Why Do People With Social Anxiety Disorder Shake?

In This Article

Shaking or trembling of the hands or other parts of the body is a common physical symptom you may experience as part of social anxiety disorder (SAD). When your shaking results from anxiety, it is a result of the fight-or-flight response.

As much as you might feel terrible in the moment that you are shaking, and that the whole world can see just how nervous you are—remember that people don't really notice as much as you think they do.


When you shake because of anxiety, it is a result of the fight-or-flight response. This physiological response to threats in the environment increases your alertness and prepares your body for exertion.

In the absence of a real physical threat, your body becomes revved up to fight a lion or tiger, but more likely what you are facing is a stranger or an audience.

If you are in an anxiety-provoking social or performance situation, your body will release the hormone epinephrine (also known as adrenaline). Epinephrine directs blood to your skeletal muscles. You may also experience increased heart rate, blood pressure, and blood sugar. A second hormone, norepinephrine, is also released and involved in many of these changes in your body. When your body starts to quiver, it is as a result of all of these complex internal processes.

Shaking can also result from a medical condition such as Parkinson's disease or be the side effect of some medications. When shaking is the result of a medical condition or medication, a medical doctor will determine the best course of treatment.

Triggering Situations

Common situations in which you might notice your hands or body shaking include when you are:

  • Pouring drinks
  • Raising a drink to your mouth
  • Holding silverware
  • Signing a check
  • Writing in front of others
  • Holding papers during a presentation

Shaking and Social Anxiety

If you struggle with social anxiety disorder, you probably have problems with shaking in front of others. Have you ever had trouble raising a glass to your lips or holding notes during a speech without shaking? You might even notice your legs shaking or your lips quivering.

Often these symptoms are also kept going by a cycle of negative thinking.

"Oh no, I'm starting to shake!" You think.

Guess what that causes? More shaking. Tense muscles. You trying to control your shaking, hiding your hands behind your back—doing things to try and hide it from others.

Unfortunately, fighting against your anxiety and using avoidance strategies will tend to make your shaking worse. But don't worry—there are things you can do to shake less.


People who shake because of anxiety may be treated with either medication or talk therapy.

Beta-blockers are sometimes used to cope with infrequent anxiety-provoking situations, such as speeches or performances. These medications treat the symptoms of anxiety by blocking the effect of adrenaline but do not address underlying psychological issues.

Talk therapies such as cognitive-behavioral therapy (CBT) or acceptance and commitment therapy (ACT) can be helpful for changing your thought patterns that contribute to social anxiety symptoms.

Contact a mental health professional (or get a referral from your doctor) to receive one of these therapies (if you are diagnosed with anxiety), or try them out as self-help methods on your own.

How to Cope

Things that may make your shaking worse (and that you can avoid):

  • Lack of sleep
  • Caffeine
  • Low blood sugar (from not eating regular meals)

Positive strategies that you can use to manage shaking:

  • Meditation
  • Regular exercise
  • Managing stress
  • Acknowledging your anxiety
  • Practicing deep breathing

While you may never be fully free of shaking, by following a lifestyle that includes positive measures to combat stress and shaking is a good first step. Remember—people probably notice a lot less than you think. If you ever find yourself shaking in front of someone, don't try to control it, as that will only make the shaking worse. Instead, focus on something else and move your mind along with so that it doesn't become fixated on the physical symptom and degenerate into a panic attack.

A Word From Verywell

Everyone gets nervous from time to time. However, if you find that your shaking is having a significant negative effect on your daily functioning, it is important to seek help. Shaking that results from social anxiety disorder can be treated with medication or therapy.

Was this page helpful?

Article Sources

  1. Herbert J, Moore GF, De la riva C, Watts FN. Endocrine responses and examination anxiety. Biol Psychol. 1986;22(3):215-26.


  2. Stein MB, Stein DJ. Social anxiety disorder. Lancet. 2008;371(9618):1115-25.


  3. Halaby A, Haddad R, Naja W. Non-Antidepressant Treatment of Social Anxiety Disorder: A Review. Curr Clin Pharmacol. 2015;10(2):126-130.


  4. Abboud H, Ahmed A, Fernandez HH. Essential tremor: choosing the right management plan for your patient. Cleve Clin J Med. 2011;78(12):821-8.


Additional Reading

  • Columbia University, Go Ask Alice. Nervous Trembling.

  • Cordingley GE. Nervousness and shaking: Are they the same thing?

  • University of Utah. How cells communicate during the fight or flight response.

  • University of Michigan Health Service. Anxiety Disorders and Panic Attacks.