Social Anxiety

Social anxiety is fear of scrutiny - of being watched, judged, or seen to be anxious - in conversations, meetings, performance or eating in front of others. Physical symptoms are part of what maintains it: blushing, sweating, trembling hands and a racing heart become the very things the person fears others will notice, which raises anxiety further. Avoidance provides short-term relief and reinforces the cycle, which is why treatment focuses on gradual, structured exposure alongside challenging predictions about what others think. Cognitive behavioural therapy has the strongest evidence and produces durable change; SSRIs are effective for moderate to severe presentations, and beta-blockers are sometimes used for discrete performance situations where tremor and palpitations dominate. On supplements, the picture is modest: l-theanine at 200-400 mg/day reduces subjective stress in small trials, ashwagandha extracts at roughly 300-600 mg/day have shown reductions in anxiety scales over 8 weeks, and magnesium helps mainly where intake is low. None has been compared head-to-head with therapy, and none addresses the avoidance pattern that keeps social anxiety going. Shyness that does not restrict life is not a disorder; the threshold is interference with work, study or relationships.

• •Intense fear of being judged or embarrassed
• •Blushing, trembling or sweating in social settings
• •Avoiding speaking up or meeting new people
• •Rehearsing conversations in advance
• •Replaying interactions critically afterwards
• •Nausea before social events

• •Behavioural inhibition and genetic predisposition
• •Self-focused attention
• •Safety behaviours
• •Bullying or humiliating experiences
• •Parental modelling
• •Comorbid depression or alcohol use

Behaviourally inhibited temperament with genetic loading, self-focused attention and negatively distorted self-imagery, safety behaviours preventing disconfirmation, adverse peer experiences including bullying, parental modelling of social threat, and amygdala hyperreactivity to social evaluative cues.