Is it shyness or social anxiety?

You have probably called it shyness for most of your life. Other people have too. Quiet, reserved, a bit awkward in groups, better one to one. It sounds like a personality, and personalities are not things you treat.

But somewhere along the way the world has narrowed. You stopped putting your hand up. You avoid the phone. You decline the invitation, then decline the next one because explaining is harder than declining. You took the job that involves less contact, or did not apply for the one that involved presenting. And the loneliness that followed got read as more evidence that something is wrong with you, rather than as the predictable result of avoiding people.

That is social anxiety rather than shyness, and it is treatable.

The difference

Shyness is a temperament. Some people are naturally more reserved, warm up slowly, prefer smaller groups and need quiet afterwards. There is nothing wrong with any of that, and treatment does not aim to change it. Plenty of people finish therapy for social anxiety still preferring a dinner with three friends to a party with thirty.

Social anxiety is a condition, and the test is cost. Is it costing you things? Opportunities turned down. People you like, avoided. Work below what you can do. Days lost to dread before and replaying afterwards. Shyness does not do that. Shyness is a preference. Social anxiety is a constraint, and the constraint is getting tighter.

How it works

Three things keep social anxiety going, and none of them is temperament.

There is the picture you have of how you come across, drawn from how you feel rather than from what anyone sees. Red, shaking, odd, too much. There is the attention you keep turned inward, watching yourself from the outside, checking against the picture, so that only half of you is ever in the room. And there are the safety behaviours, the things you do to get through: gripping the glass, over-preparing, rushing, keeping your coat on, having a drink first. Each feels like it saved you, and each prevents you from ever discovering that you did not need saving.

Then, afterwards, the post-mortem: replaying the event through the picture, finding the failure, filing it as what happened. Other people describe the same event as ordinary. You do not believe them.

It is a loop, and loops can be interrupted.

Why it rarely stays social

Social anxiety rarely stays social for long. Careers stall, because you will not speak in the meeting or go for the role that involves presenting. Friendships thin out, one declined invitation at a time, and the room to make new ones goes with them.

By the time someone comes to me, the cost has usually been accumulating for years. The good news is that the length of time does not matter much. The loop is the same whether it has been running for two years or twenty.

What treatment involves

I use the cognitive model of social anxiety that NICE recommends, delivered as individual CBT. We build your personal model of what keeps the anxiety going, then we test it. Video and role-play, early on, so you can see how you actually came across rather than how you felt you did. Experiments in real situations, dropping the safety behaviours one at a time, designed together and agreed in advance. Work on the post-mortem, so the evening stops costing three days.

Nothing is thrown at you. You always know what we are testing and why, and we start well within what you can manage. The point is information, not endurance.

What you get back

You get the choice back. By the end, you are declining the party because you would rather read, not because you cannot face it. You are putting your hand up because you have something to say, and not because you have forced yourself. The temperament stays; the constraint goes.

If the word shy has been doing a lot of work for a long time, there is more on how I treat social anxiety, and on how it differs from the broader picture of anxiety.