Jack Harley, Therapeutic Neuroscience at Oxford University
reviewed by Dr Michael Yapko
Monday, June 22, 2020
Jack Harley, Therapeutic Neuroscience at Oxford University
Monday, June 22, 2020

Hypnosis for Social Anxiety: How Can it Help?


Can hypnosis help social anxiety? The science seems to suggest so! Social anxiety is more than shyness. It is a serious mental health condition that causes persistent fear of social situations. It often starts during the teenage years then persists into older age, and treatment may be required.

What is social anxiety?

Social anxiety disorder (also called social phobia) is a common type of anxiety disorder affecting 7.5% of people worldwide. It is a mental health condition that typically features an intense fear of being watched or judged by others. Those with the disorder feel uncomfortable in everyday situations – such as speaking with friends, meeting new people, or eating in front of others. Social anxiety can affect a person’s school, work, or daily activities. It can make it hard to make and keep friends and can lead to complete avoidance of social interactions. (1)

What are the signs and symptoms of social anxiety?

Social anxiety disorder may show a range of symptoms such as:

• Feeling self-conscious and afraid others will judge you

• Staying away from places where there are people

• Avoiding eye contact and speaking with a soft voice

• Difficulty sleeping

• Dizziness

• Chest pain

• Restlessness

• Nausea (2, 3)

Social anxiety and panic attacks

The fear of social situations due to social anxiety may escalate into a panic attack. Panic attacks may last several minutes, even hours (though rarely) and cause physical symptoms, including:

• Nausea

• Trembling

• Sweating

• Heart palpitations

Although distressing, these symptoms are generally transient and do not cause any physical harm. (4)

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How is social anxiety disorder diagnosed?

Like other mental health conditions, social anxiety disorder is diagnosed based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) or International Classification of Diseases-10th edition (ICD-10). For social anxiety disorder, these include:

• A persistent fear of social situations.

• Fear of being exposed to unfamiliar people or scrutiny by others.

• Fear of acting in a humiliating or embarrassing way.

• The fear impacts upon a person’s normal routine, functioning and relationships.

• The fear is not due to an existing mental disorder or substance (e.g. drugs).  (5)

Social anxiety may stop people getting social contact

People with social anxiety often feel conflicted about interacting with others. Instinctively they often know they need social contact, but fear of embarrassment or humiliation may lead them to avoid others. They may shy away from normal behaviours such as:

• Shopping

• Starting conversations

• Speaking on the telephone

• Working

• Meeting strangers

• Eating with other people (6, 7, 8)

Complications of social anxiety

Social anxiety may sometimes cause people to experience low self-worth and feel insecure, which can lead people to lose or quit their job, experience a marriage breakdown, or stop socialising with friends. Further repercussions may include an incapacity to relax that may lead to misuse of drugs, alcohol, or reliance upon other negative coping behaviours. (9, 10)

What causes social anxiety disorder?

The exact cause of social anxiety is not known. However, as with many mental health conditions, a combination of genetic predispositions and environmental factors is thought to be involved. Several factors thought to increase the risk of social anxiety include:

• Family history of social anxiety

• Misreading other people’s behaviours as threatening

• Overprotective and highly critical parents

• Underdeveloped social skills and lack of confidence (11, 12)

What other anxiety disorders are there?

Social anxiety disorder is one of six anxieties disorders listed in the (DSM-5). The other disorders are:

• Generalized anxiety disorder

• Panic disorder

• Post-traumatic stress disorder (PTSD)

• Phobias

• Obsessive-compulsive disorder (13)

How does hypnosis work?

Hypnosis is a highly focused, deeply absorbed state of attention. The hypnotherapist will help you become relaxed and focused, thereby reducing distracting thoughts and feelings while encouraging you to become more receptive to new ideas or perspectives. Hypnosis can allow you to learn new social skills and relaxation strategies that can help you integrate these tools for you to use more effortlessly, a process called automaticity.

Hypnotherapy for social anxiety

In social anxiety disorder, social situations act as a trigger for emotional responses of fear. Hypnotherapy can allow the feeling of fear to subside to easily managed levels. A common method called systematic desensitization involves slowly exposing subjects to fearful situations. The goal is to make the scenarios feel normal in real life.

This process is divided into three stages:

1. Hypnosis and relaxation training: the therapist teaches the subject to enter a deep state of relaxation.

2. Building a hierarchy: the therapist builds a hierarchy of suggestions based on the subject’s individual’s social fears. Easy situations may include talking to a close family member, and more difficult scenarios might involve as talking to a stranger.

3. Gradual exposure to feared situations: the therapist guides the subject to imagine the less frightening social situations, then slowly introduces more challenging scenarios. (16, 17, 18)

What does the science say?

There are many studies published that have described the merits of hypnosis as an effective treatment for treating social anxiety in combination with other approaches. Hypnotherapy has also been shown to be helpful for a range of anxiety disorders and phobias such as:

• Generalized anxiety disorder (19)

• Test anxiety (20)

• Airplane phobia (21)

• School phobia (22)

• Public speaking anxiety (23)

• Panic disorder (24)

• Sexual performance anxiety (25)

• Post-traumatic stress disorder (26)

Hypnotherapy has also been shown to improve the effectiveness of cognitive-behavioural therapy (CBT). (27)

Accessing hypnotherapy

Hypnotherapy clinics are located around the world and many specialize in social anxiety. A more affordable option is hypnotherapy available from smartphone applications such as Mindset. These apps allow direct access to professional hypnotherapy recordings.

Another option is self-hypnosis, in which the subject learns to enters a deep state of relaxation, then gives him or herself detailed suggestions for more effectively managing social anxiety. (28)

Are there risks with hypnotherapy?

Hypnotherapy is a highly safe and pleasant experience in the majority of people. Realistically, any technique that has the potential to help can also harm if it is misapplied. The hypnotherapy sessions offered in Mindset have been developed by leading experts who consistently encourage a focus on the positive and what you can learn that will be beneficial to you. If you have any concerns, however, you may wish to consult a mental health professional before engaging in hypnotherapy for social anxiety. (29)

A Word from Mindset Health

Social anxiety disorder is a common mental problem that can have a severe impact on life. The disorder may be socially crippling and prevent people from participating in everyday activities. Fortunately, hypnotherapy is a promising treatment that has been used successfully to reduce anxiety and promote easier social interaction.

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Our Sources

Mindset Health only uses high-quality sources, including peer-reviewed research, to support our articles. We work with experts to ensure our content is helpful, accurate and trustworthy.

1. Fehm, L., Beesdo, K., Jacobi, F. and Fiedler, A., 2008. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social psychiatry and psychiatric epidemiology, 43(4), pp.257-265. https://link.springer.com/article/10.1007/s00127-007-0299-4

2. Cath, D.C., Ran, N., Smit, J.H., Van Balkom, A.J. and Comijs, H.C., 2008. Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: a preliminary case-controlled study. Psychopathology, 41(2), pp.101-110. https://www.karger.com/Article/Abstract/111555

3. Lochner, C., Mogotsi, M., du Toit, P.L., Kaminer, D., Niehaus, D.J. and Stein, D.J., 2003. Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology, 36(5), pp.255-262. https://www.karger.com/Article/Abstract/73451

4. Stein, M.B. and Stein, D.J., 2008. Social anxiety disorder. The lancet, 371(9618), pp.1115-1125. https://www.sciencedirect.com/science/article/pii/S0140673608604882

5. Heimberg, R.G., Hofmann, S.G., Liebowitz, M.R., Schneier, F.R., Smits, J.A., Stein, M.B., Hinton, D.E. and Craske, M.G., 2014. Social anxiety disorder in DSM‐5. Depression and anxiety, 31(6), pp.472-479. https://repository.ubn.ru.nl/bitstream/handle/2066/133519/133519.pdf?sequence=1

6. Aderka, I.M., Hofmann, S.G., Nickerson, A., Hermesh, H., Gilboa-Schechtman, E. and Marom, S., 2012. Functional impairment in social anxiety disorder. Journal of anxiety disorders, 26(3), pp.393-400. https://www.sciencedirect.com/science/article/abs/pii/S0887618512000084

7. Leary, M.R., Knight, P.D. and Johnson, K.A., 1987. Social anxiety and dyadic conversation: A verbal response analysis. Journal of Social and Clinical Psychology, 5(1), pp.34-50. https://guilfordjournals.com/doi/abs/10.1521/jscp.1987.5.1.34

9. Pierce, T., 2009. Social anxiety and technology: Face-to-face communication versus technological communication among teens. Computers in Human Behavior, 25(6), pp.1367-1372. https://www.sciencedirect.com/science/article/pii/S0747563209000971

9. Filsinger, E.E. and Wilson, M.R., 1983. Social anxiety and marital adjustment. Family Relations, pp.513-519. https://www.jstor.org/stable/583691?seq=1

10. Buckner, J.D., Heimberg, R.G. and Schmidt, N.B., 2011. Social anxiety and marijuana-related problems: The role of social avoidance. Addictive Behaviors, 36(1-2), pp.129-132. https://www.sciencedirect.com/science/article/abs/pii/S0306460310002510

11. Low, N.C., Cui, L. and Merikangas, K.R., 2008. Specificity of familial transmission of anxiety and comorbid disorders. Journal of psychiatric research, 42(7), pp.596-604. https://www.sciencedirect.com/science/article/abs/pii/S0022395607001082

12. Cartwright-Hatton, S., Tschernitz, N. and Gomersall, H., 2005. Social anxiety in children: social skills deficit, or cognitive distortion?. Behaviour research and therapy, 43(1), pp.131-141. https://www.sciencedirect.com/science/article/abs/pii/S0005796703003000

13. Stein, D.J., Craske, M.A., Friedman, M.J. and Phillips, K.A., 2014. Anxiety disorders, obsessive-compulsive and related disorders, trauma-and stressor-related disorders, and dissociative disorders in DSM-5. American Journal of Psychiatry, 171(6), pp.611-613. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14010003

14. Brown, D.P. and Fromm, E., 2013. Hypnotherapy and hypnoanalysis. Routledge. https://www.taylorfrancis.com/books/9781315825519

15. Wolberg, L.R., 2013. Medical Hypnosis-Volume I-The Principles of Hypnotherapy. Read Books Ltd. https://psycnet.apa.org/record/2009-04133-000

16. O'Brien, G.T. and Borkovec, T.D., 1977. The role of relaxation in systematic desensitization: Revisiting an unresolved issue. Journal of Behavior Therapy and Experimental Psychiatry, 8(4), pp.359-364. https://www.sciencedirect.com/science/article/pii/0005791677900039

17. Miller, A., 1986. Brief reconstructive hypnotherapy for anxiety reactions: Three case reports. American Journal of Clinical Hypnosis, 28(3), pp.138-146. https://www.tandfonline.com/doi/abs/10.1080/00029157.1986.10402644

18. Spies, G., 1979. Desensitization of test anxiety: Hypnosis compared with biofeedback. American Journal of Clinical Hypnosis, 22(2), pp.108-111. https://www.tandfonline.com/doi/abs/10.1080/00029157.1979.10403207

19. Golden, W.L., 2012. Cognitive hypnotherapy for anxiety disorders. American Journal of Clinical Hypnosis, 54(4), pp.263-274. https://www.tandfonline.com/doi/abs/10.1080/00029157.2011.650333

20. Sapp, M., 1991. Hypnotherapy and test anxiety: Two cognitive-behavioral constructs: The effects of hypnosis in reducing test anxiety and improving academic achievement in college students. Australian Journal of Clinical Hypnotherapy and Hypnosis. https://psycnet.apa.org/record/1992-24581-001

21. Golden, W.L., 2012. Cognitive hypnotherapy for anxiety disorders. American Journal of Clinical Hypnosis, 54(4), pp.263-274. https://www.tandfonline.com/doi/abs/10.1080/00029157.1981.10404029?journalCode=ujhy20

22. Lawlor, E.D., 1976. Hypnotic intervention with “school phobic” children. The International journal of clinical and experimental hypnosis, 24(2), pp.74-86. https://www.tandfonline.com/doi/abs/10.1080/00207147608405599

23. Schoenberger, N.E., 1995. Effectiveness of a cognitive-behavioral hypnotherapy for public speaking anxiety. https://www.tandfonline.com/doi/abs/10.1080/00029157.2011.650333

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25. de Shazer, S., 1978. Brief hypnotherapy of two sexual dysfunctions: The crystal ball technique. American Journal of Clinical Hypnosis, 20(3), pp.203-208. https://www.tandfonline.com/doi/abs/10.1080/00029157.1978.10403931

26. Abramowitz, E.G., Barak, Y., Ben-Avi, I. and Knobler, H.Y., 2008. Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: a randomized, zolpidem-controlled clinical trial. Intl. Journal of Clinical and Experimental Hypnosis, 56(3), pp.270-280. https://www.tandfonline.com/doi/abs/10.1080/00207140802039672

27. Allison, D.B. and Faith, M.S., 1996. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: A meta-analytic reappraisal. Journal of consulting and clinical psychology, 64(3), p.513. https://psycnet.apa.org/record/1996-05271-011

28. Fromm, E., Brown, D.P., Hurt, S.W., Oberlander, J.Z., Boxer, A.M. and Pfeifer, G., 1981. The phenomena and characteristics of self-hypnosis. International Journal of Clinical and Experimental Hypnosis, 29(3), pp.189-246. https://www.tandfonline.com/doi/abs/10.1080/00207148108409158

29. Mott, T., 1987. Adverse reactions in the use of hypnosis. https://www.tandfonline.com/doi/abs/10.1080/00029157.1987.10734343?journalCode=ujhy20

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