No one enjoys making mistakes, looking bad, feeling embarrassed or being humiliated in front of others. But everyone has had such an experience at least once.

An excessive and unreasonable fear of social situations, however, may signal a social anxiety disorder (SAD), and a lack of social skills may not help. People with SAD suffer with distorted thinking — false beliefs about social situations and the negative opinions of others — which interferes with normal daily routine, including school, work, social activities and relationships. SAD may be linked to other mental illnesses, such as panic disorder, obsessive compulsive disorder and depression, which are often among the initial reasons for visiting a physician.

Social phobia is the fourth most common mental health condition with about 1 in 8 people (12.1 percent) having suffered from this anxiety disorder at some time in their life. SAD may be familial, although it is unclear why some family members have it while others do not.

Researchers believe several parts of the brain are involved in fear and anxiety and that misreading the behavior of others may be instrumental in either causing or worsening social anxiety. A range of effective cognitive behavioral and pharmacological treatments for children and adults now exists, but scientists seek better treatments by evaluating fear and anxiety in the brain — and researchers are exploring ways in which stress and environmental factors may play a role.

In a recent study, researchers found that the successful treatment of an anxiety disorder alters key brain structures that are involved in processing and regulating emotions. This longitudinal multimodal study, conducted by researchers from the University of Zurich, Zurich University Hospital and the University Hospital of Psychiatry Zurich, included 33 participants diagnosed with SAD who had attended 10 weeks of cognitive behavioral therapy (CBT), a central therapy for SAD.

Participants were scanned before and after therapy. Three neuroimaging methods — surface-based morphometry, diffusion tensor imaging and network-based statistics — were applied to investigate cognitive behavioral group therapy (CBGT)-induced structural brain alterations of the gray and white matter.

Surface-based morphometry revealed a significant cortical volume reduction (pre- to post-treatment) in the left inferior parietal cortex, as well as a positive partial correlation between treatment success (indexed by reductions in Liebowitz Social Anxiety Scale) and reductions in cortical volume in bilateral dorsomedial prefrontal cortex.

According to Annette Brühl, head physician at the Center for Depression, Anxiety Disorders and Psychotherapy at the University Hospital of Psychiatry Zurich (PUK), the structural changes occur in brain areas linked to self-control and emotion regulation. As treatment became more successful, brain changes were stronger and brain areas involved in processing emotions were more interconnected after the treatment.

Although social anxiety is one of the most common mental illnesses, it remains poorly understood outside of scientific circles. This is the first study that presents a distinctive pattern of longitudinal structural brain changes after CBGT measured with three established magnetic resonance imaging analyzing techniques.

Specifically, researchers showed that psychotherapy normalizes brain changes in key brain structures involved in emotion processing and regulation.