Why Do People With Social Anxiety Disorder Shake?

Why do people with social anxiety disorder shake?

Verywell / Nusha Ashjaee 

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Shaking or trembling of the hands or other parts of the body are common physical symptoms associated with social anxiety disorder (SAD). Feeling a lack of control over your body can not only increase the intensity of your shaking, but may also worsen other anxiety-related symptoms. This uncomfortable symptom may also be present in other anxiety disorders, such as panic disorder, specific phobias, and agoraphobia.

If you are experiencing shaking or trembling because of social anxiety disorder and/or another anxiety disorder, know that many treatment options are available.

Causes

Experiencing anxiety can trigger your body to go into fight-or-flight mode—an evolutionary response meant to keep you safe in times of perceived danger. This physiological response to threats in the environment increases your alertness and prepares your body to take immediate action.

Stress hormones like epinephrine (adrenaline) and norepinephrine flood your body, which can increase your heart rate, blood pressure, and the blood flow to your muscles. Muscles may also tense up as they prepare to take quick action, which can lead to shaking or trembling.

Research indicates a high correlation between tremor-related medical conditions and social anxiety. Experiencing shakiness and tremors may be due to or exacerbated by medical conditions such as Parkinson's disease, multiple sclerosis, and essential tremor.

A visit to a doctor can help determine whether your shaking is due to an anxiety disorder, a medical condition, or both.

Triggers

Anxiety-related shaking can be triggered by various circumstances. You may notice tremors or shakiness when you are:

  • Anticipating an upcoming social interaction
  • Attending parties or other social gatherings
  • Eating or drinking in public
  • Going on a date
  • Joining a group conversation already in progress
  • Making phone calls
  • Meeting new people
  • Performing on stage
  • Speaking up in a meeting

In addition to shaking and trembling, facing a triggering situation can lead to sweating, an increased heart rate, feeling scared, nausea, and shortness of breath.

Impact

Social anxiety disorder-related shaking and tremors may be intensified by high levels of stress and exhaustion. Feeling fearful or thinking about being embarrassed about shaking in public can also lead to even more shaking, either in the moment or in anticipation of it. This may result in the avoidance of social situations, which may worsen and prolong the symptoms of social anxiety disorder.

Treatment

Anxiety-induced shaking or tremors, otherwise known as psychogenic tremors, are generally treated with psychotherapy, medication, or a combination of both. Which treatment option you choose is completely up to you and what you feel comfortable with.

Speaking with your doctor, psychiatrist, and/or therapist can help you make an informed decision about your treatment.

Psychotherapy

Talk therapies such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) may be effective treatment options for some who are experiencing shaking, tremors, and other symptoms associated with social anxiety disorder.

For those who are less comfortable with talk therapy, eye movement desensitization and reprocessing (EMDR) and equine-assisted psychotherapy (EAP) are other treatment methods to explore.

Medications

Some medications may be helpful in reducing or alleviating shaking and tremors, as well as other symptoms associated with social anxiety disorder. Keep in mind that medications may not work for everyone, and it's best to speak with your doctor about the most appropriate course of action for your unique needs.

  • Antidepressants: These medications are typically the first-line of treatment. Paxil (paroxetine), Zoloft (sertraline), Luvox (fluvoxamine), and Effexor XR (venlafaxine extended release) are FDA-approved for treating SAD.
  • Benzodiazepines: Medications like Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam) can begin working right away to reduce symptoms associated with social anxiety disorder, including shaking. However, the risk of dependence increases the longer you stay on these medications.
  • Beta-blockers: By blocking the effect of adrenaline, beta-blockers such as Inderal (propranolol) can be used to cope with infrequent anxiety-provoking situations, such as speeches or performances. They are also able to help some individuals reduce tremors.

Coping

There are many coping methods you can try that may reduce the symptoms associated with social anxiety disorder, especially shaking and tremors. These techniques may be used in addition to psychotherapy and/or medication.

  • Exercise regularly: Physical activity is a natural anxiety reliever. Exercise releases endorphins and decreases cortisol, resulting in stress hormone reduction and an increase in natural mood boosters.
  • Avoid certain substances: An overabundance of substances like alcohol, caffeine, and nicotine may intensify social anxiety-related symptoms, including shaking.
  • Practice relaxation techniques: When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing may help you feel more grounded and may reduce anxiety-related symptoms such as shaking.
  • Practice yoga: Research indicates that yoga, especially Hatha yoga, is effective in reducing anxiety-related symptoms in a variety of anxiety disorders, including social anxiety disorder.

If you or a loved one is struggling with activities of daily living because of social anxiety disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see the National Helpline Database.

A Word From Verywell

Having your hands or legs tremble or shake during social situations or when you think about an upcoming social interaction may feel frustrating and embarrassing. Anticipating or worrying about shaking can lead to even more trembling, which can leave you feeling out of control and uncomfortable.

Keep in mind that, in general, most people out and about are likely not noticing your shaking or trembling, and are definitely less focused on it than you are. If social anxiety-induced shaking is negatively impacting your quality of life, reach out to your doctor or therapist for available treatment options.

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8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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