Social anxiety therapy, online across New Zealand

What is social anxiety disorder?

Social anxiety disorder is an intense, persistent fear of social or performance situations in which you might be judged, embarrassed or seen to be anxious. It leads to avoiding those situations or enduring them with great distress, and it interferes with work, study or relationships. Individual cognitive behavioural therapy is the first-line treatment recommended by clinical guidelines.

Shyness, introversion or social anxiety?

Plenty of people are quiet, prefer small groups, or need a day alone after a busy weekend. That is temperament, and it needs no treatment. Social anxiety is different in degree and in kind. The fear is intense, it is specifically about being evaluated by others, and it costs you things you actually want.

It might mean saying nothing in a team meeting even when you know the answer, then replaying your silence on the drive home. Eating lunch at your desk because the staffroom feels like a stage. Letting calls go to voicemail and composing texts for twenty minutes. Turning down a promotion because it involves presenting. Avoiding the school gate, the gym, the barbecue, the dating app. Drinking two glasses of wine before a party so you can walk through the door.

Some people's social anxiety is limited to performance situations, such as public speaking, job interviews or being watched while they work. For others it spreads to almost any interaction with people they do not know well. Both forms respond to the same treatment.

Why social anxiety persists: the Clark and Wells model

The most widely used treatment for social anxiety is based on a cognitive model developed by David Clark and Adrian Wells in 1995. It explains something that puzzles many people with social anxiety: why years of exposure to social situations have not made it better. The answer lies in what happens inside a feared situation.

When you enter a situation you fear, your attention turns sharply inward. You monitor your heart rate, your voice, the heat in your face, the words you are about to say. From this internal information you build an image of how you must appear to others: visibly shaking, red, awkward, boring. That image feels like a fact. It is usually far more negative than how you actually look, but because your attention is inside, you never collect the evidence to correct it.

Before the event there is anticipatory worry, often for days. Afterwards comes the post-mortem: hours of replaying every sentence, noticing every pause, concluding that it went badly. Each stage confirms the belief that social situations are dangerous and that you are not up to them.

Safety behaviours and why they backfire

Safety behaviours are the things you do to prevent the feared catastrophe or hide your anxiety. Common ones include rehearsing sentences before speaking, avoiding eye contact, gripping a glass so your hands cannot be seen shaking, wearing dark or layered clothes to hide sweating, speaking quickly to get it over with, asking questions so you never have to talk about yourself, staying close to one trusted person, or having a drink first.

They feel essential. They are also a central reason social anxiety continues. They keep attention locked on yourself rather than the conversation. They often create the very impression you fear: someone avoiding eye contact and speaking in short bursts can come across as cold or uninterested, not anxious. And they stop you ever finding out what would happen without them. If the evening went fine, the anxiety takes the credit for the safety behaviours rather than for you.

Part of treatment is identifying your own list, then testing what happens when you drop them one at a time.

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What CBT for social anxiety involves

NICE recommends individual CBT based on the Clark and Wells or Heimberg models as the first-line treatment for social anxiety disorder in adults, ahead of medication. In a network meta-analysis of 101 trials involving more than 13,000 people, individual CBT had the largest effect of the psychological treatments examined, and a larger effect than any medication on its own. The therapy is specific and active. A typical course includes:

1. Your own model. Using a recent situation, you and your psychologist draw out your version of the cycle: the trigger, the self-image, the safety behaviours, the post-mortem. Most people find this uncomfortably accurate.
2. Shifting attention outward. You practise deliberately placing attention on the other person and the environment rather than on yourself, first in low-stakes situations and then in harder ones. This alone often reduces anxiety noticeably.
3. Video feedback. With your agreement, a brief conversation is recorded: you predict in detail how you will look, then watch the recording as if assessing a stranger. For most people the gap between the feared image and the reality is large, and seeing it changes something that words cannot.
4. Behavioural experiments. Rather than gradually getting used to situations, you design tests of specific predictions. If the belief is "if I pause mid-sentence people will think I'm stupid", the experiment is to pause deliberately and watch what people actually do. Experiments might involve asking an obvious question in a shop, letting your hand visibly shake while paying, or disagreeing with someone in a meeting.
5. Dealing with the before and after. Reducing anticipatory worry and learning to cut the post-mortem short, since both feed the belief without adding information.
6. Core beliefs. Later sessions often address long-held beliefs about yourself ("I'm boring", "people can see there's something wrong with me") that formed early and have been protected by avoidance ever since.

Running behavioural experiments online

People sometimes assume social anxiety has to be treated in a room with another person. In practice video sessions suit this work unusually well. You are already being seen on camera, which is itself a feared situation for many people and gives immediate material to work with. Role-plays, from a job interview to making small talk, can be run over video with no extra equipment.

The experiments themselves have always happened in real life rather than the clinic: the café, the staff meeting, the phone call to the bank. Online sessions simply mean you plan the experiment with your psychologist on Tuesday, run it on Thursday, and review your prediction against what actually happened the following week.

The evidence supports this. A randomised trial from the Oxford group that developed the Clark and Wells treatment found that an internet-delivered version with remote therapist support produced improvements comparable to face-to-face cognitive therapy, while using less than half the therapist time. Meta-analyses of live video psychotherapy more broadly show outcomes comparable to in-person treatment, with large improvements when CBT and anxiety treatment are delivered by video.

Alcohol, avoidance and the long game

Social anxiety usually starts in adolescence and, left alone, tends to stay. Over years it narrows lives in ways that come to feel like personality rather than anxiety: the job you did not apply for, the friendships that faded because you kept declining, the relationship you did not pursue. Depression is a common companion, often arriving after a period of increasing isolation.

Alcohol is a common form of self-treatment, and it works just well enough to be a problem. A couple of drinks lowers the self-focus and the inhibition for an evening. It also prevents you from learning that you could have managed sober, and it tends to escalate. Your psychologist will ask about drinking without judgement, because it is often one of the safety behaviours that needs to come down for the rest of the work to stick.

Medication, usually an antidepressant, is an option some people use alongside therapy. That is a conversation with your GP; our psychologists do not prescribe or advise on medication.

Getting help for social anxiety in New Zealand

Social anxiety is one of the most common anxiety disorders, and one of the least likely to be treated, partly because asking for help is itself a feared social situation. Booking online, with no phone call and no waiting room, lowers that barrier, which is one reason we think telehealth suits it.

Free options exist. Just a Thought offers a free online CBT course for social anxiety that some people complete before or alongside therapy. Your GP can refer you to local services or a Health Improvement Practitioner. Anxiety NZ runs a free 24/7 helpline on 0800 ANXIETY (0800 269 4389). Private psychologists, including Mindwell's team, can be booked directly and are self-funded; some health insurance policies cover part of the cost, so check yours or read our insurance guide.

What to expect at Mindwell

Everything at Mindwell happens by 50-minute video session through Carepatron, in your browser, with nothing to install. You book online, either choosing a psychologist or taking the first available appointment, and first sessions are typically within 7 days. There is no referral and no phone screening. You will receive a confirmation email with the video link and a short intake form to complete before you meet.

Your first session is a conversation about what social anxiety looks like for you: where it shows up, what you avoid, what you do to get through, and what you would do differently if it were not there. From that your psychologist will propose a plan, usually weekly sessions to start. If being on camera is hard, say so; it is a reasonable place to begin.

Sessions are $199 + GST ($228.85 including GST), paid at booking, with a receipt for insurance. Sandy Laurenson, Jake Meads, Katherine Lee and Jezebel Machado all work with social anxiety, Jezebel with a particular focus on relationships and attachment where social fear is bound up with closeness. Mindwell sees adults 18 and over in New Zealand and is not an ACC provider.

Related support: Anxiety therapy · Panic attacks · Relationships and attachment · CBT therapy