Social anxiety

People rarely describe the event itself. They describe the two things on either side of it: the rehearsing beforehand and the replaying afterwards.

Before — a sentence practised four times before a phone call. A message drafted, deleted, rewritten. After — the same thirty seconds of a conversation run again and again at night, hunting for the moment something was said wrong.

The situations people name are ordinary ones. Speaking in class. A viva. A presentation at work. Ordering at a counter with people waiting behind. A shaadi with three hundred guests, where sitting quietly in a corner gets noticed and asked about, which makes the corner no longer safe either.

There is usually a physical part people are embarrassed by: heat rising in the face, a shaking voice, a mind that goes completely blank while everyone waits. And the fear underneath is specific — not of the task, but of being judged, or of everyone seeing that you are nervous.

The cost is quiet, which is why it goes on so long. It looks like a preference. A teenager who "doesn't like parties". An employee who "prefers the back office". A student who "isn't a presentations person".

Recognising yourself in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess you, and there is nothing here for you to score yourself against.

Shyness and social anxiety are not the same thing, though they look alike from outside. Shyness is a temperament, and generally not something that costs a person much. What people bring to a clinic is different in one particular way: avoidance has started making decisions.

What a clinician pays attention to is duration and cost. Difficulty that has been there for months or years rather than around one bad experience that has passed. A subject dropped, a course not chosen, a job not applied for, a promotion turned down because it involves presenting. Invitations declined so consistently that they stopped arriving. A degree at risk because attendance or participation is required.

Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that the question is a reasonable one to bring, and that plenty of people bring it.

PHC is an assessment-first practice. Before therapy begins there is an initial session, and its job is to work out what is actually happening rather than to start treating it.

1. An initial sessionWe ask what has been going on, for how long, and what it is costing you. If talking to someone new is the hardest part, say so at the start — that is useful clinical information, not a bad beginning.
2. Emotional assessment and symptom screeningA structured screening of emotional functioning and what you are presenting with, using internationally validated instruments. Its purpose is to decide which further tests, if any, are clinically warranted — you will not be given tests you do not need.
3. A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, your presenting needs and clinical fit.
4. Therapy, reviewed as it goesThe modality most often indicated here is Cognitive Behavioural Therapy (CBT), which PHC uses for anxiety, depression and negative thought patterns. Where the work reaches a point of practising with other people rather than talking about them, group psychotherapy is one of the routes PHC offers. Sessions are 50 minutes, in clinic at our DHA clinic or in PECHS, or online.

Confidentiality, session length, fees and choosing your psychologist are answered in full in questions people ask before booking.

• Anxiety
• Panic attacks
• Low self-esteem
• Emotional assessment
• CBT at PHC