Seeking Treatment for Social Anxiety Disorder

1. Global introduction

Lydia Don, a student from the University of Birmingham, struggled with social anxiety since she was 13, causing her to isolate herself, miss classes and avoid speaking in seminars. As her social anxiety worsened over time, she kept it to herself because she feared the thought that others would think she was being irrational or overreacting. Eventually she attempted to get treatment, but that was not a straightforward process: she was passed between four or five school counselors, in which she had to repeatedly explain her painful experiences and at the end, she felt no better. She expressed that: “In my experience, institutions often claim that mental health is a concern for them but without providing formal procedures and spaces for those suffering, their rhetoric feels tokenistic and meaningless” (Don, 2024). It was only after going private that she was finally able to receive consistent counselling, but she recognized that this option is not accessible to everyone (Don, 2024). In that sense, Lydia was lucky: she was able to overcome the fear of judgement and then afford an alternative when the institutional system did not properly help her. Although her experience took place in Birmingham, getting treatment is already difficult in Canadian postsecondary institutions. Moghimi et al. (2023) found that among 448 Ontario postsecondary students, 50.5% reported financial barriers, 47.6% reported long wait times, 31.4% reported stigma and just 8.3% reported having no barrier to mental health care. This shows that students with social anxiety must not only confront their anxiety when asking for help, but they may also have to face sociological and economic barriers before actually receiving treatment. First, under the lens of psychology, this paper will argue that the symptoms of social anxiety can directly interfere with treatment-seeking because symptoms such as fear of judgement and avoidance may make students less likely to contact a professional. This section will be supported by using large screening questionnaires, surveys and a randomized controlled trial that analyzes treatment-seeking patterns and online cognitive behavioral therapy. Secondly, under the lens of sociology, this paper will argue that treatment-seeking is also influenced by stigma and masculinity norms, which can make vulnerability seen as a weakness, especially among young male students. This section will use Masculinity Scale surveys to establish that there is a pattern with gender and treatment-seeking and then gender-sensitive interventions will be looked at to analyze whether this gender gap can be minimized. And lastly, under the lens of economics, this paper will argue that willingness to receive treatment is not enough to make students receive treatment: insurance limits, private costs, long waiting lists all can prevent students from accessing treatment despite being open to it. This section will be supported using surveys of Canadian institutions’ insurance plans, funding plans for psychotherapy and cost-effectiveness of different treatment formats. Therefore, by analyzing the psychological, sociological and economical barriers of treatment-seeking for social anxiety, this paper will argue that provincial governments and postsecondary institutions must absolutely redesign treatment entry points, implement proactive gender-sensitive outreach, and reform funding and insurance structures that determine treatment capacity so that seeking help becomes realistically accessible for male students with social anxiety.

When looking at how society applauds the encouragement of saying “you are not alone” or “seek help whenever you need”, it makes the action of seeking help look easier than it is. As demonstrated by Moghimi et al. (2023) using data, those types of messages hit a wall because seeking and accessing treatment can be psychologically intimidating, culturally discouraged or unaffordable. This is a contradiction that society bears and it makes society seem like encouraging one to get help is more valued than one getting help. So instead, within the context of a modern crisis of meaning, one could argue that people lose their faith in society's values and may turn toward, for instance, traditional gender roles to fill up an identity gap caused by exclusion and difficulty in finding meaning getting indirectly alienated by society. Moreover, masculinity culture can give people a rigid identity, but it also makes help-seeking less viable: help-seeking requires vulnerability, but masculinity culture is a culture where vulnerability is frowned on.

2.1 Psychology Introduction

Psychology is the social science discipline that studies the thoughts, emotions and behaviors of a human. For Canadian postsecondary students with social anxiety, there is a major psychological barrier for them: the symptoms of social anxiety can affect with the actions required to get help. Contacting an unfamiliar person, explaining private difficulties and being evaluated can all create fear of judgment. This section will argue that first: using Olfson et al. (2000)’s study, fear of negative evaluation can itself become a barrier to treatment-seeking. Secondly, using Patel et al. (2022)’s study, this section will add nuances by arguing that people with more disruptive social anxiety symptoms are more likely to seek treatment, meaning those with clinical fear of judgement but non-disruptive to their lives will seek treatment less. Thirdly, using McCall et al. (2018), it will argue that online cognitive behavioral therapy can be used as a possible lower-pressure treatment instead of in-person, which may reduce fear of judgement.

2.2 Olfson et al. (2000)

Olfson et al. (2000) shows this psychological paradox of seeking help for social anxiety can be a source of social anxiety. The psychology researchers used data from the 1996 National Anxiety Disorders Screening Day and compared 6130 American adults who reported fear in both performance and general social situations with 4507 participants who reported neither symptom. Participants completed questionnaires about anxiety, previous treatment and eight possible barriers, then met with a mental-health professional for 10 to 15 minutes (Olfson et al., 2000). 19.7% of the non-treatment social anxiety group reported that the fear of what others might think or say is what prevented them from seeking treatment, and when comparing it with the 6% for the non-treatment non-social-anxiety group, there is a 2.8 times odds difference (Olfson et al., 2000)

Although the samples were not about Canadian postsecondary students, the study identifies a psychological mechanism that may also affect Canadian postsecondary students. Students may know that help exists and still avoid contacting a counsellor because doing so requires disclosure and evaluation. More importantly, fear of what others think has the most significant psychological correlation with social anxiety in the study (Olfson et al., 2000). The second highest psychological relation is fear of taking medication which was reported at 12.9% of the social anxiety group compared with 10.1% of the group without social anxiety, producing only 1.3 times the odds (Olfson et al., 2000). In comparison, fear of what others think produced 2.8 times the odds with 19.7% and 6% (Olfson et al., 2000). This difference strengthens the idea that fear of what others think is not just a general treatment barrier, but a psychological barrier that is especially correlated with social anxiety. The authors explain that people with social anxiety can feel ashamed of their symptoms or embarrassed to discuss them with professionals, which creates the irony that the symptoms that they want to treat acts as a barrier to treatment (Olfson et al., 2000). Limitations for this study is that it used volunteers at an anxiety screening event, meaning that these participants were already willing to participate in some form of help or screening: it cannot be translated into the broader social anxiety disorders among students who would avoid help.

2.3 Patel et al. (2022)

While Olfson et al. (2000) showed that having fear of what others might think, a key social anxiety symptom, is associated with less help-seeking, it does not measure how severity of social anxiety or how it is lived with, affect help-seeking. Patel et al. (2022) looks into this by measuring symptoms and feared situations and connects it to actual seeking treatment. Patel et al. (2022) used a survey of 36309 American adults. Using the survey data, the participants who have not met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for social anxiety disorder were excluded: leaving with 1255 participants who have met the criteria for social anxiety disorder. Of those 1255, only 494 participants had received professional help or medication for social anxiety while the rest, 761, had not received any professional treatment: 39.4% compared to 60.6% (Patel et al., 2022).

The results show that certain symptoms were more present among people who had seeked treatment. Fear of small groups was reported by 39.4% of the treatment group compared with 21.8% of the non-treatment group. Fear of talking at social gatherings was reported by 65.6% compared with 47.4% (Patel et al., 2022). Panic attacks showed the most significant difference: 45.7% of the treatment group had experienced it in a feared social situation compared to 26.7% of the non-treatment group (Patel et al., 2022). What this study indicates is that the symptoms of social anxiety disorder and how it is lived through can correlate with treatment-seeking: more disruptive symptoms like panic attacks meant higher treatment-seeking and lower for those who live with less disruptive symptoms even if they meet the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for social anxiety disorder. Combined with Olfson et al. (2000)’s finding, it can be possibly explained that if symptoms are milder, then the fear of what others might think or say may outweigh the perceived need to get treatment.

Patel et al. (2022) also found that the average age of SAD onset was 18.36 years in the treatment group and 16.10 years in the non-treatment group. This study suggests that people with earlier social anxiety might see their social anxiety as part of their identity or personality instead of as a treatable change, although the researchers states more research is needed for this (Patel et al., 2022). Post-secondary institutions should therefore not rely only on students to recognize the problem once it becomes severe. Anonymous self-screening for social anxiety disorder can possibly be used to counteract the fear of what others may think or say to at least give students an idea whether they might have a clinically significant mental disorder without the input of another person. Limitations for this study is that it used a cross-sectional American data, meaning the study cannot prove what specific psychological mechanisms makes people with less disruptive social anxiety disorder seek less treatment compared to more disruptive symptoms (Patel et al., 2022).

2.4 McCall et al. (2018)

Patel et al. (2022) shows that some people may only seek treatment once their symptoms become disruptive enough to push them toward help. McCall et al. (2018) provide a possible solution that applies directly to Canadian university students. The psychology and public-health researchers tested Overcome Social Anxiety, a self-directed web-based Cognitive Behavioral Therapy (CBT) program using cognitive restructuring, behavioral experiments and exposure exercises (McCall et al., 2018). In a randomized controlled trial at a large Canadian university, 65 students with social-anxiety symptoms were assigned either to the online program or to a waitlist control group, with symptoms measured before treatment and four months later (McCall et al., 2018).

The results of this study show that the treatment program reduced social anxiety symptoms. In the treatment group, the average Social Interaction Anxiety Scale score decreased from 38.07 to 30.73, while the control group decreased from 43.60 to 41.43. For the Fear of Negative Evaluation Scale, the treatment group went from 21.40 to 16.50, while the control group decreased from 23.37 to 22.91 (McCall et al., 2018). Also, 80% of the treatment group were mostly or very satisfied with the program and 77% said it helped them deal with social anxiety more effectively (McCall et al., 2018). What this means is that Canadian students with social anxiety may possibly benefit from a treatment format that does not require immediate face-to-face interaction which might induce social anxiety.

McCall et al. (2018) do not prove that online CBT makes students more likely to begin treatment because the study measured symptom change after students had already entered a research trial. The sample was also small, used course credit and compared the program with a waitlist rather than face-to-face therapy (McCall et al., 2018). However, when it is considered beside Olfson et al. (2000), the institutional value becomes clear. Olfson et al. found that fear of judgment was much more strongly connected to social anxiety than fear of medication, while McCall et al. found clear reductions in social interaction anxiety and fear of negative evaluation. Together, these findings suggest that Canadian postsecondary institutions should offer evidence-based online CBT as an optional first entry point rather than requiring every student to begin with immediate face-to-face disclosure.

2.5 Psychology Conclusion

Overall, this psychology section shows that low treatment-seeking can be explained partly by the symptoms of social anxiety disorder itself. Fear of what others might think or say can prevent someone from seeking help, while people with less disruptive symptoms may delay treatment until their anxiety becomes more difficult to manage (Olfson et al., 2000; Patel et al., 2022). McCall et al. (2018) also show that treatment can be organized in a format that reduces immediate social pressure while still reducing symptoms. Canadian postsecondary institutions should therefore provide confidential screening, clear explanations of treatment steps and web-based CBT entry points so that receiving help does not begin with the most psychologically intimidating form of treatment-seeking.

3.1 Sociology Introduction

Sociology is the social science discipline that studies how social groups, norms and institutions affect human behavior. For Canadian postsecondary students with social anxiety, treatment-seeking is not only influenced by the specific symptoms of social anxiety, but also by the social expectations surrounding vulnerability. This section will argue that first: using Seehuus et al. (2021)’s study, there is a gender gap in treatment-seeking. Secondly, using Clark et al. (2020)’s study, that specific gender gap can be explained by masculinity norms. Thirdly, using Sagar-Ouriaghli et al. (2023), there are interventions methods that can potentially mitigate these masculinity norms that suppresses treatment-seeking.

3.2 Seehuus et al. (2021)

Seehuus et al. (2021) show that there is a gender difference in treatment use among postsecondary students. The study consisted of 2254 undergraduate students from two small American liberal-arts colleges to complete a 15-minute online survey. Only 2073 completed every part of the survey. The researchers measured gender, anxiety and depression symptoms and whether the students had received mental health care for it during college (Seehuus et al.,2021). 23.56% of the male students had received treatment while 42.08% of women and 59.57% of students with another gender identity. Even after accounting for the fact that women reported higher anxiety and depression symptoms, they were still 2.32 times more likely to have received treatment compared to men (Seehuus et al., 2021). What this shows is that lower treatment use among male students cannot be explained only by males reporting fewer symptoms. Gender itself remained connected to whether a student entered treatment. This is relevant to Canadian postsecondary students with social anxiety because a male student can experience clinically significant anxiety and still be socially discouraged from presenting it as a problem that requires professional help. However, Seehuus et al. only measured general anxiety and depression rather than social anxiety, so it only establishes a broader gender pattern of help-seeking instead of directly proving that male students with social anxiety use treatment less. Another thing is that it is a cross-sectional study, so it cannot establish a sociological cause but a correlation.

3.3 Clark et al. (2020)

While Seehus et al. (2021) establishes the gender gap of treatment-seeking for mental health, the study still does not explain which social mechanisms creates that gap between men and women. Clark et al. (2020) explains the possible mechanism behind this gender gap by studying masculinity norms, anxiety knowledge and help-seeking among 1737 Australian adolescent males aged 12 to 18 from six male-only schools. The participants completed questionnaires at school. Anxiety mental health literacy was measured using three short stories that depict different types of anxiety, including one about a boy with social anxiety. Masculinity was measured through a list of statements about traditional masculinity norms which the participants had to rate from strongly disagree to strongly agree. Help-seeking was measured using a scores system surveys that measured: attitudes, intentions, and a yes-or-no of whether the participants or their parents had contacted a professional for help (Clark et al., 2020). Out of the 218 male participants who had clinical anxiety or depression scores, only 30% had received professional help.

The results show that stronger alignment with masculinity was connected to lower willingness to seek help. Higher masculinity scores lowered formal help-seeking intention scores by 0.25, family intentions by 0.15 and peer intentions by 0.08, while intentions to use online help increased by 0.05 (Clark et al., 2020). Stronger masculinity also decreased attitudes toward formal help by 0.03 and informal help by 0.06. More importantly, higher anxiety mental health literacy is associated with higher help-seeking attitudes among the participants with low masculinity: an increase of 0.018 points for each literacy point, but it had no significant effect with those with high masculinity alignment where the change was -0.002 (Clark et al., 2020). What this shows is that just simply teaching male students more about anxiety and mental health literacy may not be enough when their views conflict with masculinity, which is based on toughness, emotional control and self-reliance. It strengthens the point that masculinity norms can override the act of treatment-seeking despite knowing about it and knowing that it is needed.

However, Clark et al. (2020) found one different pattern that is useful for recommendations. While stronger masculinity was associated with lower intentions to seek help from formal, family and peer sources, it was associated with a 0.05 increase in intention to seek help from online sources. The online category included websites and internet chat rooms rather than a specific video call treatment program (Clark et al., 2020). What this means is that Canadian postsecondary institutions could possibly use online information, short videos, anonymous chats or self-screening as a first contact for male students who are less comfortable with face-to-face help. These options should not replace professional treatment but can act as a less direct entry point toward it. However, the study examined adolescents instead of postsecondary students, used a correlational design and included cases where parents contacted a professional, meaning it cannot establish a cause or directly represent Canadian male university students.

3.4 Sagar-Ouriaghli et al. (2023)

While Clark et al. (2020) shows that regular mental health education can be less effective when it conflicts with a high masculinity norms alignment, Sagar-Ouriaghli et al. (2023) looked at three possible interventions to circumvent that high masculinity norms alignment. 24 male university students in the United Kingdom chooses which advertised intervention they would do: nine attended the Men-Tality, a formal mental help program targeted at men, six attended Psychological Strength, a formal mental help program using gender-sensitive language, and nine attended Man Cave, an informal drop-in with games, social activities and discrete mental health information (Sagar-Ouriaghli et al., 2023). Man Cave also differentiated from the other 2 interventions: it did not require a preregistration, meaning students could enter and leave whenever they wanted and collect mental help information holistically inside the program. Help-seeking attitudes were measured using the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF), containing 10 statements about psychological help in which participants rated each from 0 to 3: higher means more positive attitude towards professional help-seeking. Masculinity was measured using the Conformity to Masculine Norms Inventory, which contains 46 statements about nine masculinity norms, including emotional control, self-reliance, winning, risk-taking and so on. Participants rated each statement from 0, strongly disagree, to 3, strongly agree: higher score means stronger masculinity norms alignment.

The most relevant findings are that Man Cave reached a different type of male students: Man Cave group had the lowest average help-seeking attitude score of 14.22, compared with 21.44 for Men-tality group and 19 for Psychological Strength group. Also, only 22% of Man Cave participants had previously used mental health support, compared with 44% for the Men-Tality group and 83% for the Psychological Strength group (Sagar-Ouriaghli et al., 2023). The Man cave group also had the highest masculinity score of 1.42 compared to 1.11 for the Men-Tality group and 1.36 for the Psychological Strength group.What all these data implies is that there is a pattern: the Man Cave informal help program attracted male students who had a more negative attitude towards treatment-seeking, less likely to seek treatment compared to the other groups and had higher masculinity score.

However, the limitations are that the study did not find significant improvements in help-seeking attitudes or mental health outcomes and only included 24 students. Meaning that this does not show that Man Cave improves attitudes of seeking treatment. What it does show is that the specific format a mental health program or service is presented has effects on whether male students with high masculinity norms scores would participate.

3.5 Sociology conclusion

Overall, this sociology section shows that treatment-seeking behavior is influenced by gender and masculinity norms. Male students sought treatment significantly less and with higher masculinity norms, it can further lower treatment-seeking (Clark et al., 2020; Sagar-Ouriaghli et al., 2023; Seehuus et al., 2021). Some interventions and protocols can potentially improve the entry point of seeking help, such as possibly looking into online format and more informal mental help programs like the Man Cave (Sagar-Ouriaghli et al., 2023). Using data from this section, Canadian postsecondary institutions should increase online help resources, and organize and advertise informal male help groups with formatting that is less clinical and more social activities.

4.1 Economics Introduction

Economics is the social science discipline that studies how money, costs and limited resources affect human decisions and institutions. For Canadian postsecondary students with social anxiety, there is a major economic barrier for them: being willing to receive treatment does not mean that they can afford or access it. This section will argue that first: using Nunes et al. (2014)’s study, Canadian student insurance plans often provide too little psychotherapy coverage to pay for a full treatment. Secondly, using Dezetter and Briffault (2015)’s study, increasing psychotherapy funding can be seen as an investment rather than only as a cost because treatment may reduce other direct and indirect costs. Thirdly, using Vasiliadis et al. (2024), group transdiagnostic cognitive behavioral therapy can be a cost-effective way to increase treatment capacity when institutions do not have enough money or professionals to provide unlimited individual therapy.

4.2 Nunes et al. (2014)

Nunes et al. (2014) shows that limited insurance coverage can become a major economic barrier, even when Canadian postsecondary students are willing to receive treatment. The researchers collected information from 210 Canadian postsecondary institutions to examine how much their health insurance plans covered prescription medication, psychotherapy or counselling. They first searched university and college websites, then used Google and contacted institutions directly when the information was not available. For each institution, they recorded whether a plan existed and how much it covered per visit and per year. This is directly relevant to my topic because students with social anxiety may overcome the psychological fear of contacting a professional, but still be unable to continue treatment if their insurance only covers a small part of its cost.

The results show a major difference between medication and psychotherapy coverage. 68% of universities and 41% of colleges provided extended health insurance, and 71% of these plans covered at least 3000$ per year for prescription medication while 28% had no maximum (Nunes et al., 2014). In comparison, only 69% of universities and 28% of colleges had plans covering psychotherapy. Even when psychotherapy was covered, the most common yearly maximum was only between 300$ and 500$. Since one hour with a psychologist generally costs between 100$ and 220$, this amount would usually only cover two to four sessions (Nunes et al., 2014). Some plans also required students to first receive a physician referral, which does add another step and possible delay before receiving treatment. What this means is that having insurance does not necessarily mean that psychotherapy will be economically accessible: a student can technically be covered but still have to personally pay most of the cost of a complete course of treatment, which can be in the thousands.

Nunes et al. (2014) also explains that it’s the student unions and student associations who negotiate these insurance plans with providers. Meaning that they are the ones that should negotiate higher psychotherapy coverage for the students, that reflects the cost of a complete treatment instead of just offering coverage that does little.

4.3 Dezetter and Briffault (2015)

While Nunes et al. (2014) showed that student insurance plans do not cover enough psychotherapy sessions for a full course of treatment, Dezetter and Briffault (2015) analyzes whether increasing this psychotherapy funding can be economically viable or justified. The researchers used data from a cross-sectional telephone survey of 20,777 adults from four regions in France. The Composite International Diagnostic Interview-Short Form was used to identify depressive and anxiety disorders, including social anxiety. They then adapted the English Improving Access for Psychological Therapies model to the French healthcare system to estimate the costs and benefits of partially funding psychotherapy. The model used a cost of 41 euro per session, a 60% public reimbursement rate, the number of recommended sessions for each disorder and an estimated psychotherapy remission rate of 30% (Dezetter & Briffault, 2015). This was not an experiment where researchers directly followed patients after treatment. Instead, they combined survey data and existing estimates to predict whether funding psychotherapy would cost or save money.

The results show that psychotherapy funding can possibly recover part or all of its own cost. For anxiety disorders, the annual economic cost was estimated at 1500 euros per person. With the estimated 30% remission rate, psychotherapy would avoid around 450 euros in direct and indirect costs, while the psychotherapy itself would cost around 395 euros per patient (Dezetter & Briffault, 2015). When dividing 450 euro of avoided costs by the 395s euro treatment cost, it gives a cost-benefit ratio of 1.14. What this means is that every 1 euro invested in psychotherapy for anxiety disorders, approximately 1.14 euro will be saved. These savings involve reducing over the long run direct costs such as medical care and indirect costs such as reduced productivity or work absences and such. Therefore, increasing psychotherapy funding should be seen as an investment rather than pure costs because it might be more expensive over the long run to leave anxiety untreated.

4.4 Vasiliadis et al. (2024)

While Dezetter and Briffault (2015) shows that increasing psychotherapy funding can possibly recover part of its cost directly and indirectly, Vasiliadis et al. (2024) examines a specific treatment model that can increase treatment capacity at a relatively low additional cost. The researchers used data from a multisite randomized controlled trial in Quebec with 231 adults aged 18 to 65 who had anxiety disorders, including social anxiety disorder. 117 participants received group transdiagnostic Cognitive Behavioral Therapy (CBT) plus treatment as usual, while 114 received only treatment as usual. The group CBT program lasted 12 weeks, with one 2 hours session per week and around 10 participants in each group. This is relevant economically because one therapist can treat several people at the same time instead of providing separate individual sessions, meaning that each supply of therapists can cover more demand for therapy.

The economic evaluation was done from the healthcare system perspective over one year. The researchers used Quebec healthcare records to calculate the cost of the group program and other publicly funded services used by each participant. In the findings, Quality-Adjusted Life Years, or QALY, represents one year lived in perfect health. The results showed that adding specifically group CBT cost the healthcare system an average of 281$ more per participant than treatment as usual, while only producing 0.0427 additional QUALYs, meaning that an improvement of about 16 days lived in perfect health in one year was seen. The economic benefits can be seen when dividing the additional 281$ cost to the additional 0.0427 QALYs: producing a cost of 6581$ per additional QALY (Vasiliadis et al., 2024). Since the study established that the willingness-to-pay threshold was at 20000$, meaning the maximum amount used to judge whether one additional QALY is worth its cost, the model found a 93% probability that group CBT was indeed cost-effective. This does not mean that the program directly saved money, but that it produced an additional health benefit at a relatively low extra cost which might be considered, especially when looking at Dezetter and Briffault (2015)’s data.

What this shows is that Canadian postsecondary institutions may not have to rely only on increasing individual therapist supply to increase treatment capacity, but to make each therapist able to serve more demand efficiently. Canadian postsecondary institutions, and provincial governments, should therefore consider that funding group CBT as a treatment option for students who are avoiding treatment due to financial reasons. One limitation is that this study only looked at adults rather than postsecondary students, so the findings cannot 100% translate into students, but it does support that it can be done while being cost-effective and treatment effective. Also, another factor is that group treatment may be intimidating for students with social anxiety so it should be combined with format that is less intimidating like online CBT (McCall et al., 2018).

4.5 Economics Conclusion

Overall, this economics section shows that being willing to receive treatment does not mean that students can economically access it. A complete psychotherapy treatment is unaffordable: insurance coverage offered in postsecondary Canadian institutions covers only two to four sessions (Nunes et al., 2014). As demonstrated by Dezetter and Briffault (2015), increasing funding for psychotherapy can possibly be cost-effective over the long run indirectly and directly. Vasiliadis et al. (2024) also shows that group transdiagnostic CBT can be another cost-effective way to increase treatment capacity when there is limited supply of professionals and funding. Using data from this section, Canadian postsecondary institutions and provincial governments should increase psychotherapy insurance coverage and funding, while also offering group CBT as an optional treatment format so that economic barriers do not prevent students with social anxiety from receiving treatment.

5.1 Recommendations

The Union étudiante du Québec (2026) found that nearly 74% of university students who felt a need for help did not use their institution’s psychosocial services, while nearly 40% believed the response delays were not reasonable. Backed by numerous scholarly articles, the stance of this paper is that low treatment-seeking is mainly caused by how treatment is organized, funded and accessed rather than by an individual unwillingness to receive help. That same Quebec organization also states that the demand for mental healthcare exceeds the resources available and specifically calls on the Ministère de l’Enseignement supérieur to renew and improve its student mental-health action plan (Union étudiante du Québec, 2026). Logically, to support UEQ, the recommendations will be directed towards the Québec’s Ministère de l’Enseignement supérieur. This ministry should mandate and fund a restructured mental health care plan for every postsecondary institution in Québec, while campus counselling centers, wellness offices, student unions and insurance committees would apply its different parts mandated by the ministry.

The first recommendation is that Québec’s Ministère de l’Enseignement supérieur should require every campus counselling service to provide confidential self-screening, a clear explanation of every treatment step and evidence-based online Cognitive Behavioral Therapy as an optional first entry point. Students should be able to complete the screening privately, understand what will happen before contacting a professional and directly choose between online and in-person options. Olfson et al. (2000), Patel et al. (2022) and McCall et al. (2018) show that fear of judgment and delayed recognition can block treatment, while online CBT can reduce symptoms without requiring immediate face-to-face disclosure.

The second recommendation is that the ministry’s mental health care plan should require anonymous online contact options and informal male-sensitive programs using less clinical language, male social activities and mental health information presented in a discreet way. These programs should include a clear pathway toward counselling so that they act as an entry point rather than replacing professional treatment. Seehuus et al. (2021), Clark et al. (2020) and Sagar-Ouriaghli et al. (2023) show that male students use treatment less, masculinity norms can reduce formal help-seeking and informal programs can attract students that regular programs may not reach.

The third recommendation is that Québec’s Ministère de l’Enseignement supérieur should provide stable funding to improve psychotherapy coverage and increase service capacity through more counsellors, group treatment and partnerships with community providers. The ministry should also require institutions to report wait times, available treatment spaces and unmet demand so that funding can be directed where access problems are the strongest. Costs, insurance limits and long waits can prevent treatment even after a student decides to seek it (Moghimi et al., 2023; Nunes et al., 2014; Vasiliadis et al., 2024).

To influence Québec’s Ministère de l’Enseignement supérieur, the findings from this paper could be turned into a short policy brief and sent by email to the office of Québec’s Minister of Higher Education. The brief will present the three recommendations, the evidence supporting them and the specific barriers that each recommendation is designed to reduce.

5.2 Global Conclusion

In conclusion, this paper demonstrates that low treatment-seeking among Canadian postsecondary students with social anxiety cannot be explained only by a lack of willingness to get treated. First, the psychology data shows that fear of what others may think or say, and avoidance can make treatment-seeking itself just another feared social situation, while students with less disruptive symptoms of social anxiety may continue delaying treatment until their anxiety becomes severe enough to disrupt their lives (Olfson et al., 2000; Patel et al., 2022). Secondly, the sociology data shows that male students seek treatment significantly less than other genders and that stronger masculinity norms alignment can further lower positive attitudes and intentions toward seeking formal help (Clark et al., 2020; Seehuus et al., 2021). At the same time, online treatment and informal male-sensitive programs can possibly make a less intimidating first contact with mental health support, lowering the threshold for a male student to seek help (McCall et al., 2018; Sagar-Ouriaghli et al., 2023). And thirdly, the economics data also shows that treatment can remain inaccessible solely because of costs, insurance limits and insufficient service supply: even if a student is very willing to get help. What these findings all show is that the barriers can stack upon each other, meaning that while treatment may exist, it can be still unattainable due to psychological, sociological and economical barriers. This raises a larger question about mental healthcare in society: whether encouraging people to seek help is enough when the systems surrounding that help are not designed around the people who are most likely to avoid or be excluded from it. As Lydia Don said at the beginning of this paper, without a systemic change, the concerns that institutions claim for student’s wellbeing will keep being “tokenistic and meaningless”.

6. References

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Dezetter, A., & Briffault, X. (2015). Coûts et bénéfices d’un programme de financement des psychothérapies auprès des Français souffrant de troubles dépressifs ou anxieux. Santé mentale au Québec, 40(4), 119–140. https://doi.org/10.7202/1036097ar

Don, L. (2024, March 24). ‘It completely consumes you’: 20 and struggling with anxiety. The Times. https://www.thetimes.co.uk/article/it-completely-consumes-you-20-and-struggling-with-anxiety-56bjn5snz

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