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Therapy for the fear of being judged
Treatment of Social Anxiety (Social Phobia)
Social anxiety is not shyness; it is the way the fear of negative evaluation narrows life, and the way avoidance limits work, relationships and opportunities. For those living in a second language, this burden often doubles.
The evidence-based treatment for social anxiety is CBT: shifting the focus of attention from oneself to the situation, gradually dropping safety behaviours, and planned exposure to avoided situations. At ViaNova Praktijk the treatment is delivered online and in Turkish; the effect of the second language and the migration context on the anxiety is worked through as a natural part of the process.
The mechanism: three wheels that sustain anxiety
Three mechanisms keep social anxiety going. Self-focused attention: in a social setting, attention turns not to the other person but to oneself ('is my hand trembling, does my voice sound strange'); this internal monitoring genuinely impairs performance and confirms the fear. Safety behaviours: speaking little, avoiding eye contact, appearing busy with the phone, this brings relief in the short term but in the long term preserves the belief 'without these I would embarrass myself'. Avoidance: every avoided meeting and invitation strengthens the sense that the anxiety is correct. The treatment targets these three wheels one by one.
The effect of migration and the second language
In Turkish speakers living in the Netherlands, social anxiety is often intertwined with a language layer: 'my accent will be noticed', 'I will use the wrong word', 'they will only half understand me'. This is not an exaggeration of anxiety but a real cognitive load: speaking in a second language occupies working memory and, combined with internal monitoring, produces freezing. In therapy, language anxiety and social anxiety are distinguished; the treatment of the two differs, and when they are confused, a person unjustly labels themselves as 'socially inadequate'.
Treatment: attention training and behavioural experiments
In CBT, the focus of attention is worked on first: through controlled exercises, the skill of shifting attention from internal monitoring to the surroundings is built. Behavioural experiments follow: the feared outcome ('everyone will notice') is turned into a concrete prediction and tested in a real situation. Video feedback is a powerful tool here, because it shows the gap between what a person feels from the inside and what appears from the outside. Safety behaviours are dropped gradually; the avoidance hierarchy is climbed in a planned way.
Social anxiety in working life
The directness of Dutch work culture, taking the floor in a meeting, giving feedback, social settings such as a 'borrel', is an intense trigger for people with social anxiety. In therapy, work is done through these concrete scenes: measurable goals such as saying one sentence in the first five minutes of a meeting produce results faster than the abstract 'gaining confidence'.
Frequently asked questions
How is social anxiety different from shyness?
The criterion is loss of functioning: shyness causes discomfort but does not run your life; in social anxiety, avoidance concretely narrows work, education, relationships and opportunities.
Is medication needed?
In moderate to severe cases, SSRIs are an effective option that can be combined with therapy; the assessment belongs to the general practitioner (huisarts) or psychiatrist. In mild to moderate cases, CBT alone is usually sufficient.
Isn't online therapy contradictory for social anxiety?
No; it lowers the threshold to begin, and the real-life exercises take place outside the session anyway. The goal is not to feel comfortable during the online meeting, but to expand real social life.
How long does it take?
Focused CBT protocols usually range between 12 and 16 sessions; the duration varies according to how widespread the avoidance is.
Clinical limits and emergencies
This page is intended solely for general information. No diagnosis is made and no personal treatment advice is given via the website. In case of an acute crisis, risk of self-harm or a threat to safety, contact 112, your general practitioner (huisarts) or the out-of-hours GP service (huisartsenpost) in the Netherlands. To talk, the helpline 113 Zelfmoordpreventie (0800-0113) is available day and night.