Social Anxiety Disorder (SAD)
- Elif Gerçek
- Jun 30
- 7 min read
What is Social Anxiety Disorder (SAD)?
Social Anxiety Disorder (SAD) is defined in the DSM-5 as “a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.” People with SAD often experience intense worries such as, “I will do something embarrassing,” or “I will make a mistake and everyone will laugh at me.” As a result, they may endure these situations with overwhelming anxiety or avoid them altogether.
This anxiety differs significantly from ordinary shyness or the typical nervousness felt before public speaking. For those living with social anxiety disorder, these fears can interfere profoundly with daily functioning across various areas of life. In other words, the individual may organise their life around this anxiety, ultimately missing out on many experiences they would otherwise genuinely enjoy.
According to the DSM-5 diagnostic criteria, symptoms must persist for at least six months and cause significant distress or impairment in work, school, or social life. However, meeting DSM-5 criteria alone is not sufficient for a formal diagnosis. A specialist’s evaluation and appropriate clinical observation are essential to accurately assess and confirm the condition.
Social Anxiety Disorder from the Perspective of Schema Therapy
Viewing social anxiety merely as “shyness” or “nervousness in public” falls short of capturing its true impact. This “shyness” can become so overwhelming that it effectively imprisons the individual. It is not the person who directs the course of their life, but rather the anxiety and worry that take control.
According to the schema therapy approach, social anxiety often stems from deeply ingrained cognitive patterns—known as schemas—that develop as a result of emotional deprivation and negative experiences in early childhood.
These schemas become triggered in adulthood, particularly in social situations or when the individual feels subject to others’ evaluation, leading to intense anxiety. In other words, from a schema therapy perspective, social anxiety is not just a momentary experience but a re-emergence of old wounds from the past playing out in present-day social relationships.
Common Schemas in Social Anxiety
In schema therapy, the most frequently observed schemas in individuals with social anxiety include:
Defectiveness / Shame: The person secretly believes they are inadequate, flawed, or shameful. They fear that this side of themselves will be exposed in social settings, leading to humiliation.
Social Isolation / Alienation: A tendency to feel different, alienated, or as if they do not belong among others.
Approval-Seeking / Recognition: Constantly striving to meet others’ expectations and seeking approval in order to be liked and accepted.
While these might be the common schemas, some individuals may be affected by additional schemas or may not experience some of the ones listed here at all.
When and in Whom Does Social Anxiety Disorder (SAD) Emerge?
Social Anxiety Disorder (SAD) typically appears during early adolescence, a period when social identity and self-concept are developing. However, signs can also be evident in childhood, such as “remaining silent in front of peers,” “inability to ask to join peer games,” “spending excessive time alone in low-interaction settings (like playing computer games),” or “being isolated in the playground.” Genetic predisposition, traumatic social experiences, and personality traits such as high neuroticism (difficulty regulating emotions) increase the risk.
Social anxiety manifests through mental (emotional), physical (bodily), and behavioural symptoms:
Physical Symptoms:
Heart palpitations
Sweating
Blushing
Shortness of breath
Trembling
Nausea
Muscle tension
Emotional Symptoms:
Intense shame
Fear of rejection
Low self-confidence
Heightened anxiety and restlessness
Feelings of embarrassment or awkwardness
Worry and tension
Anger directed at oneself or the outside world
Behavioural Symptoms:
Avoidance of social situations
Reluctance to speak in crowds
Avoiding communication with strangers
Fear of public speaking
Avoiding meeting new people
Avoiding eye contact
Hesitation to initiate romantic relationships
Continuing to socialise with disliked but familiar groups—this can feel emotionally “easier” than facing the distress of new social environments
Not participating in social events or attending unwillingly, with tendencies to leave early or avoid drawing attention
To illustrate with an everyday example: someone invited to a job interview may spend hours before even stepping into the meeting room consumed by intense anxiety, thinking, “What if I get nervous, my voice shakes, or I say something foolish?” Eventually, they might cancel the interview altogether. To avoid facing this overwhelming anxiety, they might choose to remain in a familiar but unsatisfying job simply because it feels safer.
Similarly, when invited to a high school reunion after many years, a person might prefer to stay at home, haunted by worries such as, “Everyone will think I’m ridiculous,” or “I’ve become unattractive since school, they might not like me.” In other words, they avoid social situations by coming up with various excuses and, if attendance is unavoidable, they minimise interaction with others and try to leave as soon as possible.
What Causes Social Anxiety Disorder?
There is no single cause. Social anxiety disorder generally arises from a combination of biological (genetic), psychological, and environmental factors:
Genetic Predisposition: It is more common among individuals with a family history of anxiety disorders.
Learned Experiences: Childhood events such as bullying, exclusion, or humiliation.
Cognitive Tendencies: The person’s tendency to overestimate the likelihood of negative evaluation, making mistakes, or embarrassment. This involves cognitive distortions and maladaptive schemas.
Personality Traits (Temperament): Traits such as shyness, neuroticism, introversion, or perfectionism.
Social anxiety can also develop comorbidly with other conditions. For example, someone coping with generalized anxiety disorder or depression may also experience social phobia. Treating one condition often alleviates the other.
Social anxiety is usually not a fleeting feeling that simply comes and goes. Most of the time, it progresses within a specific cycle, which the individual becomes unknowingly trapped in. Understanding this cycle is crucial both for recognising how anxiety escalates and for identifying where intervention can be most effective.
The Social Anxiety Cycle: How It Gains Strength When Fed — How Does the Cycle Works?
1. Triggering Event, Situation, or Person(s)
An anxiety-provoking situation or environment usually initiates the cycle, such as:
Speaking in a meeting
Meeting new people
Being in a crowded place
Making eye contact with someone, and so forth.
In these moments, automatic negative thoughts arise in the individual’s mind:“I’m definitely going to say something stupid.”“Everyone is looking at me.”“If I mess up, my colleagues will laugh behind my back.”
These thoughts trigger anxiety.
2. Physical and Emotional Reactions
Following these thoughts, bodily symptoms begin to appear:
Heart palpitations
Sweating
Shortness of breath
Trembling hands
Blushing
Emotionally, feelings of shame, embarrassment, and a sense of being trapped also emerge.
3. Avoidance or Safety-Seeking Behaviours
In response to this intense discomfort, the person attempts either to escape the situation or engage in safety behaviours to reduce anxiety, such as:
Staying silent
Avoiding eye contact
Constantly self-monitoring
Analysing the situation later and worrying, “Did I make a fool of myself?”
Checking their phone or leaving the environment
4. Temporary Relief
These avoidance behaviours provide brief relief — “Luckily, I didn’t speak; I didn’t embarrass myself.”
However, this short-term comfort reinforces anxiety in the long term.
5. Outcome: The Cycle Strengthens and Continues
Each time the person avoids or seeks reassurance, their brain learns:“This situation was truly dangerous, and if I hadn’t escaped, something bad would have happened. Fortunately, I protected myself this time.”
This learning strengthens social anxiety and leads to the cycle repeating more rapidly and intensely in future similar situations.
Social anxiety disorder can lead to increasing isolation, loss of self-confidence, and setbacks in professional or academic life as the individual withdraws from social environments. With early diagnosis and consistent treatment, this cycle can be broken — enabling the person to regain courage to make new friends, embark on romantic relationships, speak in public, or seize new career opportunities.
What Can Someone with Social Anxiety Do to Seek Treatment?
Firstly, it is important for the individual to understand that their experience is not unique and that they are not alone.
Keeping thought diaries to become aware of the thoughts running through their mind during moments of anxiety.
Gradually exposing themselves to social situations in small steps (for example, initiating a brief conversation with a cashier when buying a coffee).
Learning and practising anxiety-regulation techniques such as breathing exercises and meditation, especially to use during times of heightened anxiety.
Finding healthy coping strategies to regulate emotions and manage distress during intense anxiety episodes. It is crucial to identify and establish these coping methods before the anxiety peaks, so they can be applied effectively during moments of crisis.
Seeking professional support when necessary. Consulting a specialist can help the individual manage their anxiety and navigate the recovery process more effectively.
What is the Treatment for Social Anxiety Disorder?
The primary treatment for Social Anxiety Disorder (SAD) is psychotherapy. Initially, the individual becomes aware of their anxiety-provoking thoughts and then learns to overcome these fears through controlled exposure—for example, starting with a conversation in a small group of acquaintances. When necessary, selective serotonin reuptake inhibitors (SSRIs) may be prescribed with the support of a psychiatrist; these medications help reduce anxiety and create a more receptive foundation for therapy.
Medication is considered only in collaboration between the specialist and the patient and used when genuinely needed. If not required, regular participation in psychotherapy alone is sufficient to treat the anxiety.
How Does Schema Therapy Address Social Anxiety? What Does the Treatment Process Involve?
Schema therapy approaches social anxiety not only by addressing current symptoms but also by exploring their origins. It is important first to identify which schemas are active and understand the early life experiences that have reinforced them.
Next, the therapist and client revisit these past experiences to carry out emotionally corrective work. This might involve reconstructing a childhood memory of embarrassment or challenging a deeply internalised voice repeating, “You are not enough.”
Throughout this process, the individual learns to recognise the automatic thoughts generated by their schemas, identify which mode they are in during anxious moments, and act from the Healthy Adult mode using adaptive coping strategies.
Similar to Cognitive-Behavioural Therapy (CBT), the person gradually approaches anxiety-provoking situations through behavioural experiments and exposure exercises. However, the key difference is that in Schema Therapy, these steps are taken with increasing awareness of one’s internal dialogue and by weakening maladaptive schemas.
If left untreated, social anxiety can significantly impair social, academic, and occupational functioning. However, with appropriate therapeutic interventions, individuals can learn to manage their anxiety, cope with negative thoughts, and build healthier social relationships.
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