Social anxiety disorder (SAD), also known as agoraphobia, is a form of anxiety disorder in which sufferers experience feelings of fear and anxiety in public settings, accompanied by corresponding physical reactions such as blushing, a racing heartbeat, trembling, sweating, shortness of breath, dizziness, muscle tension and nausea.

These symptoms can cause significant disruption to their daily lives and, at times, immense distress.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for social anxiety disorder are:

• Persistent fear and anxiety in social situations

• Excessive anxiety about being criticised or rejected by others

• A tendency to avoid social situations as much as possible, whilst simultaneously feeling anxious about one’s own refusal to participate and believing that such avoidance is wrong

• Excessive fear and anxiety that cannot be alleviated even when one is aware of it

• Social fear and anxiety persisting for six months or longer

• The aforementioned physical and psychological issues are not caused by other medical conditions

Social anxiety disorder is one of many forms of anxiety disorder. Whilst there are numerous online self-assessments available, I would advise against taking them too seriously, as most are intended primarily for entertainment. 

If you genuinely have concerns in this regard, it is best to seek a formal assessment at a specialist hospital, where more professional tests can be carried out to provide an authoritative diagnosis. I am merely offering a brief introduction here.

Currently, there are actually many treatment methods for social anxiety disorder. Apart from medication, the most common approach is cognitive behavioural therapy.

Cognitive Behavioural Therapy (CBT) is a psychological and behavioural intervention that treats various mental health conditions by modifying the physical responses people exhibit when facing certain situations. It has proven highly effective in treating conditions such as anxiety disorders, post-traumatic stress disorder (PTSD), anorexia nervosa and borderline personality disorder.

The philosophy behind Cognitive Behavioural Therapy has its origins in ancient philosophical systems, of which the Stoic school is the most prominent. Stoicism, also known as the Stoic school, was a philosophical school founded in Athens in the 3rd century BC by the ancient Greek philosopher Zeno of Citium (Greek: Ζήνων, 335 BC–263 BC). Its adherents focused on personal happiness and virtue ethics, and their most famous tenet was that ‘virtue is the only good’.

Together with Aristotelian ethics, this school laid the foundations of virtue ethics.

In 1924, Mary Cover Jones, an American psychologist and pioneer of behaviour therapy, introduced the concept of cognitive behavioural therapy in her work discussing how to eliminate fears in children. It is worth noting here that Mary was the second wife of John B. Watson, the American psychologist who conducted the famous ‘Little Albert experiment’ in the history of psychology; I shall be producing a dedicated video to introduce this experiment to you all.

Over the following half-century, cognitive behavioural therapy began to be implemented worldwide, with numerous psychologists conducting various explorations in this field. In 1960, the American psychiatrist Aaron Temkin Beck developed what is now known as cognitive behavioural therapy, building upon the research of his predecessors; he is therefore regarded as the father of cognitive therapy (CT) and cognitive behavioural therapy (CBT).

In the summer of 1921, a little boy was born into a Jewish family in the United States. He was the youngest son; his father was a local publisher and an active free-thinker who enjoyed sharing his views with others, whilst his mother had recently suffered from depression following the death of one of her children, though her condition had improved somewhat with the arrival of the little boy.

At primary school, the boy consistently struggled to keep up with his studies and had to repeat Year 1. This was a huge blow to him, and he began to resist going to school; the mere thought of attending filled him with anxiety and panic. Yet he also felt utterly incapable, wondering why he could not overcome his difficulties. Eventually, he even came to believe that he was inherently inferior to others and that this was simply how his life would be.

It was not until one day, when he confided this distress to his mother, that she explained to him that his frequent illnesses from a young age were the reason he had fallen behind in his studies. This suddenly gave the young boy a great deal of confidence; he began to study diligently and eventually graduated from primary school a year ahead of his peers.

In 1946, the boy graduated from Yale Medical School with a Bachelor of Medicine degree. He subsequently enlisted in the army as a military doctor; during his service, he served as Deputy Director of Neuropsychiatry at the Foch Valley Military Hospital. In 1954, he became a lecturer at the University of Pennsylvania. That little boy was Aaron Beck.

Through many years of clinical observation, Baker discovered that many patients suffering from mental illness exhibited a phenomenon known as ‘internal monologue’. Whilst they were berating others, they were simultaneously berating themselves internally: ‘I shouldn’t have done that; I’m really terrible.’

However, this inner monologue is not easily detected and requires the therapist to pose specific questions to the patient. Through years of exploration, Beck gradually developed a therapeutic model that helped patients become aware of the root of their problems and gradually regain a sense of control over their lives. This therapeutic approach is known as cognitive behavioural therapy.

Having accumulated a substantial body of case studies and clinical experience, he also developed a series of quantitative scales to assess depression and anxiety, designed to assist people in self-assessment. In particular, the Beck Depression Inventory (BDI) is now widely used as a medical tool for measuring the severity of depression.

In 1994, he and his daughter, Judith S. Beck—who is also a psychologist—founded a non-profit organisation, the Beck Institute for Cognitive Behavioural Therapy, to conduct more in-depth research into CBT and to provide CBT treatment and related training.

CBT treatment typically involves the following steps:

• Prior to the first session, the therapist will conduct a psychological assessment of the patient to identify the issues requiring correction and the situations in which distressing emotions arise.

• Once goals have been established, the therapist will ask the patient to describe their situation as objectively as possible and encourage them to share their thoughts, whether positive or negative. Some patients may be reluctant to express themselves at first; in such cases, they can use a ‘thought diary’ to write down their thoughts.

• The therapist helps patients identify when negative emotions arise and teaches them techniques to help alleviate these feelings.

• Once patients recognise when these negative emotions occur, the next step is to change their previous negative coping strategies and replace them with more positive and effective ones—much like breaking a bad habit.

• Once these approaches begin to show results, the focus shifts to maintaining this positive habit over the long term, ensuring that negative emotions no longer feel so overwhelming. Perseverance is the ultimate victory.

• Through regular follow-up appointments after treatment, patients can monitor their progress through ongoing discussions with their doctor, enabling them to move more confidently towards a fulfilling life.