Social Anxiety

An NHS self help guide

www.cntw.nhs.uk/selfhelp
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 Page

Introduction 4
Do I suffer from social anxiety? 5
What is social anxiety? 7
What causes social anxiety? 9
What keeps social anxiety going? 10
How can I help myself to overcome social anxiety? 13
Understanding social anxiety 14
How can I reduce my negative thoughts, beliefs 15
and images?
How can I stop focusing on myself? 19
Become more comfortable with uncertainty 20
How can I change my own behaviour? 21
How can I reduce my physical symptoms? 24
Where can I get further help? 30
Useful organisations 31
Useful books 34
Mindfulness downloads 36
Relaxation downloads 36
References 36
Rate this guide 36

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“I dread going to places where I may have to talk to people.
Before I set off I just think I’m going to do or say something
stupid, and that people will think I’m an idiot. No one else
seems to be like this and I really feel there is something
wrong with me. The only way I can face people is if my
girlfriend is with me. It’s not fair, she is full of
confidence...”

“If I have to talk in a meeting I just can’t cope. My legs go

wobbly, I flush up and I feel quite sick. I feel everyone is
watching me closely. I know it is silly and other people
don’t seem to have the same difficulty. I keep thinking
afterwards that they must feel I’m not really up to the job...”

These are the thoughts of two people who have a problem with
social anxiety. This is a common problem though people don't
often talk about it.

This booklet aims to help you to:

 Recognise whether you may have a problem with social
anxiety.
 Understand what it is, what can cause it, and what can help
keep it going.
 Look at ways you can help yourself to overcome social
anxiety.

Social anxiety is one of the most common sorts of anxiety and

affects both men and women. Most of us feel shy or anxious in
social situations at some point. This can be much more serious
for some people, however, who find that their relationships,
career and life in general can be deeply affected by their
problem.

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Do I suffer from social anxiety?
In order to check whether you may be suffering from social
anxiety place a tick next to those symptoms you experience
regularly.

What happens to your body

What you experience in your body with social anxiety is exactly
the same as any anxiety reaction. It is your body's basic
response to threat; the fight and flight response. It is not
dangerous, and is in fact a helpful response for dealing with a
real physical threat, which has helped us survive as a species.
With social anxiety, these body symptoms are all about social
situations. When you go into a situation with others and you
suffer from social anxiety, you may have some of the following
feelings in your body:
 Heart racing and pounding.
 Chest feeling tight or painful.
 Tingling or numbness in toes and fingers.
 Stomach churning or butterflies.
 Dry mouth.
 Having to go to the toilet.
 Feeling jumpy or restless.
 Tense muscles.
 Sweating.
 Breathing changes.
 Dizziness and feeling light headed.
 Blushing.

What you feel/think

 You feel a strong sense of fear in social situations that won’t
go away.
 You know that the fear is too much or unreasonable.
 You think you may act in a way that will be embarrassing in
front of others.
 You believe that others are judging and thinking badly of you.

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 You tell yourself “I must not look anxious”.
 You believe “If I get it wrong people won’t like me” or “If I
show I’m nervous people will think I’m stupid”
 You think “I will make a fool of myself” or “I will look stupid”.
 You think “I’m boring” or “I’m strange”.
 You have a negative picture of yourself in your mind, which
is how you fear other people see you, this may be flustered,
foolish, uninteresting, weak, timid etc.
 Before you go into social situations you think that things will
go badly.
 After you’ve been in a social situation you think “that was
awful”, “I looked so stupid”, etc. You may go over these
thoughts again and again.

What you do
 Sometimes you go into social situations that you find difficult
but find this very distressing and become very anxious.
 You avoid going into social situations that you find difficult,
even if this is inconvenient to you. For example, going out to
buy sandwiches rather than having to go into the busy staff
canteen.
 Avoid talking on the telephone sometimes not even
answering it.
 Do things to help yourself when you can't relax in social
situations, such as: drinking a lot of alcohol; smoking more
than usual; rehearsing what you are going to say; offering to
help in social situations so that you can keep busy; sitting
hiding in a corner; planning your exit; checking out the toilets
and visiting frequently; avoiding eye contact; talking too
much or too little.

If you have ticked most of the boxes then you may have social
anxiety.

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What is social anxiety?
People who suffer from social anxiety often believe that others will
think badly of them or that people will be judging them. They think
that they are being watched closely and they want to come
across well. At the same time they may fear that they are not as
good as other people and are not ‘up to the mark'. They suffer
symptoms of anxiety such as tension, rapid heartbeat and light-
headedness when they are in social situations. They may blush
or stammer or be unable to speak.

Certain situations may be more difficult than others. Some socially

anxious people feel quite at ease speaking to those they know well,
but feel very anxious with strangers. Sometimes it may be the other
way round. Eating in front of others can be very difficult for some
people, as can crowded places such as canteens, pubs, shops or
queues or just being seen in public. For some people, their social
anxiety is mainly about getting up and talking or doing something in
front of others, for example, giving a presentation. Others may fear
talking to authority figures or being seen in public can also be very
anxiety provoking. Many actors, comedians and musicians suffer
from social anxiety when performing in public, and have had to
seek help in order to continue with their career.

Some people will begin to avoid difficult situations completely,

often leading to great inconvenience, loss of social life or even
career prospects. Other people will cope with their anxiety by
doing certain things that make them feel more confident and
'safe' in what feel like scary situations. These 'safety
behaviours' can include things like: not looking people in the
eye so as not to draw attention to themselves, sitting on the
outside of a group; staying close to someone they know; hiding
visible signs of anxiety (such as wearing a jacket to avoid
sweating or make-up to hide blushing); finding a task to look
busy; asking lots of questions to keep focus on the other person
or saying very little; using alcohol or recreational drugs; wearing
sunglasses or a hat. The list is endless. You may recognise
some of these in yourself and we will look at this more closely

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later. People may fear that they cannot control their anxiety in
these social situations and that they will make a bad impression
on others.

In summary – People who experience social anxiety fear that

other people will think badly of them and often believe that they
are not as good as others. This makes social situations very
difficult or impossible with anxiety affecting the body, thoughts
and behaviour.

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What causes social anxiety?
Social anxiety is something that most people experience in a mild
form at some point, and as we have said it is one of the most
common forms of anxiety. When severe it can be extremely
distressing, and have a huge effect on someone's life.

It is often related to ‘low self-esteem’ or a poor opinion of self,

which may have begun in childhood or adolescence. Some
people seem to be naturally more anxious and have learned to
worry about social situations. Others may have had stressful or
distressing life experiences, such as bullying or a critical parent,
which have led them to feel like this. Most social anxiety begins in
adolescence, and sometimes runs in families, but really no-one
knows for sure what causes it. We do know quite a lot about what
keeps it going, however, which is very important when it comes to
dealing with it!

There are some other health conditions where social anxiety is

present along with other difficulties. These include severe
depression and generalised anxiety. As well as people diagnosed
with autism or attention deficit hyperactivity disorder (ADHD) may
also experience social anxiety. If you feel any of these may be the
case for you it is important to discuss with your doctor so that you
may get the correct help.

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What keeps social anxiety going?
Some people feel socially anxious when they are young but
become more confident as they get older. For other people it
can just go on and on and become a life-long problem. There is
one very good reason for this which is that a vicious circle
develops involving the following:
1. If someone has been socially anxious for many years, say
from childhood, they may have long-term beliefs that they
are ‘no good in social situations’. They may recall difficult
social situations from their past. Research has shown that a
person with social anxiety has equal social skills to others
but does not believe this. People with social anxiety tend to
wrongly believe that they are not socially skilled.
2. Avoidance of social situations keeps the person from
becoming more used to social occasions. This stops them
from learning that they can cope and feel fine. If a situation
is avoided it feels even more difficult the next time. As
mentioned, most socially anxious people also have 'safety
behaviours' that stop them learning that they are doing fine.
For example, not making eye contact.
3. As well as lots of negative thoughts about themselves, the
person with social anxiety often holds an unpleasant image
in their mind of how they look to others. When mixing with
others the anxiety tends to make them focus on themselves
more. They think of this image, feel anxious and believe that
they look terrible to others. They rarely look to see how the
other person is really responding to them. They make
negative guesses about what the other person is thinking
and therefore never challenge their negative, unpleasant
image of themselves.

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4. ‘Fear of fear’ will sometimes take over so that the person will
predict that they will be anxious in certain situations and
expect certain symptoms, “I know I will go bright red when I
speak”, “I won’t be able to get my words out” or “what if
people notice my hands shaking”? These thoughts increase
anxiety even before they go into the feared situation, and
unfortunately some of the feared symptoms may actually
happen.
5. After a social situation the person is likely to look back with
lots of negative thoughts about how badly things went, such
as “I looked stupid” (self criticism) and “they must have
thought I was an idiot” (expecting others to be critical too).
6. With all these negative thoughts going on before, during and
after social situations, the feared symptoms unfortunately will
almost always happen, for example, blushing, shaking,
sweating, mind going blank. Therefore strengthening beliefs
and increasing fear for future situations. We come to believe
that we cannot cope or control our feelings.

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So putting these all together, a vicious circle of social
anxiety can develop which may look a bit like this:

In summary - social anxiety is linked to low self-esteem and

continues because people hold long-term beliefs that they are
‘no good in social situations’. Although unlikely to be true,
these beliefs are never challenged because of avoidance,
'safety behaviours' and self focusing when faced with social
situations. A vicious cycle can develop which keeps the anxiety
going.

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How can I help myself to overcome social anxiety?
There are a number of ways you can begin to help yourself
overcome social anxiety.

The approaches we suggest are:

1. Understanding social anxiety;
2. Understanding and reducing negative thoughts, beliefs and
images;
3. Reducing how much you focus on yourself;
4. Becoming more comfortable with uncertainty;
5. Tackling avoidance and safety behaviours;
6. Tackling the physical symptoms of social anxiety;
7. Seeking further help.

These are tried and tested approaches which do work, although

they can take a lot of time and effort. They are based on
cognitive behavior therapy (CBT).

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Understanding social anxiety
You may already by now have some ideas about what is
causing your social anxiety, but to understand this even better,
it may help to try the following:

Think back to an actual social occasion you found difficult over

the last month and try to work out what was happening for you
by drawing out your own vicious circle.

If you can’t get a clear picture of your difficulties by thinking

back, then it may help to keep a social anxiety diary. For one or
two weeks only, keep a diary of when and where you felt
anxious and what was going on at the time. Keep a brief note of
the thoughts, physical symptoms, and safety behaviours you
are aware of having had; before, during and after each
situation.

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Once you have a clearer view of your own problem then you
can begin to tackle the various parts of it and break the vicious
circle of anxiety.

How can I reduce my negative thoughts, beliefs and

images?
We have seen the role that thoughts have in keeping the
vicious circle of social anxiety going. Thoughts can be words or
they can be pictures in your mind. The following examples may
help you to identify your own thoughts and pictures.

Examples:

Negative automatic thoughts Picture

 “I don't know what to say -  Image of self as small mousy

people will think that I'm creature.
stupid".

 Everyone will look at me  Image of self shaking like a

when I walk in and I will leaf and others smirking.
shake".

 "I will stammer and not find  Image of self flushed and
my words". sweating, look of pity on faces
of others.

 “I sounded really pathetic  Image of self with high

when I asked a question". squeaky voice, others looking
strong and calm.

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It may help to write down your own negative thoughts and
images:

Thoughts Images

…………………………………
…………………………………
…………………………………
…………………………………
…………………………………
…………………………………
…………………………………
…………………………………
…………………………………
…………………………………

Once you know what they are you can begin to fight back and
break the vicious circle.

In particular ask yourself if you have any of the following

unhelpful thinking styles?
1. Am I mind-reading? e.g. “he/she thinks I’m boring”.
In this case you don’t tend to find out or look to see what
the other person really thinks. You believe your own
negative views and blame it on the other person! e.g. “he
doesn’t like me”. This is a very common problem for
socially anxious people who assume their own negative
view of themselves is also held by others.

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2. Am I fortune-telling? e.g. “I'm going to have an awful time,
everyone will be laughing at me”.
3. Am I catastrophising? e.g. “If this talk doesn't go right, I
will lose my job” or “If they notice I am anxious, they won't
want to know me”.
4. Am I personalising the situation? e.g. “they are all
laughing, they must be talking about me” or “he looks fed
up, it’s probably because he thinks he’s got to sit with me”.
5. Am I focusing only on the bad things e.g. “I really
clammed up when I tried to speak to Jane” (ignoring that
you had been able to speak easily to other people that day).

These unhelpful thinking styles mean that you don’t view

yourself in social situations in a fair way. It may help to begin to
try and answer back to find a clearer picture of what is
happening. A good way of doing this is to write two columns –
one for your anxious thoughts and the other for a fairer more
balanced thought:

Anxious thought Balanced thought

 “I am trembling all over and  “People would not have

my voice is shaky, people thought I was odd, and
must think I am really odd.” probably didn't even notice
me trembling. People always
say I look and sound
confident. I just expect
people to be negative about
me when there really isn't
any evidence”.

 “I just gabbled away all the  “No one seemed bothered

time, I must look like an by this. People came over to
idiot”. talk, I can’t be that bad”.

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Write down some of your thoughts now and write as many
answers or balanced thoughts as you can. Look out for
unhelpful thinking. This question might also help, “What would
you say to a friend who was thinking that way”?

The aim is to get better at catching these anxious thoughts and

answering back almost instantly. In time, you may also begin to
challenge your long term and faulty beliefs if you have some.
You need to accept that a thought is just a thought and is not
always true. It takes a lot of practice, but really does work.

Anxious thoughts Balanced thoughts

………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………… …………………………………
………………………………... …………..…………………….
………………………………… …………………………………
………………………………… …………………………………

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How can I stop focusing on myself?
Research has shown that people with social anxiety tend to
show an increase in self-focus in situations where they feel
anxious. This means that:
 They concentrate a lot on their own body, especially looking
for the symptoms of anxiety, e.g. shaking, sweating,
blushing, difficulties in speaking.
 They focus on their own thoughts with the negative images
and views of themselves mentioned in the previous section.
 They have a strong negative image of how they look to
others.
 The image is often not the way they appear to others as it is
driven by anxiety not reality.
 They believe they are the focus of everyone else's negative
and critical attention.
 They expect themselves to be perfect in social situations,
which very few people actually are.
 They judge themselves really harshly after the event. Often
going over this again and again, thinking how they could
have done better.
 Ways of reducing self focus are:
 Do not 'monitor' yourself in social situations, pay attention to
what is happening around you:
 look at other people and the surroundings;
 really listen to what is being said (not to your own
negative thoughts);
 don’t take all the responsibility for keeping conversations
going – silence is OK, other people will contribute.
 Begin to recognise that your physical symptoms of anxiety
are not as noticeable as you think. If you focus less on your
own body then you’ll stop noticing these symptoms.

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 Begin to look at other people to see if they show signs of
anxiety.
 Begin to believe that people will not dislike you because you
are anxious – would you dislike someone just because they
were anxious?
 Begin to note that you are really not the central focus of
everyone’s attention.
 Try not to go over social situations in your head after the
event. Remind yourself that negative judgements are
unhelpful and try to move on. One good way of doing this is
to distract yourself with another activity as soon as you start
to have negative thoughts about how a social situation has
gone. This might be playing on a game, reading, watching
TV. Anything that takes your mind off it.

Become more comfortable with uncertainty

We know that social anxiety can be triggered by feelings of
uncertainty. People who have social anxiety would prefer to
have 100% certainty about what will happen in social situations.
When they are not 100% sure of something, they are likely to
be more anxious about it, even when there is nothing to fear. It
is helpful for anxious people to try to become more comfortable
with and accept uncertainty as part of life. If you are a worrier
then it is most likely that you are trying to achieve 100%
certainty. But as 100% certainty is not often possible you have
probably noticed this is not very successful. To become more
comfortable with uncertainty try and change your behaviour to
act ‘as if’ you are comfortable with it. For example try to reduce
your tendency to ‘over plan’. Try to be more spontaneous. Let
go of control of some events and allow others to plan things for
you. It’s hard at first but will help you to reduce worry.

Try out some of these ideas if you can and see if they work for
you.

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How can I change my own behaviour?
Changing what you do is probably the most helpful way to
overcome social anxiety. We have already talked of how
avoidance and safety behaviours keep social anxiety going. It
will help to be clear which behaviours you need to tackle. The
following examples may help you to pinpoint your own
avoidance and safety behaviours.

Avoidance (write your own list here or tick)

 Not going to places ……………………………………………

where you will meet
people. ……………………………………………

 Asking other people ……………………………………………

to do things for you ……………………………………………
so you can avoid
having to meet ……………………………………………
people. ……………………………………………
 Avoiding talking to ……………………………………………
someone you know.
……………………………………………

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Safety behaviours (write your own list here or tick)

 Not looking people ………………………………………………

in the eye.
………………………………………………
 Saying little or
………………………………………………
letting someone
else do the talking. ………………………………………………
 Planning what to ………………………………………………
say or rehearsing
………………………………………………
words before
speaking. ………………………………………………
 Gripping objects ………………………………………………
tightly.
………………………………………………
 Going to a safe
………………………………………………
place/corners.
………………………………………………
 Looking away.
………………………………………………
 Keeping very busy.
………………………………………………
 Speaking quickly
………………………………………………
 Not speaking about
self. ………………………………………………
 Looking for a safe ………………………………………………
person to stick with. ………………………………………………

All of these types of avoidance and safety behaviours keep the

problem going. It is important to:
 Gradually reduce the avoidance and begin to face the things
you fear.
 Begin by making a list of all the avoidance and safety
behaviours that you aim to prevent.

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It may help to look at this example:

Fear of talking in front of a group of people

John fears talking in front of others. In the past he has avoided
this by using safety behaviours such as drinking alcohol, not
looking at others, keeping busy, speaking very quickly and staying
next to a close friend who talks a lot. Recently his problem has
got worse and he has stopped going to his local social club,
because of his fear. He really misses this. He has made up the
following 'anxiety ladder' where those targets easiest to achieve
are at the bottom and the most difficult situations are at the top.

John will begin with step 1 and gradually work towards step 6.
He will gradually reduce his safety behaviours and make sure
not to take on new ones!

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Try this for yourself. Make up your own anxiety ladder.
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How can I reduce my physical symptoms?

As anxiety is largely physical, our body is one of the first things
to be affected. In order to reduce the severity of physical
symptoms it is useful to ‘nip them in the bud’, by recognising the
early signs of tension.

Once you have noticed early signs of tension you can prevent
anxiety becoming too severe by learning to relax. Some people
can relax through exercise, listening to music, watching TV, or
reading a book. Relaxation or yoga classes may also be useful.

For others it is more helpful to have a set of exercises to follow.

Controlled breathing, deep muscle relaxation, mindful
breathing and distraction can all help in reducing tension and
switching off some of the physical signs of anxiety.

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Controlled breathing
To begin with, choose a time of day when you feel most
relaxed. You can do this exercise sitting or standing with your
eyes open or closed. Concentrate on your breathing for a few
minutes, breathing slowly and calmly in through your nose and
out through your lips. Place one hand on your chest and one
on your stomach. Imagine you are filling a bottle from the
bottom up, so the hand on your stomach moves first then your
hand on your chest. You are filling and emptying your lungs
with each breath. It may help to count in-two-three and out-two-
three. Once you have mastered the controlled breathing try
saying to yourself 'calm' as you breathe in and 'relax' as you
breathe out. Controlled breathing can be used any time and
anywhere to switch off the body's stress response.

Deep muscle relaxation

It is helpful to read through these instructions a few times first
and eventually learn them by heart. Start off by sitting or lying
somewhere warm and comfortable, where you won't be
disturbed. This relaxation exercise takes you through different
muscle groups in the body, teaching you firstly to tense, then
relax. Don't tense your muscles too tightly. It should not be
uncomfortable or painful. Each time you relax a group of
muscles notice how they feel when they are relaxed. Don’t try
too much to relax but just let go of the tension. Allow your
muscles to relax as much as you can. Think about the
difference in the way they feel when they are tense compared
to when they are relaxed.

It is useful to stick to the same order, as you work through the

muscle groups:
Breathing – Close your eyes and concentrate on your
breathing for a few minutes, breathing slowly and calmly in two-
three and out two-three. Say the word 'calm' to yourself as you
breathe in and 'relax' as you breathe out.

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Hands – Start with your hands. Clench one fist first and notice
the tension in your hand and forearm. Hold it and study the
tension for a minute...and then relax. You might feel a slight
tingling; this is the relaxation beginning to develop.
Arms – Bend your elbows and tense your arms. Feel the
tension especially in your upper arms. Remember, do this for a
few seconds and then relax.
Neck – Press your head back and roll it gently from side to
side. Feel how the tension moves. Then bring your head
forward into a comfortable position.
Face – There are several muscles here, but it is enough to think
about your forehead and jaw. First lower your eyebrows in a
frown. Relax your forehead. You can also raise your eyebrows,
and then relax. Now, clench your jaw, notice the difference
when you relax.
Shoulders – This is where we hold a lot of tension. Shrug your
shoulders up – then relax them. Notice the tension ease away
as you drop your shoulders down. Circle your shoulders slowly
and let go of any remaining tension.
Chest – Take a deep breath, hold it in for a few seconds, notice
the tension, then relax. Let your breathing return to normal.
Stomach –Tense your stomach muscles as tightly as you can
and relax.
Buttocks – Squeeze your buttocks together and relax.
Legs – Straighten your legs and bend your feet towards your
face then relax.
Feet – Point your toes to the floor, hold it for a few seconds,
then wiggle your toes. Imagine you are letting go of the last bit
of tension through your feet.

You may find it helpful to get a friend to read the instructions to

you. There are also many free relaxation resources online or to
buy. We have suggested some free resources at the end of the
booklet.

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To make best use of relaxation you need to:
 Practice daily.
 Start to use relaxation in everyday situations.
 Learn to relax without having to tense your muscles first, just
focus on the muscles and let the tension go.
 Use some relaxation techniques to help in difficult situations,
e.g. breathing slowly, dropping your shoulders.
 Practice in public situations (on the bus, in a queue etc).
 Use the deep, slow breathing, with the word calm to instantly
relax where ever you are.
 Slow down.
 Don't try too hard, just let it happen.

Mindful breathing
This is a different approach to managing stress. The goal of
mindful breathing is calm, non-judging awareness, allowing
thoughts and feelings to come and go without getting caught up
in them. The aim is to concentrate only on the present moment,
not the past and not the future. Much of our stress is linked to
thoughts and feelings about the past and the future, so just
being in the here and now can be very helpful. Follow these
instructions:
 Sit comfortably, with your eyes closed or lowered and your
back straight.
 Bring your attention to your breathing.
 Observe the natural rhythm of your breathing. Every time
you breathe in, notice what it feels like. Where do you feel the
breath? How does it feel? Each time you breathe out, notice
your lungs deflate. Notice the sensations as your lungs fill
and empty. Breathe in through your nose and out through
your lips.
 Thoughts will come into your mind, and that’s okay, because
that’s just what the mind does. You don't need to dwell on
them though. Just notice the thoughts, then bring your
attention back to your breathing.

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 You may notice sounds, physical feelings, and emotions, but
again, just bring your attention back to your breathing.
 Don’t follow those thoughts or feelings, don’t judge yourself
for having them, or analyse them in any way. It’s okay for the
thoughts to be there. Just notice those thoughts, and let them
drift on by bringing your attention back to your breathing.

Thoughts will enter your awareness, and your attention will

follow them. No matter how many times this happens, just keep
bringing your attention back to your breathing. The more you
can practice this exercise the better you will get at being in the
present moment. You can then start to be mindful in everyday
situations, bringing your full focus of attention to whatever you
are doing. Be it washing the dishes, having a shower or being
out for a walk.

There are many useful websites with further information about

mindfulness (see suggestions at the end of the booklet).

Distraction
We know that people with social anxiety tend to focus on
threatening information about social situations. This tends to
increase anxiety. Studies have shown that it can be helpful to
attend away from threatening information or thoughts.

If you take your mind off your symptoms you will find that the
symptoms often disappear. Try to look around you. Study
things in detail, registration numbers, what sort of shoes people
are wearing, conversations.

Whilst controlled breathing, relaxation, mindful breathing and

distraction techniques can help reduce anxiety, it is vitally
important to realise that anxiety is not harmful or dangerous.
Even if we did not use these techniques, nothing awful would
happen. Anxiety cannot harm us, but it can be uncomfortable.
These techniques can help reduce this discomfort.

28
You may have to accept a certain level of social anxiety, many
people have some social anxiety. By focusing on identifying
and getting on with your goals for life, based on values that are
important to you social anxiety may become less troublesome in
time.

Take things one step at a time

You will need to practise regularly to manage thoughts and
physical symptoms of anxiety using the skills you have learned
in the other sections. You will gradually learn that you can cope
and feel comfortable in social situations. It is worth
remembering that many other people feel anxious in social
situations too, it just doesn’t show. You are not the only one.

Summary - coping with social anxiety.

Understand all the parts of your anxiety, the physical

symptoms, the thoughts and beliefs and your safety and
avoidance behaviours.

Reduce negative thoughts by looking for and challenging

unhelpful thinking. Use balanced thoughts to get a fairer picture
of yourself. Do not spend time on self-critical review after social
events.

Reduce self focus - try not to monitor your own physical

symptoms and thoughts. Look to what is going on around you.
Reduce avoidance and safety behaviours by gradually facing
situations you fear whilst reducing safety behaviours.

Tackle the physical symptoms of social anxiety using

relaxation and other methods described.

29
Where can I get further help?
We hope you will use the exercises suggested in this booklet.
They may help you overcome social anxiety and return to
normal life.

If you feel you are making little progress or the problem is

getting worse then seek help in overcoming your problem.

Your GP is the best person to talk to first. Your GP may

suggest a talking treatment or tablets or both. He or she may
suggest you see a mental health worker who can offer expert
help with your problems. Cognitive behaviour therapy (CBT)
one to one with a therapist or in a group has been found to be
very successful for most people with social anxiety. Medication
prescribed by your doctor may also help.

If you feel so distressed that you have thoughts of harming

yourself then visit your doctor as soon as possible and explain
to him or her how you are feeling.

30
Useful organisations
 Anxiety UK
Infoline: 03444 775 774
Text service: 07537 416 905
Email: [email protected]
www.anxietyuk.org.uk
Provides information and support to people suffering from
anxiety disorders.
 Anxiety Care UK
www.anxietycare.org.uk
Provides information and support to those suffering from
anxiety. For emotional support please contact
[email protected]
 British Association for Counselling and Psychotherapy
Tel: 01455 883 300
Email: [email protected]
www.bacp.co.uk
Offers an information service providing contacts for
counselling in England and Wales.
 Healthwatch
www.healthwatch.co.uk
Healthwatch England is the independent consumer champion
for health and social care in England. Working with local
Healthwatch networks, we ensure that the voices of
consumers and those who use services reach the ears of the
decision makers.
 Mental Health Matters
Tel: 0191 516 3500
Email: [email protected]
www.mhm.org.uk
A national organisation which provides support and
information on employment, housing, community support and
psychological services.

31
 Mind Infoline
Tel: 0300 123 3393
Text: 86463
Email: [email protected]
www.mind.org.uk
Provides information on a range of topics including types of
mental distress, where to get help, drug and alternative
treatments and advocacy. Also provides details of help and
support for people in their own area. Helpline available Mon -
Fri, 9am - 6pm.
 The NHS website
www.nhs.uk
Information about conditions, treatments, local services and
healthy lives.
 Relate
Tel: 0300 100 1234
www.relate.org.uk
Help with marital or relationship problems.
 Rethink
Advice service: 0300 500 0927
Email: [email protected]
www.rethink.org
Provides information and a helpline for anyone affected by
mental health problems.
 Samaritans
Tel: 116 123
Email: [email protected]
www.samaritans.org
Freepost: RSRB-KKBY-CYJK, PO Box 9090, Stirling, FK8 2SA
Provides confidential support for anyone in a crisis.
 Social Anxiety UK
www.social-anxiety.org.uk
Email: [email protected]
Information on social anxiety disorder and tips for living with
the condition. No helpline available.

32
 Triumph over Phobia
Tel: 01225 571 740
Email: [email protected]
www.topuk.org
Provides national network of self help groups for people with
phobias or OCD.

33
Useful books
 Complete self help for your nerves
Claire Weekes
HarperCollins 2008
Guide for everything you need to know to keep relaxed
through everyday life. Offers comprehensive insight and
advice into coping with nervous stress.
 Feeling good: the new mood therapy
David Burns
HarperCollins 2005
A drug-free guide to curing anxiety, guilt, pessimism,
procrastination, low self-esteem, and other depressive
disorders.
 Feel the fear and do it anyway: how to turn your fear and
indecision into confidence and action
Susan Jeffers
Vermilion 2012
Will give you the insight and tools to vastly improve your
ability to handle any given situation.
 Living with fear (2nd revised edition)
Isaac Marks
McGraw-Hill 2005
This self-help guide gives practical advice to people who are
suffering from phobias, panic, obsessions, rituals or traumatic
distress.
 Managing anxiety: a training manual (2nd revised edition)
Helen Kennerley
Oxford University Press 1995
This practical guide provides clear guidelines for anxiety or
stress management for a wide range of disorders. It is
appropriate for use by psychologists and non-psychologists,
and is suitable for trainees and fully qualified health or
occupational professionals alike.

34
 Overcoming social anxiety and shyness: a self-help
guide using cognitive behavioural techniques
Gillian Butler
Robinson 2016
Outlines the nature of shyness, the symptoms and possible
causes and explains how to deal with upsetting thoughts,
overcome avoidance and manage symptoms of anxiety
through relaxation, distraction and panic management.
 The mindfulness and acceptance workbook for social
anxiety and shyness: using acceptance and commitment
therapy to free yourself from fear and reclaim your life
Jan E. Fleming MD, Nancy L. Kocovski PhD, Zindel V. Segal
PhD
New Harbinger 2013
A step by step programme to help you: understand social
anxiety in a new way, stop avoiding social situations, speak
in public and start participating fully in the life you want.
 We're all mad here: the no-nonsense guide to living with
social anxiety
Claire Eastham
Jessica Kingsley 2017
No-nonsense guide to surviving social anxiety.

For young people:

 The shyness and social anxiety workbook for teens: CBT
and ACT skills to help you build social confidence
Jennifer Shannon
New Harbinger 2012
This workbook for teens offers worksheets and comic-style
illustrated scenarios that help teen readers identify their
values and practice evidence-based skills from cognitive
behavioural therapy (CBT) and acceptance and commitment
therapy (ACT) for overcoming shyness and social anxiety.

35
Mindfulness downloads
 Franticworld.com Mindfulness: Finding Peace in a Frantic
World – Free meditations and mindfulness resources.
 www.headspace.com – A free taster of mindfulness, with an
opt-in to buy further sessions.
 www.freemindfulness.org – A collection of free to download
meditations.

Relaxation downloads
 http://wellbeing-glasgow.org.uk/audio-resources/
 www.cntw.nhs.uk/relaxation

References
A full list of references is available on request by emailing
[email protected]

Rate this guide

Share your thoughts with other people and let them know what
you think of this guide at www.cntw.nhs.uk/selfhelp

36
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You may not think these services have very much to do
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Mental Health
Self Help Guides
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Written by Dr Lesley Maunder and Lorna Cameron, Consultant
Clinical Psychologists.

Many thanks to local voluntary sector groups, service users and

healthcare staff who have contributed to the review of this guide.

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Published by Cumbria, Northumberland, Tyne and Wear NHS

Foundation Trust
2020 Copyright PIC/100/0220 February 2020 V4
Review date 2023

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