Social Anxiety: When Being Around Others Causes Distress

Social anxiety disorder is one of the most common mental health problems. It affects an estimated 5–10 percent of the population at some stage of life. Yet it is often poorly understood and recognized. Many struggle alone for years before seeking help.

What Is Social Anxiety?

Social anxiety is intense and persistent fear of situations where one might be judged by others. It is not the same as shyness or introversion. Shyness is a personality trait that does not necessarily cause suffering. Social anxiety is a disorder that significantly limits life and causes intense distress.

Frightening situations may include:

• Speaking in groups or giving presentations
• Meeting new people
• Talking on the phone
• Eating or drinking in front of others
• Shopping in stores
• Work or school situations
• Parties and social events

Symptoms of Social Anxiety

Social anxiety manifests on multiple levels:

Physical symptoms:

• Blushing, sweating, trembling
• Rapid heartbeat, shortness of breath
• Nausea, stomach problems
• Voice trembling
• Dizziness

Psychological symptoms:

• Fear of embarrassment or being humiliated
• Fear that others will notice the anxiety
• Advance worry about upcoming situations
• Post-event analysis and self-criticism
• Difficulty concentrating in social situations

Behavioral changes:

• Avoidance of situations
• Safety behaviors (avoiding eye contact, staying quiet, using alcohol)
• Social isolation
• Difficulty advancing in career or studies

Why Does Social Anxiety Develop?

Social anxiety typically has multiple underlying factors:

Genetics: A genetic predisposition to anxiety can be inherited. If there are anxiety disorders in the family, the risk is higher.

Early experiences: Bullying, humiliation, rejection, or overprotective parents can predispose to social anxiety.

Learning: Social anxiety can strengthen through an avoidance cycle: avoidance brings short-term relief but reinforces fear in the long term.

Beliefs: Negative beliefs about oneself ("I am boring," "I always say something stupid") and social situations ("everyone judges me") maintain the anxiety.

Treatment of Social Anxiety

Cognitive Behavioral Therapy (CBT): The most effective evidence-based treatment. In CBT:

• Anxiety-maintaining thoughts and beliefs are identified
• Negative interpretations are challenged
• Gradual exposure to feared situations in a safe environment
• Learning to abandon safety behaviors
• Practicing social skills when needed

Medication: SSRI medications (selective serotonin reuptake inhibitors) can be an effective addition to therapy, especially in more severe cases.

Group therapy: Especially beneficial for social anxiety, as the group provides a safe practice environment.

Self-Help Strategies

Alongside therapy, you can try:

• Gradual exposure: Start with small steps. If phone calls are frightening, start with a short call to someone familiar.
• Breathing exercises: 4-7-8 technique: breathe in for 4 seconds, hold for 7 seconds, breathe out for 8 seconds.
• Mindfulness: Awareness skills help stay in the present moment instead of getting caught in fearful thoughts.
• Increasing exercise: Regular exercise significantly reduces anxiety.
• Reducing alcohol: Although alcohol may seem to ease tension momentarily, it worsens anxiety in the long run.

Therapy Costs and Availability

A therapy session typically costs 80–120 euros.

Kela and rehabilitative psychotherapy

Kela's rehabilitative psychotherapy is available to people aged 16 to 67 whose ability to work or study is threatened by a mental health disorder. You must have been in appropriate care for at least 3 months, and a psychiatrist must have written you a B statement (B-lausunto). Kela covers up to 80 sessions per year and up to 200 sessions over three years. The reimbursement for individual therapy is 57.60 euros per session, and you pay the rest yourself. The therapist must be a Kela-approved provider, so check the therapist's eligibility in advance. Current conditions and reimbursement amounts are at kela.fi.

Social anxiety does not define you. It is a treatable disorder, and the vast majority of people who receive treatment experience significant relief. You deserve to live a life that fear does not limit.

Where to find a therapist

You can look for a therapist in several places:

• Search services run by the Finnish Psychological Association (Psykologiliitto) and professional bodies.
• Kela's service provider search, if you are applying for rehabilitative psychotherapy (only Kela-approved therapists qualify for reimbursement).
• The Valitse Terapia service and other directories.
• Your own health centre, occupational health service or student health service (YTHS), which can refer you onward.

You can contact several therapists and see with whom the collaboration feels natural.

Sources

• Current Care Guidelines: Anxiety disorders
• Mielenterveystalo: Self-help programmes
• Kela: Rehabilitative psychotherapy