If your child gets nervous around other kids, avoids playdates, or struggles in group settings like school or birthday parties, they might be experiencing social anxiety. It’s one of the most common forms of anxiety in children—and the good news is, it’s also very treatable.
In a recent episode of The Therapist Thrival Guide, I sat down with two of my colleagues—Gina, who works primarily with kids, and Letisha, who works mostly with adults—to break down what social anxiety looks like, how we diagnose it, and the evidence-based ways we treat it.
Here’s what I think parents should know:
What Is Social Anxiety in Kids?
Social anxiety isn’t just being “shy” or introverted. It’s a persistent fear of being judged, embarrassed, or rejected in social situations. For kids, this fear often shows up as:
- Crying or tantrums when faced with social events
- Freezing or shutting down around peers
- Avoiding eye contact or refusing to speak in group settings
- Clinging to a parent or avoiding social interaction altogether
As Gina explained, “Most of the time when I diagnose kids with social anxiety, it starts with parents saying things like, ‘She’s just really anxious’ or ‘He hates being around other kids.’” One helpful tool therapists use is the SCARED assessment, which helps pinpoint the specific type of anxiety a child is struggling with—whether it’s social, separation, school-related, or generalized.
Let me be clear: separation and social anxiety is completely developmentally normal, to a certain extent. When I leave my 18 month old with a new babysitter, he will cry for a period of time, and my four year old gets shy when she meets new friends. This moves out of the “realm of normal” (it becomes a diagnosable disorder) when it’s interfering in the child’s life, when they are completely avoiding new experiences or meeting new friends, when they can’t be calmed in a new situation, or when they are feeling debilitating anxiety when in social situations.
How Therapists Treat Social Anxiety in Kids
The most common approach for treating social anxiety in kids is CBT: Cognitive Behavioral Therapy. It helps kids understand the connection between their thoughts, feelings, and behaviors. For example, if a child is thinking, “Everyone will laugh at me,” CBT teaches them how to challenge that thought and try a more realistic one—like, “Most kids are too busy to notice if I mess up.”
Therapists like Gina use a version of CBT that’s tailored to a child’s developmental level. “Even five-year-olds can learn the basics of the CBT triangle, how thoughts, feelings, and behaviors are connected,” she said in the podcast interview. Kids are also taught to name their feelings and recognize when they’re experiencing worry or fear.
Another helpful tool? Social stories.
What Are Social Stories?
Social stories are short, personalized narratives that help kids prepare for and cope with anxiety-inducing situations. Whether it’s starting school, going to the dentist, or attending a birthday party, a social story can outline:
- What will happen
- How the child might feel
- What they can do to cope with those feelings
Gina shared how social stories normalize the experience of anxiety: “It says, ‘Here are the feelings you might encounter, and here’s how to deal with them.’” It helps take the unknown and make it known—which is incredibly important for kids who are anxious about what might happen.
I have even used social stories to help children adjust to big life transitions, like moving homes or adjusting to a new bedtime routine.
Exposure and EMDR: Advanced Tools for Older Kids
For more severe cases, therapists might use exposure therapy or EMDR (Eye Movement Desensitization and Reprocessing). These techniques help kids build tolerance to uncomfortable thoughts and feelings in a safe, controlled setting.
“We do a lot of EMDR work focused on sitting with uncomfortable feelings and building up a window of tolerance,” Gina shared. “And therapy offices or even school settings are a great place to practice that.”
How Parents Can Help
If your child is showing signs of social anxiety, here are a few tips:
1. Validate their feelings
Avoid dismissing their worries. Say things like, “It makes sense that you feel nervous,” rather than, “There’s nothing to be afraid of.”
2. Practice through play
Use pretend play, books, or stories to help kids process social situations and rehearse how they might respond.
3. Create a plan together
If they’re nervous about an event, talk through what to expect and how they can cope. Maybe they bring a favorite object or identify a “safe” adult they can turn to. I like to say, “prepare, don’t push” – forcing a kid into things will just increase their anxiety.
4. Practice in low-stakes settings
Think of this as mini-exposure-therapy. Start small by saying hello to a neighbor, having playdates with one other child or in smaller groups, asking a store employee where something is, attending a group storytime at the library where they aren’t expected to talk or interact, or ordering their own drink at a restaurant.
5. Teach Coping Skills
Equip them with tools that they can use in the moment. Some of my favorites to teach are:
- Positive mantras (i.e. “I can do hard things,” “The people here are my friends.”)
- Square breathing (inhale four seconds, hold four seconds, exhale four seconds, hold four seconds)
6. Seek support early
“The sooner you can get help for anxiety, the better,” Gina emphasized. Therapy not only reduces anxiety, but it improves a child’s quality of life.
Anxiety isn’t Uncommon for Kids
Like I said, anxiety is a normal part of being human. But when it starts to interfere with your child’s relationships, school, or happiness, it’s time to get support. The good news? Social anxiety is very treatable and your child doesn’t have to face it alone.
If you found this helpful, be sure to check out the full episode of The Therapist Thrival Guide and subscribe for more conversations like this one. And if you’re a parent who’s concerned about your child’s anxiety, don’t hesitate to reach out to a therapist in your area. You’re not alone, and neither is your child.
Podcast Transcript
Miranda: Welcome to The Therapist Thrival Guide. My name is Miranda. I’m a licensed clinical social worker, and we are back with Letisha and Gina. Today we’re talking about social anxiety. This is just going to be a short little episode because Letisha has to go pick up her kids—and I also need to get home!
But we were all in the studio together and thought, hey, let’s talk about this. The cool thing about this topic is that Gina mostly works with kids, and Letisha mostly works with adults, but you both work with clients who have social anxiety. So, let’s start with: What is social anxiety? Then we’ll switch gears to how each of you treats it.
Gina: Great idea. Do you want me to read what the DSM says about social anxiety?
Miranda: Yeah, give us the cliff notes.
Gina: Okay—social anxiety is a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. In children, the anxiety must occur in peer settings and not just during interactions with adults.
The individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated—something humiliating or embarrassing, or that might lead to rejection or offending others. The social situations almost always provoke fear or anxiety.
In kids, this fear may be expressed through crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
Most of the time when I diagnose kids with social anxiety, it starts with parents saying things like, “Oh, she’s really anxious,” or “He’s super anxious.” Then I give them the SCARED assessment. What I like about that tool is it’s 41 questions covering different types of anxiety.
Miranda: Yeah.
Gina: When you go through and score it, you can see—oh, this kid has generalized anxiety, or most of their anxiety is about school, or separation, or social situations. I really appreciate how it helps differentiate those things.
Letisha: Yeah, anxiety is so rooted in fear. That assessment is helpful because it shows us what the fear is about.
Gina: Right, and at Ellie—especially in Ellie Minnesota—most practitioners use it. It’s a very useful tool.
Miranda: What about you, Letisha? When you’re diagnosing or working with someone with social anxiety, how does it usually show up? Do they score really high on the GAD-7, and then you break it down? Maybe they score low on the question about “worry for no apparent reason” because they do know what the reason is—but score high on everything else?
Letisha: Yeah, definitely—on the GAD-7, they usually score pretty high. But I also observe how they interact with me. If they frequently say things like, “I get nervous in groups,” or “I get nervous around certain family members,” or “I avoid socializing,” that’s a big clue.
If they’re not actively engaging in activities or even avoiding family interactions, that tells me there’s likely social anxiety. There’s a lot of fear around how they’ll be perceived or judged.
Miranda: So then, how do you treat social anxiety?
Letisha: CBT.
Miranda: That’s the gold standard, right? I thought you were gonna say, “Throw them into a party”!
Gina: [laughs] Nooo, that’s the last thing you’d do!
Letisha: Yeah, so the two biggest approaches are CBT and ACT—Acceptance and Commitment Therapy. ACT is often more adult-focused, and CBT works for both kids and adults.
The first step with CBT is identifying the negative beliefs—those persistent, intrusive thoughts that make people believe others are judging them, when in reality, most people aren’t paying attention.
Miranda: I think ACT is a little confusing. I associate it with mindfulness, values, and acceptance. So how does that work with social anxiety?
Gina: ACT helps people become aware of their thoughts and emotions, stay present, and focus on what matters to them. It encourages accepting thoughts and feelings instead of avoiding them.
Letisha: Exactly. It’s about validating those emotions and letting people experience them in a healthier way. If we can accept that these negative thoughts exist, we can begin to understand why they’re there. Not necessarily replacing them with positive ones, but reframing them—and then changing the behavior that follows. But without acceptance, change is hard.
If I’m anxious in a social environment, understanding why helps me accept it—and then I can work on coping and moving forward.
Miranda: I’m not one of those pure-blood CBT therapists—some people are all in with CBT. I’d love to understand their brain! But what I do like is the part where you question the thoughts: Are they realistic? Do we have evidence that people are actually thinking this about us?
Gina: Yes! “Do you have proof of that happening?” is a big CBT question.
Miranda: Okay, what about kids?
Gina: Still CBT, but developmentally appropriate. It’s the classic triangle—thoughts, feelings, behaviors—and you can teach that to kids as young as five.
As soon as kids realize that other people are thinking about them, that worry can start. So with kids, it’s a lot of helping them name the feeling—“This is worry”—and identifying the negative beliefs attached to it.
Miranda: How would you use a social story for that?
Gina: We love a social story.
Miranda: I know you do!
Gina: Social stories help normalize what’s happening. They’re commonly used for kids or teens with autism who may miss social rules or cues—like going to the dentist, the airport, or even just the lunchroom.
A social story breaks it down: what’s going to happen, what feelings might come up, and what to do about those feelings. It’s a way for kids to read a narrative that validates and normalizes their experience.
Miranda: That’s what I’ve used them for too. Back when I did child protection, I used them to help explain why a child was moving away from their parents or what a safety plan was. Now, I still use them.
I had a kid with separation anxiety. He’d done kindergarten during COVID, so everything was virtual. He was starting first grade in-person and had no idea what to expect—he hadn’t even gone to preschool.
So we created a social story about what school would be like: meeting his teacher, what drop-off would feel like, how he might miss mom and dad. It included coping skills, not just a “happy ending.” It said: He felt sad. He felt worried. And then, here’s what he did next.
We also did one about bedtime because he was struggling to sleep in his own bed. So social stories can be really flexible.
Gina: A social story takes the unknown and makes it known. It says, “Here are the feelings you might encounter, and here’s how to deal with them.”
Letisha: We use the same idea with adults—we just call it something different, like a rehearsal or roleplay. If someone is going to see a family member they haven’t seen in 10 years, we talk through it. What are your worries? How might you cope?
Gina: Yes, and I use metaphors or examples. If someone’s anxious about a family event, we talk through: What are your initial feelings? How do they show up? How do you express them? If things go off course, what’s your plan?
So many anxious thoughts are about the unknown—what might happen, how others might react. Talking through it helps lessen the overwhelm and gives people a sense of control, even if they still don’t know exactly what will happen.
Miranda: I had an adult client who wasn’t diagnosed with social anxiety, but she had a lot of it around family gatherings. We talked about having a “buffer person”—someone safe like a partner, auntie, or friend. We also set boundaries around how long she’d stay. Those strategies really helped.
I’m curious—have you ever heard of exposure therapy or virtual reality therapy being used for this?
Gina: Sure, depending on the severity of the anxiety and what the specific fear is. I know Ollie does quite a bit of that, and we use it a lot in EMDR as well. Somehow, I’ve become the go-to person for kids who are afraid of throwing up.
Miranda: I have a client for you.
Gina: Please don’t—I’m full! laughs. Yeah, we do a lot of EMDR work focused on sitting with uncomfortable feelings and building up a window of tolerance.
Miranda: For those—for those uncomfortable body sensations.
Gina: Yeah. And the experiences and thoughts that come up when someone around us is sick.
With Leticia’s clients, it’s a lot of talking, narrating, planning, and helping kids and adults cope with what might come up.
Miranda: That makes so much sense—how EMDR or something similar could be used for this.
Gina: Yeah, and it’s done in a controlled environment. You know what’s going to happen, it’s for a short period of time, and the goal is to build tolerance over time.
A therapy office—or even a school setting—can be a great place for that kind of work.
Leticia: Yeah.
Gina: We could honestly do a whole podcast on social stories if you want.
Miranda: That’s actually not a bad idea! They’re so useful—I use them for everything.
Gina: Same. I love them.
Miranda: Any other thoughts?
Gina: The sooner you can get help for anxiety, the better. It’s so common—so many of our clients deal with it.
Leticia: Yeah.
Gina: And in this day and age, there are more anxious people than ever.
Leticia: And that’s the thing—it’s normal. Anxiety is a normal part of being human. It’s when it becomes overwhelming that it’s time to seek help.
Gina: Exactly. And it’s absolutely treatable.
Miranda: And it can really improve your quality of life—significantly.
Gina: Oh yeah, absolutely.
Miranda: Thanks for doing this little mini episode with me.
Gina: Anytime.
Miranda: And thank you all so much for listening! If you’re not a subscriber yet, please hit that subscribe button so you’ll be notified when new episodes drop. And if you have a moment, please rate and review the podcast—it helps us reach more people, and lets me keep doing this fun job.
Thanks again for being here. See you next time!
