Talking to your doctor about social anxiety

You don’t need the right words. One sentence is enough to start: “I think I have social anxiety, and it’s stopping me from doing things.” Your doctor (a GP or family doctor) can ask a few questions, check for other causes, refer you to therapy and talk about medication if you want it. If talking is hard, you can hand over a written note.

Why it is worth going

Social anxiety rarely goes away on its own, and treatment works. Yet only about 23 in 100 people with social anxiety ever get treatment, often after many years. A doctor’s visit can be the shortest route to therapy, especially where you need a referral.

What to say

Keep it short. Say what happens and what it stops you doing. For example:

“I get very anxious around other people. I’m afraid of being judged or embarrassing myself. I avoid [phone calls / meetings / eating in front of people]. It’s been going on for [years], and it’s affecting my [work / studies / friendships]. I’d like help.”

If you want to, you can add:

• “I’ve read about CBT for social anxiety. Can you refer me?”
• “I’d like to know about medication too.” or “I don’t want medication, I’d like therapy.”
• “I sometimes drink to cope.” (It helps the doctor to know.)
• “I’ve been feeling low as well.”

A note you can hand over

If you fear your mind will go blank, write it down and hand it over at the start. Doctors are used to this.

About me: I think I have social anxiety. I find this hard to say out loud. What happens: [e.g. my heart races, I blush, I can’t think when people look at me] What I avoid: [e.g. phone calls, speaking in meetings, going to the shop] How long: [e.g. since I was 13] How it affects me: [e.g. I turned down a promotion; I have no close friends] Other things: [e.g. low mood, drinking, sleep problems] What I’d like: [e.g. a referral for CBT; information about medication]

What the doctor may ask

In the UK, NICE guidelines suggest doctors ask two simple questions: whether you avoid social situations, and whether you feel fearful or embarrassed in them. They may also use a short three-question form called the Mini-SPIN. A yes, or a high enough score, means they should look more closely.

The doctor may also ask about:

• your mood, sleep and energy;
• alcohol, drugs and any medicines you take;
• your physical health;
• whether you ever have thoughts of harming yourself.

That last question is routine. It is asked to keep you safe, not because they think you are in danger.

What the doctor can offer

A referral for therapy. The first choice for adults is individual CBT made for social anxiety. A study that combined 101 trials found it helped more than any other treatment compared with waiting. See finding a therapist for what to look for.

Guided self-help. A CBT-based book or online programme with support from a practitioner. NICE suggests it for adults who don’t want face-to-face CBT.

Medication, if you want it. The usual first choice is an SSRI, a type of antidepressant. A review of 66 trials found SSRIs helped more people than a placebo. They take a few weeks to work and can have side effects. NICE advises closer check-ups for people under 30 when starting them. See SSRIs and SNRIs.

Questions about propranolol. Many people ask for propranolol, a beta-blocker, to stop shaking. People report it calms the body but not the thoughts. A review of the trials found very little evidence for it in social anxiety disorder, and it is not among the medicines NICE recommends for it. See propranolol.

Never start, stop or change a medicine without talking to your doctor.

If the appointment doesn’t go well

Some doctors know less about social anxiety than others. If you feel brushed off (“you’re just shy”):

• say again what it stops you doing: “This is affecting my work and I want treatment”;
• ask directly for a referral to talking therapy;
• ask to see another doctor at the practice;
• where self-referral is allowed, such as NHS Talking Therapies in England, refer yourself.

Making the booking easier

If booking the appointment is the hard part, read when booking is hard. It has scripts for the phone, online options and ideas for bringing someone with you.

If you are having thoughts of ending your life, don’t wait for an appointment. See crisis lines.