Social anxiety, also known as social phobia, is a common mental health disorder that affects individuals across the globe, often impacting their ability to lead fulfilling social lives. In Hong Kong, the impact of social anxiety is considerable. Local research has shown that up to 28.7%of Hong Kong residents are suffering from various degree of social anxiety symptoms.

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Despite these numbers, relatively few people seek help. Only 8.7% of affected individuals in Hong Kongseeks professional support, compared to over 20%in Western countries.

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What is Social Anxiety?

What is it about social anxiety that affects even the most confident people on the surface? Social anxiety disorder is a chronic mental health condition characterized by a pervasive fear of social situations where individuals feel they may be judged or scrutinized negatively by others. This condition often leads to avoidance behaviors, impacting one’s ability to participate in everyday activities such as public speaking, meeting new people, or engaging in casual conversations.

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For many, social anxiety can be a lifelong issue, significantly disrupting relationships, work, and daily routines. Although anxiety disorders generally show nearly a 2:1 female-to-male ratio in Hong Kong3, social anxiety does not show a notable gender difference. The condition typically begins in adolescence or early adulthood, making it crucial to recognize symptoms early and seek treatment if needed.

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What Are the Symptoms of Social Anxiety Disorder?

Individuals with social anxiety experience a range of symptoms that can affect their emotional well-being and physical health, often leading to significant lifestyle changes.

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1.Fear of being judged: A persistent worry about facing negative evaluation from others.

2.Fear of embarrassment: A deep-seated fear of doing something embarrassing in public.

3.Difficulty with strangers: Anxiety in situations that require interacting with people they do not know well.

4.Physical symptoms: Signs of distress, such as blushing, sweating, trembling, or a shaky voice, often intensify their anxiety.

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The excessive anxiety that’s out of proportion to the situation and these symptoms typically cause individuals to avoid social interactions, impacting their social lives and personal relationships.

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Diagnosis

Diagnosing social anxiety disorder involves a detailed assessment by a mental health professional to ensure that the condition is appropriately understood and treated. This typically includes a physical exam to rule out any underlying medical causes of symptoms, such as hyperthyroidism or medication side effects. The professional then examines the frequency, intensity, and specific situations that provoke anxiety. Identifying situational triggers helps distinguish social anxiety from general shyness, allowing for a tailored treatment approach.

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Criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association must be fulfilled.

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The use of screening tools like the Social Phobia Inventory (SPIN) may help to identify those who need to be referred to qualified healthcare professionals. A cutoff score ≥ 19 indicates the need for referral. SPIN also helps to monitor treatment progress.

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Treatment of Social Anxiety Disorder

Treatment depends on how much social anxiety affects the daily life of the individual. The most common treatment for social anxiety disorder includes psychotherapy, medication or both.

Social Anxiety Psychotherapy Treatments

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Psychotherapy, particularly cognitive-behavioral therapy (CBT), is highly effective for treating social anxiety disorder. CBT helps individuals identify and change cognitive distortion and their associated behaviour to improve emotional regulation and develop personal coping strategies.

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Cognitive-Behavioral Therapy (CBT)

CBT is widely regarded as one of the most effective treatments for social anxiety disorder, focusing on identifying, challenging, and transforming the distorted thought patterns and beliefs that fuel anxiety.

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Through CBT, individuals learn to recognize distorted thoughts about social interactions, such as fears of judgment or embarrassment, and replace them with more balanced, realistic perspectives. This process helps individuals move away from self-defeating thought cycles, encouraging them to develop healthier coping mechanisms. CBT also equips individuals with practical skills for managing anxiety, such as breathing exercises and thought-stopping techniques, which they can use during high-stress moments.

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Exposure-Based CBT

Exposure-based CBT is a specialized form of cognitive-behavioral therapy that involves gradually exposing individuals to feared social situations in a controlled and systematic way. This approach is structured to help patients slowly and safely confront situations that typically provoke anxiety, such as speaking in front of a group, meeting new people, or even making eye contact.

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Starting with less intimidating scenarios and progressively working toward more challenging situations, individuals build confidence and learn to manage their anxiety step-by-step. Techniques used in exposure-based CBT include role-playing social interactions, social skills training, and practising real-life scenarios in safe settings.

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Social Anxiety Drug Treatment

Selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. The serotonin and norepinephrine reuptake inhibitor (SNRI) also may be a treatment option.

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To reduce the risk of side effects, the treating doctor usually starts at a low dose of medication and gradually increases to a full dose. It may take several weeks to several months of treatment for those anxiety symptoms to noticeably improve.

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Don’t Give Up

Both psychotherapy and drug treatment don’t work quickly. Learning new skills to help manage one’s anxiety takes time and finding the right medication for society anxiety disorder takes time.

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For some people, the symptoms of social anxiety disorder may fade over time and medication can be discontinued but others may need to take medication for years to prevent a relapse.

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Overcoming socialization barrier for Social Anxiety in Hong Kong

Social anxiety is a prevalent mental health condition in Hong Kong, affecting individuals across various social and professional backgrounds. Unfortunately, the stigma around mental health issues often discourages people from seeking help, leading to prolonged struggles with anxiety and isolation.

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By increasing awareness and promoting open conversations about social anxiety, Hong Kong can foster a more inclusive society where people feel encouraged to seek help. With medication and/ or psychotherapies, or a combination of both, individuals with social anxiety can find effective ways to manage their symptoms and returning to society to lead fulfilling lives.

Remarks:

1. Source：新生精神康復會 (2023) https://www.nlpra.org.hk/annualreportdetail/tc/pub/330/253

2. Source：精神健康諮詢委員會 (2020) https://www.shallwetalk.hk/en/mental-health-information/anxiety-disorders/

3. Source: 社交恐懼症調查表 (2024) https://greenspacehealth.com/en-us/social-anxiety-spin/

4. Source : Lee, Ng, Kwok, & Tsang. (2009). Prevalence and correlates of social fears in Hong Kong. Journal of Anxiety Disorders, 23(3), 327-332.

5. Source : Lee, S., Lee, M. T. Y., & Kwok, K. (2005). A community-based telephone survey of social anxiety disorder in Hong Kong. Journal of Affective Disorders, 88, 183–186.

6. Source : Connor K.M., Jonathan R.T., et al. Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry (2000) 176: 379-386