CHAPTER 1
Shyness and Social Anxiety
Rachel was a twenty-six-year-old woman who worked as an assistant manager of a small 
bookstore. She was referred to our Anxiety Treatment and Research Centre to get help 
for intense anxiety about her upcoming wedding. Rachel wasn’t afraid of being married; 
in fact, she looked forward to spending years together with her husband. She was terri -
ﬁed of the wedding itself. The idea of being on display in front of such a large audience 
was almost unthinkable. In fact, she had postponed her wedding twice before because 
of her fear of being the center of attention.
Rachel’s anxiety involved more than just a fear of her wedding. She reported that 
she’d always been shy, even when she was very young. When she was in high school, 
her anxiety around people had become so intense that it was affecting her school life. 
She was convinced that her classmates would ﬁnd her dull or boring, or that they would 
notice her anxiety and assume that she was incompetent. Typically, Rachel avoided doing 
oral reports at school and didn’t take any classes where she felt her performance might be 
observed or judged by her classmates (such as physical education). On a few occasions, 
she even asked for special permission to hand in a written essay instead of doing a pre -
sentation in front of the class. Despite being an excellent student, she generally tended 
to be very quiet in class and rarely asked questions or participated in class discussions.
Throughout college, Rachel found it difﬁcult to make new friends. Although people 
enjoyed her company and often invited her to parties and other social events, she rarely 
accepted the invitations. She had a long list of excuses to get out of socializing with