While there are numerous manifestations of social anxiety, including performance anxiety, fear of public speaking, selective mutism, erythrophobia (fear of blushing), hyperhidrosis, fear of being noticeably nervous, school phobia, dependent personality, and pervasive social avoidance, there are two basic types of individuals who have the problem: These are people with “initiative” and those without “initiative”. Initiative does not mean ability. It means the motivation to start up or motivation to get help. When an individual of any age does not have initiative, treatment begins with parents, given the avoidance-dependence dynamic.

The dynamic that distinguishes social anxiety from other anxiety disorders is the element of performance. That said, social anxiety is commonly co-morbid with other anxiety symptomatology; especially Obsessive-Compulsive Personality Disorder, which includes perfectionism and Obsessive-Compulsive Disorder.

Jonathan’s book Beyond Shyness: How to Conquer Social Anxieties (Simon & Schuster) was so named because “shyness” is too abstract and nonfunctional a term. The reality is that shyness is social anxiety. The question is, to what degree is it present? To really understand the phenomenon, it is important to understand its components. Think of F.A.T.E. (See Figure 1).

Any treatment modality that does not integrate this architecture is, in essence, trivializing the problem.

The biggest confusion that people experience when starting treatment is understanding how ingrained the problem can become. That’s the reason intervention as early as possible will facilitate high performance treatment.

Each individual has their own learning curve. The primary variables for this include length of the problem, severity of the problem, motivation, expressive ability, ability to integrate new concepts, readiness to face fear, and degree of obsessive worry and panic.