Social Anxiety Reduction

Social anxiety disorder involves persistent fear of scrutiny and negative evaluation, maintained by avoidance, safety behaviours and post-event rumination. Cognitive behavioural therapy with graded exposure has the strongest evidence base, with SSRIs as effective pharmacological treatment. Anxiolytic supplements are attractive precisely because they reduce the discomfort that exposure therapy requires you to experience, which can entrench the disorder. Alcohol self-medication is common and strongly predicts worsening. Impairment in work, education or relationships warrants professional treatment.

1) Pursue exposure-based CBT, the treatment with the strongest and most durable evidence. 2) Practise graded exposure deliberately rather than avoiding, and drop safety behaviours such as scripting or phone-checking. 3) Cut caffeine, which mimics and amplifies the physical arousal that fuels social fear. 4) Avoid alcohol as a coping tool, since it reliably worsens anxiety over time. 5) Exercise regularly, with meaningful anxiolytic effects across trials. 6) Prioritise sleep, as deprivation sharply increases threat sensitivity. 7) Practise mindfulness to reduce post-event rumination. 8) Use situational supplements cautiously and never as a substitute for exposure practice.

• •Exposure-based CBT
• •Dropping safety behaviours
• •Caffeine reduction
• •Avoiding alcohol coping
• •Regular exercise
• •Sleep sufficiency
• •Mindfulness for rumination