Social Anxiety Disorder

People with social anxiety commonly experience:

Emotional and Cognitive Symptoms

• Intense worry about everyday social activities (meeting new people, speaking, eating in front of others)¹
• Fear of criticism, humiliation or embarrassing oneself
• A sense of being watched or judged constantly
• Replaying or over-analysing social situations afterwards³
• Low self-esteem or feelings of inadequacy

Physical Symptoms

• Trembling, sweating, nausea, diarrhoea
• Rapid or pounding heartbeat
• Dizziness, blushing or muscle tension
• Feeling sick or having panic attacks lasting a few minutes²⁴

Many individuals also experience co-existing conditions such as depression, generalised anxiety disorder or substance use challenges⁵.

Seek help if your anxiety:

• Interferes with daily life, school or work
• Causes you to avoid social or performance situations
• Leads to distress, isolation, panic attacks or low confidence
• Feels unmanageable

A GP, clinical psychologist or psychiatrist can make a diagnosis by assessing your symptoms and their impact over the past 6 months (DSM-5 criteria)⁶. In South Africa, support can also be accessed through SADAG, primary healthcare clinics, or private practitioners.

There is no single cause, but several factors increase vulnerability:

• Genetic factors – anxiety disorders run in families³
• Temperament – children who are very shy or inhibited are at higher risk⁶
• Environmental factors – bullying, critical parenting, trauma or social rejection²³
• Brain and biological factors – altered serotonin pathways and heightened fear response centres⁷

Self-help strategies are often a helpful first step:

1. Understand Your Anxiety

Writing down social situations that trigger fear can help you recognise patterns and challenge unhelpful thoughts¹.

2. Gradual Exposure

Break intimidating situations into smaller, manageable steps. Start with small challenges and work slowly upwards (CBT-based approach)³.

3. Relaxation Techniques

Breathing exercises, grounding techniques and progressive muscle relaxation help reduce physical symptoms⁴.

4. Focus Outward

Instead of focusing on how you appear, focus on the conversation or task.

5. Healthy Lifestyle

Regular activity, sleep consistency, hydration and reduced caffeine can help regulate stress responses⁸.

1. Cognitive Behavioural Therapy (CBT)

CBT is the first-line treatment and most effective therapy for social anxiety³⁶.
A trained therapist helps you:

• Identify and challenge negative thoughts
• Reduce avoidance and safety behaviours
• Practise exposure to feared situations
• Build confidence through structured coping skills

In South Africa, CBT is offered by clinical psychologists and specialised counsellors in both private and public sectors.

2. Guided Self-Help

A CBT-based workbook or online programme with therapist support can help when therapy access is limited¹.

3. Medication

If symptoms are severe or therapy alone is insufficient, medication may help. The most common medicines are SSRIs such as sertraline or escitalopram⁷.
Medication is typically considered for adults; children usually receive therapy first.

Medication should always be prescribed and monitored by a healthcare professional.

4. Support Groups

Connecting with others who share similar challenges can reduce isolation and support recovery.
In South Africa, SADAG runs free support groups nationwide.

Children may show:

• Excessive clinging
• Tantrums, crying or irritability
• Avoiding school or group interactions
• Difficulty asking for help
• Fear of classroom participation

Treatment usually involves CBT adapted for children, family involvement and supportive school strategies. Medication is rarely used in young children.

With appropriate treatment, most people experience significant improvement. Helpful long-term habits include:

• Challenging avoidance patterns
• Setting small, achievable goals
• Maintaining healthy routines (sleep, diet, exercise)⁸
• Limiting alcohol and avoiding drugs (which may temporarily reduce anxiety but worsen long-term symptoms)⁵
• Practising mindfulness or meditation techniques

Staying connected with supportive people

While diet alone cannot cure social anxiety, certain nutritional habits support emotional wellbeing:

Helpful Choices

• Foods rich in omega-3 fatty acids (sardines, salmon, flaxseed) – support brain health⁸
• Complex carbohydrates (whole grains, oats, legumes) – stabilise energy and mood
• Fresh fruits and vegetables – rich in antioxidants and B-vitamins
• Hydration – reduces tension and fatigue

Limit

• Caffeine (coffee, energy drinks) – can trigger palpitations and worsen anxiety symptoms⁸
• High sugar snacks – cause energy dips
• Alcohol – may temporarily ease anxiety but significantly worsens long-term symptoms⁵

• SADAG (South African Depression and Anxiety Group)
  Helpline: 0800 567 567 / SMS 31393
• Psychiatry Management Group (PsychMG) — directory of registered psychiatrists
• South African Society of Psychiatrists (SASOP)
• Your GP or local clinic
• Private clinical psychologists (HPCSA-registered)

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.