Social Anxiety Case Study: Helping a College Student Find His Voice

Written By

Dr. Amar Shinde

Published on: 05 Jun 2025

Patient Information:

Age: 20
Gender: Male
Background: Second-year university student studying business administration, lives in a shared dormitory in Mumbai.

History or Cause:

Arjun (name changed for anonymity), a twenty-­year-old university student, attended therapy because he had been struggling with significant distress during classroom presentations, group discussions and social situations on campus. Although Arjun generally performed well academically, he had begun to avoid speaking in class or participating in networking events and started to isolate himself from his group assignments. He found himself anxious about even the most mundane social interactions, such as ordering food or asking for help.

Arjun's anxiety began long before starting university; Arjun was a shy child, but had never experienced anything psychologically. As a middle schooler, after some teasing about his accent and being quiet, he began to avoid more and more. He built a fear of judgment from those around him in combination with a pattern of avoiding any public speaking opportunities and all group activities.

Now, in the second year of university, Arjun's reliance on patterns of avoidance began to have a diminishing impact not only on his academic performance but were affecting his social opportunities as well. He went on to fail a class after skipping too many presentations. He began to avoid and withdraw from all forms of social settings. He spent the majority of his weekends all alone in his room in a shared dorm, convinced that everyone perceived him to be awkward and unlikable. Eventually, after his professor wrote to him about consistently not being in class or communicating whether he was attending, he suggested to Arjun that he attend a couple of sessions of counselling. Arjun reluctantly complied, describing himself as feeling “like a prisoner in [his] own head”.

Diagnosis:

Following a referral, Arjun was assessed by a licensed clinical psychologist with a comprehensive assessment process including structured interviews, self-reports, and observation data. 

Assessment Tools Used:

• Liebowitz Social Anxiety Scale (LSAS) 
• Social Phobia Inventory (SPIN) 
• Clinical Interview Mapping based on the DSM-5 
• Beck Depression Inventory-II (BDI-II) for assessment of potential comorbid depression

Findings:

• Liebowitz Social Anxiety Scale (LSAS): 92 (Very severe social anxiety) 
• Social Phobia Inventory (SPIN): 46 (Severe range) 
• Beck Depression Inventory-II (BDI-II): 17 (Mild depression) 
• Diagnosis based on DSM-5 criteria: Diagnosed with Social

Final Diagnosis:

• Social Anxiety Disorder (performance type) 
• Mild depression (secondary to anxiety-induced social isolation)

Treatment:

The treatment was centred around Cognitive Behavioural Therapy (CBT), which is the gold-standard evidence-based treatment for social anxiety disorder. The aim was to help Arjun diminish his fear of negative appraisal, get him back to engaging in those feared situations, and cease his self-deprecating thoughts by restructuring them.

The treatment programme also included social skills training, exposure therapy, and mindfulness techniques to optimise emotional regulation and confidence.

Program:

1. Psychoeducation:

• Arjun learnt about the nature of social anxiety disorder, that social anxiety is more than just being shy, but is a treatable condition. 
• The client was introduced to the "vicious cycle of avoidance", illustrating how fear, avoidance, and self-criticism perpetuate each other. 
• He learnt his fight-or-flight response and how it malfunctions in social circumstances.

2. Cognitive Restructuring (CBT sessions):

• We identified automatic thoughts such as:
  1. "I'm going to make a fool out of myself." 
  2. "People are judging me silently."
  3. "If I stutter, they'll think I'm dumb."
• "I'm going to make a fool out of myself." 
• "People are judging me silently."
• "If I stutter, they'll think I'm dumb."
• The therapist initiated Socratic questioning to dispute these beliefs. 
• We began to develop realistic alternatives, such as "Everybody stumbles at some point. It's only human."
• "I'm going to make a fool out of myself." 
• "People are judging me silently."
• "If I stutter, they'll think I'm dumb."

3. Behavioural Experiments:

• We started with low-stakes interactions (e.g., asking a librarian for help) 
• Collected data on his level of anxiety, then progressed to scenarios that he feared (e.g., group discussions, presentations). 
• Each task was rated before and after the experiment using a scale from 0-10 so that we could see a difference between his real outcome and the one he had predicted.

4. Exposure Hierarchy:

• Developed a ranking of social situations
• Level 1: Small talk in class
• Level 3: Asking a question during a lecture,
• Level 5: Leading a study group,
• Level 7: Delivering a class presentation
• Weekly assignments followed each level and proceeded in the order described above

5. Social Skills Training:

• Role-played greetings, people introductions and opening conversation starters;
• Practised eye contact, bodily posture and assertiveness (standing up for myself);
• Videotaped my performances and provided corrective feedback on my exaggerated evaluations of negative self-evaluations.

6. Mindfulness Training:

• Utilised a meditation app daily.
• Taught him body scan meditation and Mindful breathing meditation.
• Reviewed noticing levels of emotional reactivity and reducing reactivity to remain in the present during social interactions.

7. Medication (Optional):

• After discussing with his psychiatrist, Arjun was prescribed a course of sertraline (Zoloft) 25 mg, which was increased to 50 mg two weeks later.
• Reported mild nausea in the initial stages of treatment, which quickly subsided.
• The medication was well tolerated and seemed to assist in stabilising mood during exposure work.

Therapy:

Cognitive Behavioural Therapy (CBT):

• Arjun used a 'Thought Diary' to watch for triggering situations, emotional responses, automatic thoughts, and more helpful options
• Used 'evidence exercises' by obtaining feedback from peers and then comparing that to his assumptions
• Worked on 'reality testing' regarding his fears, i.e., reading prepared speech with small intentional errors and observing audience response

Group Therapy:

• Participated in a University-led social anxiety group
• Practised in-vivo interactions of introducing oneself, sharing stories, and providing feedback
• Noted that his fear of being 'the most awkward' was widely present among the group members

Relapse Prevention Plan (Month 4 onwards):

• Developed a personal protocol to guide him through a flare-up of anxiety: mindfulness breathing, reviewing thought logs, and grounding exercises
• Created a 'social goal calendar – a list to keep him engaging in avoidance (i.e., two new interactions each week)

Improvements/Recovery Timeline:

Week 1-2:

• Obtained more information about anxiety as a psychological and biological condition. 
• Established a positive relationship with my therapist and began embarking on identifying triggers. 
• Began to journal my thoughts/feelings after social interactions.

Week 3-4:

• Engaged in low-stakes exposures (e.g., asked strangers for the time). 
• Noted decreases in anxiety scores after the tasks: perceived fear 9/10 → actual distress 3/10. 
• Shared my "least embarrassing" story in group therapy.

Week 5-6:

• Completed our group assignment and gave our presentations. 
• Noted feeling "shaky but proud" afterwards. 
• Noted a decrease in heart rate and sweating before delivering the keynote.

Week 7-8:

• Participated in a class debate and managed my anxiety during this time. 
• This was the first time I received public praise from a professor. 
• I began to mentor a first-year student, which helped to solidify my experience and confidence.

Month 3:

• Started to put myself out socially, joined a student club. 
• With fewer avoidant behaviours, I started eating in the cafeteria again. 
• Noted improvements with making eye contact and my posture.

Months 4-5:

• Attended a career networking event and asked two professionals questions. 
• Began journaling more positive self-observations ("I looked confident", "I made eye contact"). 
• The medication dose had helped me to stabilise, and I began to have a consistent effect.

Month 6:

• Fully completed the exposure hierarchy. 
• Completed the semester with higher grades and more active class participation. 
• Elected as secretary of his student club.

Jagruti Rehab Treatment’s Impact on Arjun’s Life:

Arjun's experience of social anxiety has been one of quiet courage. It began as an invisible wall between him and the world, but has slowly transformed into a curtain that he can pull back. He is no longer terrified of being seen, and he looks forward to the occasions when he can speak.

He now strikes up conversations, makes contributions in class, and has casual friendships with classmates. Arjun is not only reducing his symptoms but is rewriting the story of who he thinks he is. He has transitioned from someone who feels "awkward and judged" to someone who feels "capable and growing". This change in self-concept has been powerful.

Family and Community:

Arjun's parents, worrying about his withdrawn nature, now describe him as "energetic and confident". He returns home more often and has begun to share about his therapy process with younger cousins who are trying to work through similar issues.

His classmates are not only noticing this shift. One classmate said, "I thought Arjun was just quiet before. Now he is leading our meetings and telling jokes."

The Final Thought:

In this social anxiety case study, it is evident that the disorder can uphold its amplified verbalisation in silence, yet stifle one's ability to express oneself. But it also illustrates that therapy, which is structured and small and with support from others, can allow you to put your voice back on.

This case outlines the significance of early intervention, the mayhem of CBT, and the importance of the Jagruti Rehabilitation Centre in Bangalore in healing. Social anxiety will not disappear overnight, but step by step, as each small risk is taken and each courageous word spoken, silence is gone.

And in that gone, a voice is found.

Dr. Amar Shinde

Dr. Amar Shinde, founder of Jagruti Rehab, is a renowned psychiatrist in India with over two decades of experience in mental health, addiction recovery, and neuropsychiatry, dedicated to holistic, compassionate patient care.