The Shyness & Social Anxiety Workbook
24People who are depressed are often embarrassed about feeling down, may assume 
that others don’t want to be around them, and may avoid being around other people. 
Social anxiety and depression are associated with similar thought patterns as well—
speciﬁcally, negative thoughts about oneself and about one’s relationships. Finally, there 
is reason to think that social anxiety disorder and depression may be related to similar 
biological processes in the brain. In fact, the treatments discussed in this book (including 
both psychological treatments and medications) have been shown to be useful for both 
anxiety and depression.
Body Image Problems
People who are unhappy with their physical appearance may feel anxious when 
socializing or being watched by others. For example, people with eating disorders such 
as anorexia nervosa and bulimia nervosa may avoid activities that involve eating in front 
of others or showing their bodies (such as wearing shorts, swimming, or exercising in 
public). People who are overweight may also be concerned about having their physical 
appearance judged negatively by others. In fact, dissatisfaction with any aspect of one’s 
physical appearance (for example, losing your hair, not liking your nose, and so on) can 
lead some people to experience social anxiety.
Substance Abuse 
Some people who experience excessive levels of social anxiety use alcohol or other 
drugs to help cope with social situations. In most cases, this may involve only having an 
extra glass of wine at a party or having a beer when eating out with friends. However, 
for some people, using alcohol or drugs to manage anxiety can become a problem if 
the drug or alcohol use becomes excessive. If you frequently use excessive amounts of 
alcohol or other drugs to feel more comfortable in social situations, it may be important