Social Anxiety
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Social anxiety is one of the most common mental health problems and affects approximately 7-13% of people but why do we get so stressed when we are in crowds or at large events? There are several causes listed below:-​
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Genetic and Biological factors – having an overactive amygdala, the region of the brain that controls fear responses.
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Temperament – Children who are shy or restrained when facing new situations or people are at higher risk of developing social anxiety later on in life.
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Environment and Life Experience – Negative social experiences like bullying, rejection or humiliation can trigger or worsen social anxiety. Growing up with overly critical, controlling or overprotective parents may increase vulnerability. Observing and living with (socially) anxious behaviour in parents or caregivers can also teach children to view social situations as threatening.
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Learned behaviours – can perpetuate the disorder. Avoiding social situations provides short-term relief but reinforces anxiety long-term, creating a cycle that’s difficult to break.
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What causes Social Anxiety?
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Therapy can help by talking about our fears and looking at them in a non-judgemental way. Learning what drives our social anxiety and looking at patterns and triggers can help us understand the underlying causes and give us clues as to how to predict, plan, measure and work with our anxiety.
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Emotional Regulation
We have all heard about fight or flight, which is our nervous system's response to danger. Our body fills with hormones building our strength and energy to run or fight. What also happens is the logical part of our brain is switched off meaning we are unable to think, plan or have access to the systems that help us remain calm and focused.
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Emotional Regulation is the first part of the therapy process, understanding what happens when we get anxious (or dysregulated) and looking at ways to help the system get back to a normal, calm state. Therapy can help co-regulate and teach ways of calming the nervous system. I have enclosed a list of relaxation and grounding techniques below.
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Neuroplasticity
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Will I always be anxious?
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Its a fair question and understandable if we've suffered for a long time. Neuroscience however teaches us, that as we have learned that social situations and certain people can cause anxiety so the brain can learn to trust and be comfortable with people and social situations. Learning something new, such as a language or a new way of thinking can create new pathways in the brain. It takes time but experiencing positive social interactions in a controlled slow process can help us over time to be more comfortable with our anxiety.
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Measurement
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When we go through a panic attack or anxious event we feel terrible but have no perspective on the nature of the attack- it just feels bad. It sounds simplistic to say, but using a measure out of 10 or 100 can give us an idea of the scale of the attack and give us valuable information for the future.
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Say for example we had two social events to go to and felt anxious during both of them. They both felt bad, but if the first was a 9 out of 10 and the second was an 8 then these are both highly anxiety- inducing but there is a difference in the second one and understanding that difference can help us predict and plan for future events. Measuring our level of anxiety can help us track our progress and learn how to plan.
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Pre-event Planning Predicting
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It sounds easy - planning for anxiety but a lot of the anxiety we struggle with, we have experienced before - almost as if you could write down the whole scenario beforehand. Knowing already how we are going to feel before we go out gives us an advantage and allows us to make small changes that can help. If we are planning to go to a public event, we can look at practical ways to make the situation work better for us (see below)
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Safety
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Our brains are logical and often see threat but our nervous system has been trained to look for danger - it is the one thing that has kept us protected over the years. Telling ourselves we are fine and everything is ok doesn't work as we still feel unsafe. Slowly building a safety map of places and people that make us feel secure gradually teaches our nervous system that the world can be a safer place and gives us a map of people and places we can go to if we feel anxious.
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Post Event Analysis
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When we are anxious, we cant think straight. Focusing on as many details as possible during a social situation (which is a grounding technique in itself), allows us to remember and analyse when we are much calmer.
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I have enclosed the following below:-
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Practical Techniques to help with Social Anxiety
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ERP (Exposure and Response Prevention)
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Relaxation and Grounding Techniques
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Anxiety Links​​​​​​​​.
How can therapy help?
Practical Techniques for Social Anxiety
​​Exposure
Before the Event: Preparation Strategies
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Gradual Exposure Practice (see below)
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Research shows that starting with low-stress social interactions and slowly increasing exposure intensity is effective for reducing anxiety. This can include calling or voice messaging a friend instead of texting, striking up casual conversations with baristas or cashiers, or joining small group chats online to practice engagement. Begin by practising social interactions with people you feel comfortable around, such as family members or close friends, then gradually increase the level of social interaction by attending small gatherings or events.
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Exposure and Response Prevention
​​Exposure and Response Prevention (ERP) is based on a simple but powerful idea: anxiety naturally decreases when you stay in an uncomfortable situation long enough without doing anything to escape or reduce it.​
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The Problem: When you have anxiety or a phobia, you naturally avoid the thing that scares you or do something to feel safer (like checking repeatedly, seeking reassurance, or leaving). This feels better in the moment, but it actually teaches your brain that the situation really was dangerous—because you "escaped" from it. Your anxiety never gets a chance to naturally go down.
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The Solution: ERP involves two parts:
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Exposure - Gradually facing the thing you fear (like being near a dog if you have a phobia, or touching a doorknob if you have contamination fears). This is done in a very gentle, controlled process, making sure you only do it a little at first gradually increasing your exposure in a measured way.
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Response Prevention - Resisting the urge to do your usual safety behaviours (like running away, excessive hand-washing, or checking)
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Measurement - Planning situations and events and predicting the level of anxiety expected and measuring the level of response on a scale from one to ten. We may feel anxiety but is it the same level as the last time or is it different?
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When you stay in the anxious situation without escaping or doing safety behaviors, your anxiety will spike at first—but then something important happens: it naturally comes back down on its own. Your brain learns "Oh, I stayed here and nothing terrible happened. Maybe this isn't as dangerous as I thought."
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Over time and repetition, the feared situation triggers less and less anxiety because your brain has learned it's actually safe.
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It's like learning to swim—scary at first, but the more you practice staying in the water, the more your fear naturally fades.
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Important Notes
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-These techniques are tools for self-care and stress management. they are not replacements for professional mental health treatment.
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-Different techniques work better for different people -experiment to find what works best for you. Techniques take time to master and find what works best. Its a bit like going to the gym. You don't build muscle straight away.
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-Practice these techniques when you're calm so they're more effective during stressful times.
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-If you experience persistent anxiety, depression or other mental health concerns, please seek support from a qualified mental health professional​
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-if any technique causes increased distress, stop using it and consider consulting with a counsellor or therapist.
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These techniques are taken from evidence-based practices from cognitive behavioural therapy, mindfulness-based interventions and somatic therapies. They are provided for educational purposes and general wellbeing.
Relaxation Techniques
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Breathing Techniques
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Deep Breathing (Diaphragmatic Breathing)
Place one hand on your chest and one on your belly. breathe slowly through your nose, ensuring the hand on your belly rises more than the one on your chest. Exhale slowly through the mouth. This activates your body's relaxation response and reduces stress hormones.
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Box Breathing (4-4-4-4)
Inhale for 4 counts , hold for 4 counts, exhale for 4 counts, hold empty for 4 counts. Repeat this cycle 4-8 times. This technique is used by Navy SEALS and helps regulate the nervous system during high stress situations.
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4-7-8 Breathing
Inhale through your nose for 4 counts, hold your breath for 7 counts, exhale through your mouth for 8 counts. This technique can help reduce anxiety and promote sleep by activating the parasympathetic nervous system.
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Belly Breathing
Lie down comfortably and place a small book on your belly. Breathe so that the book rises and falls with each breath, focusing on expanding your diaphragm rather than your chest. this promotes deeper, more efficient breathing.
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Coherent Breathing
Breathe in and out at a rate of 5 breaths per minute 6 seconds in 6 seconds out. This creates heart rate variability coherence and promotes emotional balance and mental clarity.
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Alternate Nostril Breathing
Using your thumb and ring finger, alternate closing each nostril while breathing in and out through the other. This technique from yoga tradition helps balance the nervous system and improve focus.
Breathing Techniques
Progressive Muscle Relaxation
​​​​​​​​​​​​​​​​​​​Full Body Progressive Muscle Relaxation
Starting with your toes, tense each muscle group for 5 seconds, then release and notice the contrast. Move systematically through your body : feet, calves, thighs, buttocks, abdomen, hands, arms, shoulders, neck and face. this technique helps identify and release physical tension.
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Quick Muscle Release
Tense your body all at once for 5 seconds, then release everything and breathe deeply. Notice the wave of relaxation that follows. This is useful when you have limited time but need quick tension relief.
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Facial Muscle Relaxation
Focus specifically on facial muscles by raising your eyebrows, then releasing. Squeeze your eyes shut, then relax. Clench your jaw, then let it drop open slightly. Many people hold stress in their face without realising it.
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Visualisation Techniques
​Safe Place Visualization
Create a detailed mental image of a place where you feel completely safe and calm. Engage all your senses - what do you see, hear, smell, feel, and taste in this place? Return to this mental sanctuary whenever you need comfort.
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Body Scan Meditation
Mentally scan your body from head to toe, noticing any areas of tension, warmth, coolness, or other sensations without trying to change them. This builds body awareness and promotes relaxation through mindful attention.
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Colour Breathing
Imagine breathing in a calming colour (like blue or green) that fills your body with peace, and breathing out a colour that represents stress or tension (like red or black). This combines breathing with visualization for enhanced effect.
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Nature Imagery
Visualize yourself in a peaceful natural setting - a beach, forest, mountain, or garden. Focus on the details of this environment and how it makes you feel. Nature imagery can reduce cortisol levels and promote feelings of wellbeing.
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​5-4-3-2-1 Sensory Grounding
Identify 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. This technique brings you into the present moment by engaging all your senses.
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Physical Grounding
Feel your feet on the ground, press your hands together, or hold a cold object. Focus on the physical sensations to anchor yourself in the present moment. Physical touch activates pressure receptors that can calm the nervous system.
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Mental Grounding
Count backwards from 100 by 7s, recite the alphabet backwards, or name items in a category (like animals or countries). These cognitive tasks require focus and can interrupt anxious thought patterns.
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Emotional Grounding
Name your current emotion and rate its intensity from 1-10. Remind yourself that emotions are temporary and will pass. This creates distance between you and overwhelming feelings.
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Temperature Grounding
Hold ice cubes, splash cold water on your face, or step outside to feel the air temperature. Temperature changes can quickly shift your nervous system state and bring you into the present.
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Mindfulness and Present-Moment Techniques
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Mindful Breathing
Simply focus your attention on your breath without trying to change it. When your mind wanders, gently return attention to your breathing. This builds concentration and present-moment awareness.
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Body Awareness
Notice how your body feels in this moment - the weight of your body in the chair, the temperature of the air on your skin, any areas of tension or relaxation. This builds the foundation for all mindfulness practices.
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Mindful Observation
Choose an object and observe it carefully for 2-3 minutes, noticing colours, textures, shapes, and details you might normally overlook. This strengthens your ability to focus and be present.
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Loving-Kindness Meditation
Send kind thoughts to yourself, then to loved ones, neutral people, difficult people, and finally to all beings. Start with phrases like "May you be happy, may you be peaceful, may you be free from suffering."
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Movement-Based Relaxation
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Gentle Stretching
Simple neck rolls, shoulder shrugs, and gentle twists can release physical tension and promote relaxation. Movement helps process stress hormones and improves circulation.
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Walking Meditation
Walk slowly and deliberately, focusing on each step and the sensations of walking. This combines the benefits of gentle exercise with mindfulness practice.
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Yoga Poses for Relaxation
Child's pose, legs up the wall, and gentle twists can activate the relaxation response. These poses stimulate the vagus nerve and promote parasympathetic nervous system activation.
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Quick Techniques for Immediate Relief
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STOP Technique
Stop what you're doing, Take a breath, Observe your thoughts and feelings, Proceed with awareness. This creates a pause that allows you to respond rather than react.
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Hand on Heart
Place your hand on your heart and feel it beating. This simple gesture can activate self-compassion and feelings of safety through the release of oxytocin.
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Butterfly Hug
Cross your arms over your chest and gently pat your shoulders alternately with your hands. This bilateral stimulation can be calming and is used in trauma therapy.
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Cold Water Technique
Splash cold water on your face or hold cold water in your mouth for 30 seconds. This activates the dive response and quickly calms the nervous system.
Grounding Techniques
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Anxiety Links
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Anxiety Care UK
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anxietycare.org.uk​​
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Helps people with anxiety disorders.
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Anxiety UK
03444 775 774 (helpline)
07537 416 905 (text)
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Advice and support for people living with anxiety.
MIND
Helplines
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https://www.mind.org.uk/information-support/helplines/
Local MIND services
https://www.mind.org.uk/about-us/local-minds/
Side by Side online peer community
https://www.mind.org.uk/information-support/side-by-side-our-online-community/
NHS Inform
https://www.nhsinform.scot/illnesses-and-conditions/mental-health/anxiety/
No More Panic
Provides information, support and advice for those with panic disorder, anxiety, phobias or OCD, including a forum and chat room.
No Panic
0300 7729844
Provides a helpline, step-by-step programmes, and support for people with anxiety disorders.
Samaritans
116 123 (freephone) jo@samaritans.org
Samaritans are open 24/7 for anyone who needs to talk. You can visit some Samaritans branches in person.
Triumph Over Phobia (TOP UK)
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Provides self-help therapy groups and support for those with OCD, phobias and related anxiety disorders.
Young Minds
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Fighting for young people’s mental health.
https://www.youngminds.org.uk/young-person/mental-health-conditions/anxiety
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