More than Shyness: What is Social Anxiety Disorder and how is it Treated

Presented by Daniela Colognori, Psy.D.
View this webinar by clicking here
Download this webinar’s corresponding slides here.
Dr. Colognori discussed that Social Anxiety Disorder is a prevalent anxiety disorder that often goes undetected and untreated because many discount it as “normal shyness” or “just a phase.” She described present evidence-based treatment approaches as well as parenting strategies to aid in the prevention and treatment of this disorder.


  1. KelleyT says:

    Which of the strategies discussed tonight would be most helpful to a child who is selectively mute?

    • Dr. Colognori says:

      There is some debate about whether selective mutism represents the severe end of a continuum that includes social anxiety disorder, or whether it is a separate phenomenon that also includes some degree of oppositionality and speech deficits. Regardless of these debates, CBT has been effective with selective mutism and many of the guiding principles of treatment are similar, particularly the use of exposure. The main difference is that items on the hierarchy would be more focused on communication (e.g. making nonverbal gestures, whispering in easy situations, whispering in more difficult situations, giving one word answers, giving previously scripted answers, etc.). Also, the use of rewards as reinforcement is more critical because the end result of a successful exposure may not be as intrinsically motivating to the child as a successful social interaction (as in a social anxiety exposure). If your family or the family you have in mind when asking this question is near the NYC area, there is a week-long treatment camp for kids with selective mutism that will be run by the NYU Child Study Center in mid-August.

  2. KelleyT says:

    What about a child who stares at you when you ask a question, or is asked to give an opinion, etc. and just continues to stare…would you consider this s.a.d.? More importantly, would someone with s.a.d. also exhibit bizarre behavior, speaking to self, mumbling under his breath etc.?

    • Dr. Colognori says:

      Not responding to others’ questions or comments is not unusual for someone with severe social anxiety disorder, and if it happens consistently may meet criteria for selective mutism. It is also not unusual for individuals to mumble to themselves, especially if they feel too anxious to say these things out loud. Based on your brief description, I might also consider an auditory processing deficit.

  3. KelleyT says:

    Will the book help my anxious child cover teen issues as well. Daughter is 16, she has been in group therapy for a year, now on medication, but I want to maintain treatment on my end.

    • Dr. Colognori says:

      Rapee’s book is geared a little more toward children but all the core concepts will certainly be applicable to adolescents.

  4. KelleyT says:

    What if the kids have given up on their grades? That wouldn’t be incentive.

    • Dr. Colognori says:

      Correct, not all kids are motivated by grades, but most parents are and it can often be a useful motivator to convince parents that S.A.D. is impairing the child enough to warrant intervention. The key to working with individuals with social anxiety (who are, by definition, impaired in at least one major domain), is finding something they really care about and enjoy but are not able to do because of social anxiety. This could relate to athletics, music, art, travel, anything really. It can sometimes take awhile to discover what this is, but without motivation, it is almost impossible to engage them in exposures.

  5. KelleyT says:

    Your slide about possible eating issues in front of people, is there any known link between social anxiety and eating disorders?

    • Dr. Colognori says:

      I am not aware of specific data about the comorbidity of eating disorders and social anxiety disorder, but it is important to evaluate the content of the fear. Individuals with social anxiety disorder avoid eating in front of others for a variety of different reasons, but the core fear is related to making a “social mistake” or doing something embarrassing, rather than gaining weight. These individuals often have no difficulty eating in front of close friends or family members.

  6. KelleyT says:

    Your slide about lacking social skills – Is it possible that SA could be kind of a chicken and egg problem? Some anxiety is present, but can develop into social phobia because a child does not know how to behave/react/conduct themselves in social settings. As they get older they are unprepared and thus lack confidence?

    • Dr. Colognori says:

      You make a good point about the association between social anxiety and social skills deficits. While we know that one exists, we have little data about causal factors (e.g., which comes first). The current theory reflects a “cyclical” interaction. Social skills deficits lead to lack of success in social situations, which in turn, is hypothesized to result in expectancies of poor outcomes and negative thoughts about future social situations, which generates anxiety and avoidance. In addition, the experience of anxiety in social situations further inhibits/diminishes the effectiveness of the individuals’ social skills, impairing social performance. Similarly, avoidance will reduce the opportunity for learning new skills, further contributing to the perpetuation of the cycle (article by Spence, Donovan, & Brechman-Toussaint, 1999). It is important to note that this theory also acknowledges the role of genetic factors, temperament, and parental practices.

  7. KelleyT says:

    I have a preschooler in my class who has been diagosed on the autistic spectrum. As his communication skills have improved, particularly for pragmatic and social language, his behavior appears less autistic like and reflects more of the social anxiety symptoms you described. Can you speak about the relationship between autism and social anxiety disorder. Have you had success with the use of social stories with this young population? My teacher tip and reward for this child has been a Staples button, “That was easy!!”

    • Dr. Colognori says:

      I am far from an expert on autism spectrum disorders, but the main distinction between social anxiety disorder and autism spectrum disorders is the ability and desire to form social relationships. While kids with social anxiety disorder may have some deficits in social skills, they do not have the same level of impairment as children with autism, and they are very aware (sometimes overly aware) of social cues. This is not the case in kids with autism. Another factor to consider is whether the child seems to have a desire to interact and form relationships with others. Individuals with social anxiety often feel lonely and isolated, and have a strong desire to form relationships. They sometimes make excuses that they are happy being alone, but it is usually easy to tell that this is just avoidance. On the other hand, children on the autistic spectrum are usually content to play/entertain themselves and do not seek social interaction. Autism Spectrum Disorders also include other behaviors that are not seen in Social Anxiety Disorder, such as restricted interests and repetitive behavior.

  8. KelleyT says:

    Does it matter what school professional should monitor or control the therapy group situation? Could it be a Speech-Language Specialist in the school setting?

    • Dr. Colognori says:

      School is an ideal place to conduct treatment groups for Social Anxiety Disorder, and I believe that many different types of professionals could be successful facilitating such groups. However, I would strongly discourage attempting this without significant training in CBT, specifically how to conduct exposures, which can end up doing more harm than good if they are not conducted correctly.