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You are not the only one

About 4 in 100 people around the world have social anxiety disorder at some point in their lives, according to surveys in 28 countries. It usually starts early: half of all cases begin before about age 14.

Most people never get treatment. In surveys across 24 countries, fewer than 1 in 4 people with social anxiety disorder had ever been treated for it. Those who did waited about 15 years on average. If you have lived with this for years, you are in the majority, not the exception.

It also tends to stay without help. In studies that followed people over five years, fewer than half recovered. The good news is that treatment works, and some of it you can start alone.

First, check what this is

If you are not sure whether this is social anxiety, shyness or something else, read Is it social anxiety?. Then read What keeps social anxiety going. It explains the loop that every good treatment tries to break, and it will make the rest of this page make sense.

Four steps of help

Each step gives more support than the one before. It also asks more of you, or of a health service. You can start at any step.

Step 1: Learn the loop and try small experiments

Read about what keeps social anxiety going. Then pick one small situation and try it without your usual safety behaviours. The pages on situations give example steps for phone calls, meetings, eating in public and more.

Step 2: Work through a self-help book

A good self-help book teaches the same skills as therapy. In a trial in Sweden, people who worked through a book on their own improved more than people on a waiting list, and kept the gains a year later. Look for a book based on cognitive behavioural therapy (CBT) that asks you to practise, not just read. Self-help books explains what to look for.

Step 3: Do a guided online program

In an online program you work through lessons and exercises, with short written messages from a therapist each week. A study that combined 37 trials found these programs help a lot more than waiting. One online version of a leading therapy worked as well as seeing a therapist in person, with less than half the therapist time. In a study that followed people for five years, the gains lasted. See Online CBT.

Many online programs do not need a phone call to start. That can make this step easier to reach.

Step 4: See a therapist, or ask a doctor about medication

The best-tested treatment is one-to-one therapy made for social anxiety. It is called cognitive therapy for social anxiety. In one trial, 84% of people no longer had social anxiety disorder at the end. In the largest comparison of treatments, one-to-one CBT had the biggest effect.

Some therapists use virtual reality for practice inside therapy. It works about as well as practising in real life, and some people find it an easier first step.

Medication is another option. SSRIs and SNRIs are the best-tested medicines. A doctor can talk you through them. Some people use both therapy and medication.

How to choose a step

• If you want to start today, alone: steps 1 and 2.
• If you want structure but can’t face a phone call or a waiting room: step 3.
• If you have tried self-help and it hasn’t been enough, or the anxiety is stopping work, study or relationships: step 4.
• If you also feel very low or hopeless, or drink to cope: go to step 4 now, and tell the professional about those too. Read Depression and social anxiety and Alcohol and social anxiety.

If booking an appointment is itself the hard part, When booking is the hard part has scripts and ways to book without a phone call.

If you are in crisis

If you are thinking about ending your life or you are in danger, call your local emergency number now. Crisis lines lists free helplines by country.