Social anxiety: when other people's eyes take up all the room

You rehearse your sentence three times before making a phone call. You walk into a meeting with one thought in mind: do not blush. In the evening, you replay an ordinary conversation, looking for what you should have said. If this sounds familiar, you may be living with social anxiety, the fear of other people's judgement that ends up making decisions for you.

I am a sophrologist, hypnotherapist and wellbeing coach in Bordeaux. The people who tell me about it have often taken a long time to do so, because they have been told all their lives that they are just shy. Sometimes that is true. Sometimes it is not, and the difference matters, because it changes what can help you.

Here you will find some markers to tell the two apart, what keeps this fear going, three exercises to try, what research shows and when it is better to see a doctor.

Shyness or social anxiety: where the line falls

Being shy means taking a while to feel at ease. Social anxiety, also called social phobia, goes further. The NHS describes it as a lasting fear that affects everyday activities, self confidence, relationships and work or school life. You worry before, during and after.

The MSD Manual, a medical reference, gives more precise markers. The fear has been there for at least six months, concerns social situations, comes back almost every time in those same situations and centres on being judged by others. It pushes you to avoid, stays out of proportion to the actual danger and clearly gets in the way of daily life. Giving all this a medical name is a doctor's job, not mine.

The situations that come up most

The MSD Manual's list looks a lot like what I hear at my practice:

• speaking in public or reading a text in front of others;
• eating with people you hardly know;
• meeting strangers or holding a conversation;
• signing a document in front of a witness;
• using a public toilet.

Some people only struggle in one or two of these situations. Others struggle almost everywhere. When the fear centres on close exchanges, with a colleague or a new partner, people sometimes speak of relationship anxiety. It is not a medical term, but it captures what many people feel.

You are not alone in this

The figures vary from one survey to another. An analysis of 28 surveys from around the world, covering 142,405 people, puts this disorder at 2.4% of the population over a year and 4% over a lifetime. The MSD Manual gives higher ranges, 3 to 7% a year and 5 to 13% over a lifetime. Either way it is not rare, and it often starts early, during the teenage years according to the NHS.

What the fear does to your body and your mind

Your body reacts as if the danger were physical: racing heart, sweating, trembling, nausea. The NHS lists these signs, along with the panic attacks that can occur. What makes it so hard is that these reactions become the threat themselves. You are afraid people will see your hands shake, and that fear makes them shake more. I have written an article about emotional sweating, because this loop comes up so often.

In your head, there is a running commentary. "My voice sounds strange." "They saw me blush." Meanwhile you are no longer really listening to the person in front of you, and your answer misses the mark, which feeds the commentary. This doubt sometimes resembles feeling like an impostor, even though the two are not the same.

Why avoiding brings relief, then keeps the fear going

Cancelling an evening out feels good straight away. The relief is real, and that is exactly the problem: your body records that the danger was removed by running away. Next time, the alarm goes off sooner. The MSD Manual notes that avoidance can make anxiety worse, because you also miss out on the pleasant side of being with people. It also points out that some people turn to alcohol to get through, something to raise with your doctor if it becomes a habit.

A review in the Annual Review of Clinical Psychology looks at three mechanisms that keep the fear in place:

• attention fixed on yourself;
• what are called safety behaviours;
• going over it all afterwards.

In session, these safety behaviours take discreet forms: preparing your sentences in advance, keeping a glass in your hand, staying near the door, talking fast to get it over with. They reassure you in the moment. They also let you believe that things went well because of them, and never because of you. When I spot this with someone, we do not drop them all at once. We take away one, then another.

Three exercises to try, before, during and after

These exercises come from what I practise at my practice, and some overlap with NHS advice. Try them in easy situations first. You will not make nerves disappear, and that is not the aim: the aim is to be able to stay there in spite of them.

Before: settling your breath and your body

The NHS suggests a very simple breathing exercise, to practise every day rather than in an emergency.

1. Sit down with both feet flat on the floor.
2. Breathe in gently through your nose, counting to 5 if that feels comfortable.
3. Breathe out gently through your mouth, counting the same way.
4. Carry on for at least five minutes, without forcing it.

I often add a quick tour of the body: forehead, jaw, shoulders, belly. Let go of what you can, without trying to relax everything. You will find other ideas in my article on managing stress and emotions.

During: bringing your attention back outside

When the inner commentary starts up, ask yourself a question about the other person: what did they just say, exactly? What colour is their jumper? The NHS also advises focusing on what people are saying rather than assuming the worst. Feel your feet in your shoes too, it is discreet and nobody notices. Your mind will wander and you will come back. That is the practice.

After: cutting the evening replay short

In the evening, the film plays again. Take a notebook and write down, in five minutes at most:

• what happened, sticking to observable facts;
• what you had predicted;
• what actually occurred.

The NHS suggests this kind of diary to better understand what goes on in you. Then close the notebook. Over time, the gap between prediction and reality becomes your best argument. You can also break a difficult situation down into small steps: saying hello, asking a question, staying ten minutes longer.

What research says about what helps

I would rather be clear: what has been studied most is not what I practise. A meta-analysis of 92 studies shows that the six main approaches it compared all do better than simply waiting, and that cognitive behavioural therapy (CBT) is generally the most effective. Internet-based versions of these therapies seem to give results comparable to face-to-face work. The NHS also considers CBT the best option. The MSD Manual adds gradual exposure and, sometimes, medication, which is a decision for your doctor.

On mindfulness, which is close to some sophrology exercises without being the same thing, an analysis of 11 randomised trials found it better than no support at all but less effective than CBT. On hypnosis, a meta-analysis of 15 studies on anxiety in general, not social anxiety in particular, shows a favourable effect, stronger when it is combined with other approaches. I have not found a solid trial on sophrology for social anxiety.

What I can offer, knowing my place

In sophrology, you learn to notice tension as it begins and to let it go, then we prepare the situations you dread by picturing them in a calm state. That meeting, that meal, that phone call. With hypnosis, only at my practice, we approach these scenes in a relaxed state, at your pace. I see this work as a complement: it can help you dare to take the steps that CBT asks of you.

My own path taught me one thing: you can hold on for a long time by gritting your teeth, in start-ups as elsewhere, right up to burnout. So I will not ask you to force yourself. We move forward in small steps.

When to talk to a doctor, and how to begin

Sophrology and hypnosis do not replace medical advice. Make an appointment with your doctor if:

• the fear makes you give up a job, your studies or relationships;
• you have panic attacks;
• you drink or take substances to get through social situations;
• you have been feeling low for several weeks.

If dark thoughts appear, do not wait. In France, call 3114, the national suicide prevention line, or 15 in an emergency. Your doctor can refer you to a professional trained in CBT. If you are already having treatment, never change it without their advice. I work alongside your doctor, never instead.

To begin today, pick one easy situation in your week and write down what you expect, then what happened. If you would like support, you can book a sophrology session for adults, at my practice in Bordeaux or by video call, which sometimes helps when even leaving the house takes a lot. Because this fear often starts early, I also work with teenagers. My prices are online.