On 26 March 2026, ACAMH will host a webinar Practical techniques for managing social anxiety in everyday clinical work.
We caught up with the presenter – Dr. Eleanor Leigh, Associate Professor and MRC Clinician Scientist Fellow at the University of Oxford – about the topic itself, her career, and her hopes for the event.
What first got you interested in social anxiety in young people, and how did you come to specialise in it?
When I was at secondary school, I did work experience at a school for children with emotional and behavioural difficulties, which I loved, and it made me sure that I wanted to work with young people. While studying psychology as an undergraduate I was particularly drawn to clinical psychology modules, and I went onto clinical psychology doctoral training.
Later, working in young people’s services in the NHS, I noticed that despite social anxiety being so common, the existing gold standard anxiety treatments were not as effective as we would like. In response, I began a programme of work focused on developing and evaluating new treatments for socially anxious young people, drawing on effective approaches that already existed for adults.
Is social anxiety in young people getting worse in recent years – and is that due to the pandemic? Social media? What else?
Studies point to an increase in common mental health problems, such as anxiety and depression symptoms, in young people over the last decade, and it’s likely that the trend is similar for social anxiety.
The reasons for this increase are unclear. It may be that young people feel more able to report difficulties, because there is less stigma around mental health. It may also be related to factors like the pandemic and widening socioeconomic disparities, which have contributed to increasing stressors. At the moment we don’t know the precise causes. Social media may also play a part – digital landscapes add to social complexity – but the evidence is mixed, and we need more robust studies to better understand these potential relationships.
Importantly, while digital spaces can be a source of stress, they can also be a vehicle for effective treatment. Working closely with young people, we’ve developed a therapist-assisted internet-delivered therapy called OSCA. Young people complete modules and try out exercises in their own time, all supported by phone calls and messages with their therapist.
How common is social anxiety in young people, and how does it differ from ordinary shyness?
Social anxiety is the third most common mental health disorder. If you look around an average classroom, you can expect to see two or three young people with elevated social anxiety. It nearly always first occurs in the teenage years.
Social anxiety becomes a problem when it causes distress and impairment which interferes with a young person’s everyday life. When social anxiety gets in the way of learning in class, making friends, or carrying out everyday tasks like ordering in a café, it may benefit from intervention.
Why does social anxiety often go undetected?
Young people with social anxiety face particular challenges to seeking help. They might perceive social anxiety as a part of ‘who they are’ rather than a problem that can be treated. They may feel too embarrassed or ashamed to ask for help. They also tend to go under the radar – they may be quiet and not cause trouble, meaning difficulties can be missed by teachers, caregivers and others. There’s also a common assumption that teenagers are just shy, or that it’s just a phase.
Social anxiety can also be overlooked when it co-occurs with other difficulties, such as depression, which it often does.
On detection, what needs to improve?
Working with young people, families, schools, and services to understand the barriers and facilitators to help-seeking is key. Most services rely on young people asking for help in the first place. We know that young people with social anxiety often find this difficult to do.
We have learnt that taking a more proactive approach to detecting social anxiety can help. For example, at the moment, we’re running a clinical trial of a treatment for social anxiety in school mental health services, and by using active screening and triage we are identifying many young people who might otherwise be missed. There are useful key questions and very brief tools that are freely available that can help practitioners spot if social anxiety is a problem.
You mentioned the gold standard treatments might not work as well for social anxiety – what needs to change?
Most young people with anxiety – whether it’s general worry, separation anxiety, or social anxiety – will get the same kind of psychological therapy, which is graded CBT, also called graded exposure.
While this treatment has good outcomes overall, recent research suggests that it is more effective for general worry and separation anxiety, but less good for those with social anxiety.
Newer approaches specifically target the attention, behaviour and thinking processes that operate in social situations and that maintain anxiety. By targeting these processes directly, we can help young people learn how they come across in reality and feel more confident.
How common is social anxiety amongst autistic young people?
Roughly half of autistic young people experience social anxiety.
Historically, much of the research in this area has not included autistic young people. That is now changing. My colleagues and I have published a paper examining how psychological processes that maintain social anxiety operate in autistic individuals and how this may inform treatment.
What else do you hope attendees will get out of this session?
I hope they will feel more confident in their ability to recognise social anxiety in young people and to sensitively assess it.
I also want them to understand the core thinking and behaviour traps that can get in the way of people being able to learn positive things about themselves and their social environment and how these can be effectively targeted in treatment.