Social anxiety disorder (SAD) can present challenges in developing and maintaining romantic relationships. Though socially anxious people may strongly desire romantic relationships, they may struggle to tolerate the uncomfortable interpersonal realities of dating. In late adolescence, those with SAD report having fewer sexual partners, dating experiences, and relationships (La Greca et al., 2011; Ranta et al., 2016). Teens with SAD may find it difficult to manage their anxiety enough to take the emotional risks involved in building friendships and beginning to date. Missing out on these important experiences during adolescence can make it harder to form and maintain close, healthy relationships in adulthood.
Research indicates that adults with SAD tend to have fewer friendships, smaller social networks, and are less likely to be married than people who are not socially anxious (Alden & Taylor, 2004; Hudson & Rapee, 2009, Teo et al., 2013). People with SAD reported difficulty establishing relationships, developing emotional intimacy, and displaying emotional vulnerability, and also perceived themselves to have poor social skills, low self-esteem, and low social support (Kasalova et al., 2017).
Social Support, Emotional Intimacy, and Relationship Satisfaction
Individuals with SAD fear negative evaluation by others, including rejection or abandonment by their partners. Open communication of feelings can be seen as a sign of weakness or feel too risky, and therefore, feelings are often suppressed (Spokas et al., 2009). Self-disclosure of beliefs, preferences and emotions is often avoided for fear of being rejected or abandoned by intimate partners. When they do form romantic relationships, people with SAD, especially women, tend to be less disclosing of emotions to their partners, felt lower levels of emotional intimacy, and reported lower levels of satisfaction with their romantic relationships (Cuming & Rapee, 2010; Porter & Chambless, 2014; Sparrvohn & Rapee, 2009).
Fears of negative evaluation and rejection can also contribute to unhelpful interpersonal patterns of behavior in romantic relationships. When people with social anxiety disorder feel rejected by their partners, they may try to protect themselves from getting hurt. This can look like pulling away, downplaying their partner’s importance to them, or avoiding asking their partner for support.
Though conflict is a normal part of romantic relationships, social anxiety has been found to be associated with higher levels of conflict and arguments, as well as less overall positive communication during conflict (Casey et al., 2023). In addition, higher levels of social anxiety are related to increased fear of intimacy, which predicts lower satisfaction with sexual communication, which in turn predicts lower sexual satisfaction (Montesi et al., 2013).
Support vs. Symptom Accommodation: A Challenge for Partners
Partners of people with social anxiety can struggle with how to most effectively support their partners while also balancing the effects of SAD upon the non-socially anxious partner. The partner without SAD can feel strained by missed socialization opportunities when the partner avoids events and become burned out by their partner’s reassurance-seeking behavior (Alden & Taylor, 2004). Several studies show lower relationship satisfaction for both those with high SAD symptoms and for their romantic partners (Bar-Kalifa et al., 2015; Montesi et al., 2013).
Additionally, partners of people with SAD can inadvertently fall into a vicious cycle of anxiety symptom accommodation, which reinforces and helps to maintain SAD. Anxiety symptom accommodation has mostly been studied within the context of obsessive-compulsive disorder (OCD), and has generally been described as people assisting in the completion of tasks and making modifications to daily life in order to enable loved ones to avoid anxiety triggers (Calvocoressi et al., 1995). For partners of people with SAD, common accommodations might include providing excessive reassurance, making phone calls on behalf of their partners, facilitating social interactions at events, or avoiding social outings with others to stay home with their partners.
Accommodation may seem like a loving act of support because it reduces their partners’ anxiety in the short term by enabling avoidance or escape of anxiety-provoking situations (Merlo et al., 2009). However, accommodation reinforces and maintains the SAD in the long term by preventing opportunities for their partners to experience corrective feedback and learn that they can handle being exposed to feared situations, and that they can competently navigate them and manage feelings of discomfort without resorting to avoidance. When we make accommodations for guests in our home, we are trying to make them comfortable so they can stay with us; however, we do not want to make SAD comfortable so that it can stay and limit a loved one’s opportunities to meaningfully engage with others!
Accommodation is frequently studied in the context of social situations that involve others (e.g., making phone calls for their partner). However, anxiety symptom accommodation by partners may also contribute to patterns of maladaptive interactions within the romantic relationship itself that are frustrating for both parties. The graphic below provides an illustration of the vicious cycle of SAD accommodation by a partner:
Does this cycle suggest that partners should withdraw all social support around their partners’ SAD symptoms? Definitely not. Social support is an important part of close intimate relationships. However, it demonstrates the need for people with SAD and their partners to work together to understand how partner support may be interfering with recovery from SAD, and how loved ones can more effectively provide support without accommodating and reinforcing anxiety symptoms.
Opportunities for Recovery from SAD: Individual and Couples Therapy
Cognitive-behavioral therapy (CBT), is an evidence-based treatment for SAD, meaning that many research studies have demonstrated that CBT is an effective treatment for SAD. CBT involves exposure therapy so that patients learn to effectively face feared situations without avoidance or engaging in ‘safety behaviors’, which they believe will reduce the likelihood of feared outcomes (e.g., only attending an event if the partner accompanies them).
Individual CBT can also be an opportunity for people with SAD to problem-solve interpersonal dynamics in romantic relationships that may be interfering with relationship functioning and satisfaction. This might involve learning effective interpersonal communication skills, practicing role-plays of navigating conflict, learning to cognitively re-frame perceived criticism from partners, and more.
A partner may also be included briefly in individual treatment to provide additional information to the therapist about social functioning. This could be helpful, as people with social anxiety may be overly self-critical and struggle to accurately judge their own social and relationship skill levels. When people with SAD report interpersonal problems, it may be difficult to discern if problems are the result of actual, observable skills deficits, or rather, if they are viewing their social interactions through the negative bias associated with SAD (Moscovitch et al., 2009). In addition to providing information about the person’s actual social performance deficits, if they exist, the inclusion of the partner also enables the therapist to observe interactions between the partners as well! With a therapist’s assistance, the patient with SAD and their significant other could plan concrete interventions for exposure practice within varied settings, as needed, and evaluate their impact on symptom reduction and improvements in functioning (Hunger et al., 2020). This could be a great way for significant others to effectively support their partners with SAD who are in individual treatment.
Couples therapy could also be a fruitful place for supporting people with SAD and working towards a more satisfying romantic relationship. In couples therapy, the partner with SAD may practice gradual exposures to facing difficult situations in their relationship within the supportive structure of couples therapy. For example, they might practice exposure to the expression of negative emotion or discussing conflict, while using coping skills and cognitive reframing in the moment. Both partners learn to change their interaction patterns to improve dynamics, practice navigating conflicts, and increase relationship health.
Evidence-based couples therapy, such as cognitive behavioral couple therapy (CBCT, Baucom et al., 2019) and integrative behavioral couple therapy (IBCT, Christensen & Doss, 2017), are well-studied modes of couples therapy which can be helpful for treating couples who may experience both relational issues and mental health issues. Research has demonstrated that couples therapy for these issues can help address both the relationship and mental health symptoms (Barbato & D’Avanzo, 2020). Such treatments involve developing insight into relational patterns and emotional sensitivities that each partner brings to the relationship, as well as skill building, including problem-solving, positive interactional and social skill building, assertive communication techniques, and using role-plays to practice these skills with support of a therapist in session.
CBT in Action
How might couples therapy look with our earlier example of Thomas and Michael? Their couples therapist may help them identify their maladaptive cycle around conflict, help them gain insight, and increase awareness of when it is happening. This approach would avoid the ‘blame game’ and emphasize that both partners have opportunities to modify their strategies for managing conflict. Their therapist might select a recent and relevant negative interaction between them to foster insight into the softer, more vulnerable emotions that can lie beneath their anger and frustration in order to enhance their emotional understanding of each other. The therapist might teach emotion regulation, cognitive reframing and communication strategies in session, so that both 4 and Michael can learn to bring up issues they are having during more adaptive times at lower levels of emotional arousal, regulate the anxiety or unwanted emotion that might be occurring during conflict, and use adaptive communication strategies to navigate resolving issues as a team. The therapist might suggest home practice for the couple to reinforce and generalize these skills to their daily life together.
Additionally, the therapist might encourage Michael to consider engaging in individual treatment that would focus directly on his SAD to help augment the couples treatment and to help him address other social anxiety-related concerns that might be detracting from his quality of life.
While SAD may present unique challenges to romantic relationships, there are evidence-based treatment options that are effective for both individual and couples therapy to decrease symptoms and enhance relationship health and satisfaction.
References
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