My first signs of social anxiety emerged when I was around six years old. I'd been invited, at the last minute, to the birthday party of a boy in my class. When I arrived, his older brother noticed that I was shaking.
He asked if I was shy. “I’m just cold,” I told him, even though it was the middle of spring. He looked doubtful as he took my arm and led me into their living room.
My parents hoped that those fears would leave me as I grew up, but they continued well into adulthood. The shaking may have stopped, but my mouth would go dry and I’d blush heavily whenever I had to speak in a team meeting.
Such experiences are surprisingly common.
The UK’s National Institute for Health and Care Excellence (NICE) estimates that around 12 per cent of people will experience social anxiety disorder at some point in their lives, making it the most prevalent form of anxiety.
For a long time, it was seen as something purely in the mind – the anxiety being a reflection of personality, rather than biology. But researchers are starting to see it differently.
New studies suggest that the condition may be rooted in changes within the brain, and even the gut, offering clues not just to how social anxiety begins, but how it could be managed or reversed.
Anatomy of anxiety
Before we begin exploring this new science, it’s worth defining our terms. Almost everyone feels a little shy from time to time, but social anxiety disorder is ‘an overwhelming fear of social situations’, according to NICE guidelines.
People with social anxiety, these guidelines say, are afraid of doing or saying something that will result in embarrassment, humiliation or rejection by others.
They may worry about blushing, sweating, shaking or appearing nervous – or fear seeming boring, foolish or strange. Many also fret about talking too much or too little when anxious.
It’s different from introversion, a personality trait that describes some people’s preference for spending time with themselves over large groups, without worrying about how they perform in social situations.
Introverts may find quiet solitude restorative and noisy gatherings draining, but they’re quite happy meeting new people or presenting their work in front of others.
It’s perfectly possible to be both introverted and socially anxious, but the two don’t automatically go together.
Social anxiety, then, isn’t about preferring solitude – it’s about how the brain responds to perceived threat.
And with advanced scanning techniques, such as functional magnetic resonance imaging (fMRI), scientists can now watch that response unfold in real time, revealing the three key brain networks that appear to malfunction in people with the condition.
The first is the salience network, which includes the amygdala – an almond-shaped region deep in the brain that helps detect emotionally charged or threatening events.
The second is the executive control network, involving regions such as the middle frontal gyrus – a fold on the brain’s surface that supports focus, planning and emotional regulation.
Finally, there’s the default mode network, including areas like the precuneus near the brain’s centre, which becomes active when our minds wander or we reflect on ourselves.
In a healthy brain, these networks constantly shift in and out of gear, depending on what matters most in the moment.
When you’re reminiscing, for instance, the default mode network takes the lead, helping you sift through memories and make sense of them.
The salience network might then jolt into action if, say, you hear an unexpected loud noise; but most of the time, it should hum along quietly in the background, not demanding your full attention.
Holding a conversation, however, calls on the executive control network to keep your attention fixed on the other person so you can listen, think and reply appropriately.
For people with social anxiety disorder, the brain may struggle to switch between the different networks at the appropriate moments.
The amygdala in the salience network may become hyperactive, so that you interpret the slightest change in facial expression as a sign of hostility, triggering those familiar feelings of panic.
Or the default mode network may become overly active, fuelling self-conscious thoughts and inner commentary.
“[People with social anxiety] are very tuned in to how they’re feeling, such as the pounding of their heart, or they may be focused on how people are looking at them,” says Dr Franklin Schneier at Columbia University’s department of psychiatry.
In the end, it’s the disrupted interplay between these networks that seems to shape how social anxiety takes hold in the brain.
Yet that still leaves the deeper question: why do these systems falter for some people and not others?
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Gut feelings
For decades, psychology has explained social anxiety as something partly rooted in your upbringing.
Several studies show that children raised on an emotional knife-edge, given warmth one moment and coldness the next, are far more likely to grow into socially anxious adults.
But biology may also play a role.
Twin studies offer one of the clearest clues of this: by comparing identical twins, who share almost all their genes, with fraternal twins, who share only about half, researchers have found that social anxiety is partly genetic, with heredity accounting for around a third of the differences seen between adults.
One of the other more surprising discoveries is that the roots of social anxiety may extend far beyond the brain – to the trillions of microbes that live in the gut.
The idea has precedent. Studies as far back as 2016 revealed distinct microbiome profiles in people with depression, suggesting that our mental health may be shaped in part by the organisms living inside us.
To find out whether this would also be true for social anxiety, Dr Mary Butler at University College Cork, in Ireland, and colleagues analysed the faeces of 31 people with the disorder, and 18 without.
Sure enough, they found clear differences in the gut bacteria of the two groups – with higher levels of some species (such as Anaeromassillibacillus and Gordonibacter) and lower levels of others (like Parasutterella) in those with social anxiety.
To determine whether those differences could have a meaningful impact on people, the team transplanted some of the participants’ faeces into the stomachs of laboratory mice, before putting them through a series of behavioural tests.
One test analysing ‘social fear conditioning’ proved especially revealing. Here, mice were given a small electric shock whenever they approached another mouse, causing them to learn that social contact led to pain.
Butler and her colleagues found that the mice receiving their faecal transplant from someone with social anxiety disorder were much more susceptible to this form of conditioning.
They were also much slower to ‘unlearn’ the association when the electric shocks stopped.
Crucially, the transplant didn’t appear to alter other behaviours unrelated to the disorder. The mice weren’t, for example, more hesitant to explore an elevated maze, which would have indicated generalised anxiety.
“The striking part of our work was the specificity of the transferred phenotype,” says Butler. “The microbiota from donors with social anxiety disorder produced a social-fear-selective effect in otherwise behaviourally normal mice.”
In short, the microbes didn’t simply heighten general worries – they seemed to transmit the hallmarks of social anxiety itself, making the condition, in a sense, contagious.
Exactly why the differences in the microbiome might bring about those symptoms is unclear, though the team has some hypotheses.
For example, there’s some evidence that people with social anxiety disorder are more likely to convert the nutrient tryptophan – normally used to make brain chemicals like serotonin – into compounds such as kynurenine and kynurenic acid, which can disrupt how nerve cells talk to one another.
The differences in the gut microbiota might be responsible for this, which could contribute to the altered connectivity in the brains of people with social anxiety.
A better understanding of those pathways may ultimately lead to new treatments.
Butler points to an observational study of student diets, which found that those eating fermented foods – which are known to be good for the microbiome – tended to show fewer signs of social anxiety.
This doesn’t prove causality, of course. For that, we would need a clinical trial that compares a random sample of people eating a new diet with a control group taking a placebo.
But Butler believes that there’s certainly potential ahead. “Interventions such as probiotics and targeted dietary changes have [already] shown great promise in clinical trials for depression and generalised anxiety disorder,” she says.
“Diets rich in fermented foods or specific probiotics might one day complement conventional treatment approaches.”
Mind over chatter
Until dietary approaches are better understood, the standard treatment for social anxiety remains cognitive behavioural therapy (CBT).
In essence, it’s a form of training for your mind. Over a series of sessions, a therapist helps you gradually face the situations that trigger anxiety, while teaching you new ways to interpret your thoughts and reactions.
The theory is straightforward, but putting it into practice can be far harder. The trick is to start with small challenges before building up to the things that really daunt you.
You might begin by raising a point in a work meeting, for example, before giving a presentation to a few colleagues.
All the while, you can identify the negative thought patterns (‘I’m so awkward’, ‘I’m going to fail’) that could be transformed into more positive chatter.
“You can give your brain instructions at each stage, such as ‘I can do it even if it’s unpleasant’, ‘I’m no different from others’ and ‘I’ve faced similar situations before’,” says Dr Wenceslao Peñate Castro at the University of La Laguna in Tenerife.
On a neuronal level, this approach helps to restore balance across the three core brain networks discussed earlier.
It boosts activity in regions responsible for executive control, while dampening the overactive responses of the salience network that instinctively flags threat. “You begin a ‘dialogue’ with the amygdala,” Peñate Castro says.
With enough practice, he explains, these thinking strategies can bring about lasting changes in both the brain and behaviour. “Within a year, you might have someone giving a talk in public who was once unable to do so,” says Peñate Castro.
Cutting-edge research may help to accelerate that progress. One of the most intriguing is gaze-contingent music reward therapy, which aims to retrain the anxious brain’s habit of scanning for threat.
Developed by Prof Amit Lazarov at Tel Aviv University, the technique combines eye-tracking with your favourite music. It works like this: you’re shown grids of faces – some neutral, some expressing disgust – while your gaze is monitored.
The music continues to play only when you focus on the neutral faces, but cuts out if your attention lingers on the negative ones.
In Lazarov’s studies, this approach has helped people gradually shift their instinctive bias away from threat and towards calm.
After eight 12-minute sessions over four weeks, the participants showed a significant reduction in their symptoms of social anxiety, benefits that lasted for three months after the intervention had finished.
Those in a control group, who simply listened to their music during the sessions, saw no such improvement.
Like standard CBT, gaze-contingent music reward therapy seems to trigger measurable changes in brain activity.
In one fMRI study of people undergoing the treatment, Schneier and his colleagues found that greater connectivity within the executive control network, associated with focus and attention, predicted better outcomes at the end of the intervention.
Equally exciting are new strategies to manage the chatter in our heads using a process called self-distancing, pioneered by Prof Ethan Kross at the University of Michigan.
At its simplest, this involves talking to ourselves in the second- or third-person.
Before work, for instance, I might say to myself, ‘David feels nervous about his upcoming presentation’, and go on to describe the things that I fear and how I might cope with them.
It sounds childish, like you’re channelling Elmo from Sesame Street, but Kross has shown that it can ease emotional regulation.
As a result, self-distancing can soothe our stress in the face of many types of challenges, including difficult social situations.
During one series of studies, Kross asked participants to practise self-distancing while they met new people or gave a talk in public. In both situations, the participants showed fewer nerves.
They were more likely to make eye contact, for example, and to speak eloquently without too much hesitation, and less likely to fiddle with their hair or touch their face bashfully.
Crucially, the effect of self-distancing seemed to remain even at the highest levels of social anxiety – suggesting that it could benefit anyone who feels trepidation at a forthcoming engagement, be that a simple trip to the shops or an upcoming TED Talk.
I can vouch for its effectiveness: since learning about Kross’s research a few years ago, I’ve found my social anxiety dissipating. It’s helped me to feel more confident at parties, in media interviews and on the stage at literary festivals.
As an adolescent, I had worried that my shyness would define my life, but as I enter my forties, I know that it’s no longer an essential part of my personality.
Social anxiety, I’ve learned, is just a pattern of brain activity that can change.
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