By Leonardo Dominguez Ortega and Darby Saxbe
February 2020: You’re an average teenager waking up for school. You get to first period and chat with your tablemates. Your chemistry assignment is difficult, but you figure it out together. Lunch comes around and you flock to your friend group. You all sit shoulder-to-shoulder with trays of recently microwaved pizza in front of you as you pass around a funny Instagram video. You then present after lunch during Spanish class. You play with the tag of your sweater to deal with your nerves, but you feel a weight lifted when your presentation on Frida Kahlo ends. A few hours later, the football game starts and you meet some kids from the opposing school. They’re also taking the SAT soon and you bond over how annoying it is. You all sit together and enjoy the game until you get picked up by a parent. You get in the car and reflect on your day. You have a lot of social anxiety, and your therapist challenged you to expose yourself to difficult situations. Though the day was difficult, you feel a lot better.
April 2020: School starts at 8 a.m. and you wake up at 7:58 a.m. Whilst still in your bed, you reach over for your Chromebook. You log onto Zoom—camera and mic off, of course. The day cruises by. You play video games after “school” and, before you know it, it’s 1 a.m. You’ve seen no one and done very little with your day. The COVID-19 pandemic has taken a hold of your routine, and your social anxiety is back. How will you go back to normal?
Adolescence is a notoriously tricky time. Big life transitions, like starting high school and puberty, can bring on stress and make it hard to adjust. Social anxiety disorder (SAD), an intense fear of others’ judgments during social interactions (Aderka et al., 2013), is a common issue adolescents face, with 17% of youth dealing with this disorder globally (Salari et al., 2024). Despite these difficulties, social relationships play a pivotal role in adolescents’ development and can help ease these challenges (Butler et al., 2022). For this reason, exposure to social interactions is a key aspect of treating SAD. This aspect of treatment leverages the benefits of the school environment: bountiful opportunities for social interaction.
During the spring of 2020, school routines were turned upside-down. Governments rapidly imposed lockdowns, implemented social distancing measures, and closed schools to curb the spread of COVID-19. Overnight, daily class-time chats and after-school socials morphed into staring at black boxes on a computer screen for hours on end.
On the surface, this might seem like a winning lottery ticket for adolescents with SAD. You’d think removing the requirement to talk to peers or teachers, perform at an athletic event, or walk down the hall in the face of scrutiny would seemingly resolve these worries. Indeed, some researchers suggested the pandemic may have served as a positive respite for those who struggle with social interactions (Kindred & Bates, 2023). However, a deeper look highlights these changes may have made it harder to treat SAD in the long run.
COVID-19’s Impact on Social Anxiety Disorder Treatment
We know that we can treat social anxiety effectively using treatments like social skills training, interpersonal psychotherapy, and medication. Amongst these treatments, cognitive behavioral therapy (CBT) stands out as especially effective—particularly exposures to uncomfortable situations (Heimber & Magee, 2014; Radtke et al., 2020).
In the therapy setting, clients are pushed to play out hypothetical scenarios that align with their fears and worries. They learn that, though these moments are distressing, they are not catastrophic—they are taught to endure. Treatment then extends into homework assignments outside of treatment to promote their benefits in real life outside of treatment. Clients take on the role of a “scientist” collecting data to disprove their fears and worries. If an adolescent has difficulties talking to others, they would be assigned homework to begin and maintain conversations with new peers. If they struggle with attention, they may be prompted to raise their hand in class more often. Overall, the goal is to be wrong. The aim is for clients to incorporate these data into their thought patterns, replacing their fears and worries with more realistic scenarios backed by experience.
School is a helpful setting for these homework assignments, as it promotes social interactions and instigates friendships. Students encounter their peers in multiple places, from riding the bus to school, to sitting together in class, to joining clubs or sports. If you had SAD and received treatment during the pandemic, you’re the first to know that this treatment process became very difficult over Zoom. Instead of being able to push yourself to engage with your peers, exposure exercises were relegated to discussions with a clinician over a screen.
Why Does This Matter and What’s Next?
So, what does this all mean? SAD can make it difficult for youth to make the most of this exciting time in their lives. We have very effective treatments to help with these difficulties, but their magic dust was countered by the difficulties of COVID-19. Rather than benefiting from the full effects of treatment, progress was stymied or undone altogether.
As a result, if you received treatment for SAD during the pandemic and felt as though it didn’t help the way you wanted it to, don’t worry: You didn’t do anything wrong. Rather, a key ingredient from the dish that is treatment was missing. If your social anxiety is still rearing its ugly head, treatment under better conditions outside of the pandemic can be just what you’re looking for. Embrace the exposure afforded by a lack of social distancing and give treatment another shot.
To find a therapist, please visit the Psychology Today Therapy Directory.