How to treat social anxiety: CBT built for social anxiety works best. Learn to drop safety behaviors, build an exposure ladder, and when SSRIs help.
The best-supported way to treat social anxiety is cognitive behavioral therapy built specifically for social anxiety, which teaches you to shift attention outward, drop the "safety behaviors" that keep fear alive, and test your predictions in real situations. Medication (an SSRI) is an option if you prefer it. You can start on your own tonight with a small exposure ladder.
The short answer
Social anxiety is more than shyness: it is a persistent fear of being judged or embarrassed that makes you avoid things and gets in the way of work, school or relationships. The NHS describes it as a fear that does not go away and affects everyday activities, self-confidence and relationships.
Shyness tends to fade once you warm up. Social anxiety usually doesn't: you might dread a phone call for days or leave a party early, sure everyone saw you blush. NIMH notes that the fear often feels uncontrollable and that the condition usually starts in childhood or adolescence.
It is also common. An estimated 7.1% of US adults had social anxiety disorder in the past year, and about 12.1% will have it at some point. Yet, according to the NICE guideline summary in the BMJ, only about half of people with it seek treatment, many after waiting 10 to 15 years. Many assume it is just their personality. It isn't fixed, and it responds well to treatment.
The best first treatment for adults is individual cognitive behavioral therapy developed specifically for social anxiety. The UK's NICE guideline CG159 recommends individual CBT "specifically developed to treat social anxiety disorder," based on the Clark and Wells model or the Heimberg model. A Clark and Wells course runs up to 14 sessions of 90 minutes over about four months.
That recommendation rests on a large network meta-analysis of 101 trials with more than 13,000 participants. Individual CBT had the largest effect of the talking therapies and outperformed psychological placebo, psychodynamic therapy, mindfulness and supportive therapy. The authors called it the best initial treatment, with SSRIs having the most consistent evidence for people who decline therapy.
In a randomized trial of cognitive therapy for social anxiety, 84% of people no longer met criteria for the disorder after treatment, compared with 0% on the waitlist, and its advantage over the comparison treatment held at one-year follow-up.
Here is how the main treatments for social anxiety compare, from the strongest evidence down. Most adults do best starting with individual CBT built for social anxiety. If that isn't available or isn't right for you, supported self-help or an SSRI are reasonable next choices, and you can combine them later.
| Option | What it is | How well it works | How to access |
|---|---|---|---|
| Individual CBT for social anxiety | Up to 14 sessions with a therapist, using the Clark and Wells (or Heimberg) model | Strongest evidence; first-line per NICE | Therapist trained in CBT for social anxiety; NHS Talking Therapies (self-referral in England) |
| Internet-delivered cognitive therapy | The same treatment through online modules with remote therapist support | As effective as face-to-face therapy on the main outcome in a 2023 trial, with less than half the therapist time | Offered by some services; ask your provider |
| Supported self-help | A CBT-based self-help book or program with brief check-ins from a professional | Better than waiting; second-line per NICE | GP, talking therapies service, or a therapist offering guided sessions |
| Self-help on your own | CBT-based book or program, no support | Better than waiting, somewhat smaller effect than supported self-help | Books and programs based on CBT |
| SSRI medication | Daily antidepressant, usually escitalopram or sertraline | Helps many people; the Cochrane review rates the evidence as very low to moderate quality | Prescribed by a doctor |
| Short-term psychodynamic therapy | Insight-focused therapy adapted for social anxiety | Works, but less well than CBT; third-line per NICE | Psychodynamic therapist |
CBT for social anxiety works by breaking the loop that keeps the fear going: turning your attention inward, protecting yourself with safety behaviors, and replaying the event afterward. NICE lists the components: education about social anxiety, experiments on self-focused attention and safety behaviors, video feedback, training in outward-focused attention, behavioral experiments, work on painful social memories and core beliefs, changing the before-and-after rumination, and relapse prevention.
When you are socially anxious, your attention swings inward. You monitor your face, your voice, your hands, and use those feelings to guess how you look. The researchers behind this treatment describe how people use these feelings to judge how they appear. If you feel hot, you assume you look bright red. The fix is practice in focusing outward, on the other person's words and expression, which gives you better information and leaves less room for inner commentary.
Safety behaviors are the small things you do to stop a feared outcome: rehearsing sentences, avoiding eye contact, gripping a drink so your hands don't shake, asking lots of questions so you don't have to talk about yourself.
They backfire in two ways: they keep your attention on yourself, and when nothing bad happens, you credit the safety behavior instead of learning the situation was safe. An experimental study found that using safety behaviors and self-focus was unhelpful in several ways, supporting the value of dropping them. In therapy, people often hold a conversation twice, once with their usual safety behaviors and once without, and the experiment tends to show them how much those habits were feeding the anxiety.
A behavioral experiment is a planned test of a specific fear. Instead of "I'll be awkward," you write "If I pause mid-sentence, the other person will look away or laugh," then go and find out. Graded exposure means arranging these tests from easier to harder. NIMH describes exposure as progressively confronting the fears behind an anxiety disorder. Some experiments deliberately show the feared sign, such as letting a pause sit, to test how much people really notice.
Video feedback means recording a conversation, predicting how anxious you'll look, then watching it as if watching a stranger. In one clinic's data, 98% of patients said they came across better than they had predicted, and their social anxiety dropped over the following week.
You can try a version with your phone: record a two-minute talk, rate beforehand how nervous you'll look from 0 to 100, then watch, judging only by what you see and hear. It works best with a therapist, who can stop you hunting for flaws.
The post-mortem is the replay after a social event, when you go over every pause and awkward moment. Psychologists call it post-event processing: repeatedly reviewing and reconstructing how you performed, which tends to make the memory more negative than the event was. It can also start before an event. CBT treats it as a habit to interrupt: when you catch yourself replaying, name it ("this is the post-mortem"), write down the facts of what happened in two lines, and move your attention to something absorbing.
You can't switch social anxiety off on command, but you can stop feeding it: put your attention on the other person, drop one safety behavior, and stay in the situation instead of leaving. Staying is what teaches you the situation is survivable.
Try this in your next conversation:
A note on breathing. Slow breathing before an event (say, in for 4 and out for 6) can take the edge off, and the NHS lists breathing exercises among self-help steps. The nuance is how you use it. Breathing beforehand and then engaging is fine. If you believe "I only got through because I did my breathing," or you count breaths mid-conversation so nobody notices you're anxious, it has become a safety behavior. Researchers disagree on how harmful safety behaviors are during exposure, and some argue for judicious use early on. A sensible middle path: breathe as a warm-up, then test later ladder steps without it.
To overcome social anxiety, list feared situations from easiest to hardest, rate each 0 to 100 for expected anxiety, then climb one rung at a time without your safety behaviors. The NHS likewise suggests breaking hard situations into smaller steps.
This one is for someone who fears being judged in conversation. Yours will differ.
A simple before-and-after record is one of the most useful self-monitoring tools for social anxiety. Before a step, write your feared prediction in observable terms and how strongly you believe it (0 to 100%), plus the safety behaviors you'll drop. Afterward, record what actually happened, facts only, as a camera would, and re-rate your belief.
A filled-in example:
| Situation | Prediction | Belief before | What happened | Belief now |
|---|---|---|---|---|
| Ask a question in the Tuesday team meeting | My voice will shake, people will exchange looks, and my manager will think I'm not competent | 80% | Voice was a little unsteady for the first few words. Two people nodded. My manager answered and said it was a good point | 25% |
Fill in "what happened" soon after, before the post-mortem rewrites the memory.
Yes, many people make real progress on their own using CBT-based self-help, though it tends to work somewhat better with a professional checking in. In the network meta-analysis behind the NICE guideline, both supported and unsupported self-help outperformed waiting, with supported self-help showing the larger effect.
NICE offers supported self-help to adults who don't want individual CBT: typically up to nine sessions with a CBT-based book over three to four months, with about three hours of professional support in total. If you go it alone, choose material based on CBT for social anxiety and do the exposure work rather than only reading about it. If you're still avoiding important parts of life after a couple of months, bring in a professional.
Yes, SSRIs help many people with social anxiety and are the recommended medication for those who prefer one. NICE suggests escitalopram or sertraline, with careful monitoring for side effects.
A Cochrane review of 66 trials found SSRIs improved treatment response compared with placebo and were the only medicines with evidence for reducing relapse, though the reviewers rated the evidence quality as very low to moderate. More people stopped SSRIs than placebo, though absolute dropout rates were low.
Antidepressants may take several weeks to start working. If symptoms have only partly improved after 10 to 12 weeks on an SSRI, NICE recommends adding individual CBT. NIMH also notes that beta-blockers are sometimes used for physical symptoms in performance situations like public speaking. Any medication decision, including stopping, is one to make with your doctor.
With structured CBT, many people see meaningful change within about three to four months, which is the length of the standard course of up to 14 sessions. Change can start earlier: in one clinic's data, social anxiety dropped in the week after the video feedback session, which usually comes third.
Supported self-help runs a similar three to four months, and medication needs several weeks. Untreated, it tends to last: the network meta-analysis authors describe it as chronic and naturally unremitting.
Many people recover fully, in the sense that they no longer meet the criteria for the disorder. In the cognitive therapy trial mentioned earlier, that was 84% of participants, and the results held at one-year follow-up.
Recovery doesn't mean never feeling nervous before a big presentation. It means the nerves stop running your choices. That's why treatment ends with relapse prevention: a short list of what helped, ready if old patterns creep back.
Get professional help if social anxiety is stopping you from working, studying, making friends or doing everyday things, or if self-help hasn't shifted it. A GP or primary care doctor is a good first stop. In England you can refer yourself to NHS Talking Therapies without seeing a GP.
Also seek help if you're drinking to get through social situations or low mood is creeping in. Social anxiety often coexists with depression and other anxiety problems. If that sounds familiar, our guides on treating depression and treating anxiety more broadly may help.
It's fine to say that coming in or calling is hard for you. NICE asks services to make this easier, for example by offering a private place to wait.
Self-monitoring is a core part of CBT: writing down what you did, what you predicted and how you felt turns vague impressions into evidence you can act on. Clinicians describe it as improving self-awareness and guiding what to work on next. It matters even more with social anxiety, because the post-mortem distorts memory. Our piece on why mood tracking works goes deeper.
Moodflow is not a treatment, but a few of its features fit this work well:
Your entries stay on your phone. You can try Moodflow free on iPhone, Apple Watch and Android at moodflow.co.
If you're thinking about harming yourself or feel you can't stay safe, please reach out now. In the US, call or text 988 to reach the 988 Suicide & Crisis Lifeline, any time. In the UK and Ireland, call Samaritans free on 116 123, day or night. Elsewhere, findahelpline.com lists free helplines by country. If you're in immediate danger, call your local emergency number.
Build a small exposure ladder of feared situations rated 0 to 100 and start around 30 to 40. Drop one safety behavior each time, and record your prediction and what actually happened. A CBT-based self-help book adds structure.
No. Shyness is a temperament that usually eases once you settle in. Social anxiety disorder is a persistent fear of judgment that leads to avoidance and interferes with work, school or relationships.
Yes, for many people. NICE suggests escitalopram or sertraline for adults who choose medication, and a Cochrane review found SSRIs beat placebo for response and relapse. They take several weeks to work; discuss benefits and side effects with your doctor.
A standard course of CBT for social anxiety runs about three to four months, and some changes can show up within the first few sessions. Lasting progress depends on keeping up the experiments and exposure after treatment ends.
Many people recover to the point where they no longer meet criteria for the disorder; in one cognitive therapy trial, 84% did. Some nervousness in high-stakes moments is normal and doesn't mean treatment failed.
Slow breathing before an event is a reasonable warm-up. If you rely on it during conversations to hide anxiety, it works like a safety behavior, so try later ladder steps without it.
How we wrote this: the Moodflow team built this guide from clinical guidelines (NICE, NHS, NIMH, WHO) and the peer-reviewed studies listed below, and links each claim to its source. Last reviewed November 2026. It is general information and isn't a substitute for advice from a doctor or mental health professional.
Sources
Mental Health Advocates
The Moodflow product, research, and clinical advisory group sharing evidence-based insights on emotional wellness.
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