Why Do People With Social Anxiety Disorder Shake?

Shaking as a Symptom of Social Anxiety Disorder

People with social anxiety may visibly shake.
Shaking can be a sign of social anxiety disorder.. Getty / DigitalVision Vectors / ScottTalent

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 because you are going through 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.

So don't panic.

What Causes Shaking Due to Anxiety

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. But wait a minute—there is no real physical threat! That's right. That is exactly the problem. Your body is all revved up to fight a lion or tiger, but more likely all you are facing a stranger or an audience.

If you are in a social or performance situation that scares the living daylights out of you, 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.

How Does Shaking Relate to SAD?

If you struggle with SAD, 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 all manner of 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.

Treatment for Shaking

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 addresses 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. You can either 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 you can try them out as self-help methods on your own.

Below are two self-help courses for CBT and ACT.

Other Causes of Shaking

Shaking can also be the result of a medical condition such as Parkinson's disease or 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.


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

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

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