health, we've witnessed countless transformations from people who couldn't make phone calls to those now thriving in leadership roles, from individuals who ate lunch alone to those enjoying rich friendships, from students dropping classes to graduates giving valedictorian speeches. 

Frequently Asked Questions

1. Is online therapy effective for social anxiety? 
2. How do I know if I have social anxiety or if I'm just shy? 
3. Can social anxiety therapy help with work presentations?  
4. Will I have to do group therapy if I have social anxiety? 
5. How long before I see improvement in social situations?