Many people experience much social anxiety when speaking a language that they did not grow up with among native speakers of that language.
According to Ethnologue, an organization that maintains a comprehensive database of the world’s languages, there are approximately 7,159 living languages spoken among the world’s 7.6 billion people (as of 2025). The United Nations Educational, Scientific, and Cultural Organization (UNESCO) estimates that 60–75% of the global population speaks at least one language in addition to their native tongue. In other words, most people on Earth are bilingual or multilingual.
As regular readers of the National Social Anxiety Center blog know, social anxiety involves a fear of negative evaluation: worry about how one is perceived based on what one says or does. This fear of judgment can lead to intense anxiety and shame, and in some cases, avoidance of social or professional situations that matter deeply. When social anxiety is severe and long-standing, it may also co-occur with depression or substance use.
Aicha’s Story
Consider the case of Aicha. (This case vignette is a composite, drawn from common clinical themes, and does not reflect a single individual.) She is a 29-year-old woman from Senegal. She grew up speaking Wolof and learned French in grade school, continuing through college. She is equally fluent in both languages. After college, she moved to Paris to attend medical school and later matched into a highly selective neurosurgery residency program in Missouri.
Aicha had studied English in both high school and college and earned top scores on the Test of English as a Foreign Language (TOEFL), the standardized exam required for non-native English speakers pursuing higher education in the United States.
In Senegal, Aicha had a rich social life and was a top student academically. While living in France, she functioned well socially, though she maintained a smaller circle of friends, many of whom were also international students. She spoke up in classes and clinical rotations primarily when called upon.
Upon arriving in the US, however, Aicha struggled significantly. All of her fellow residents were native English speakers. She was the only woman and the only person of color in her cohort. Her supervisors consistently praised her medical knowledge and technical skills, yet she received feedback that she needed to speak up more in group discussions and clinical settings.
Like many non-native speakers, Aicha was well-liked and respected. Her colleagues enjoyed hearing about her background during social gatherings. Still, she hesitated to speak in meetings, fearing she would not be understood. During one high-stress surgical moment, an attending physician said sharply, “Aicha, I don’t understand what you’re saying! We all need to understand each other in these critical moments.”
Although Aicha performed well clinically, she developed a growing belief that others viewed her as less competent because of her accent. She experienced her accent as a major barrier to being the professional and the friend she wanted to be. When she noticed puzzled expressions or had to repeat herself, her anxiety intensified. Over time, she began avoiding non-essential communication altogether.
Notably, her anxiety was not driven by fear of being evaluated for her surgical abilities, but rather by perceived negative judgment about how she spoke.
Therapy and Key Insights
At her breaking point, Aicha sought treatment with a cognitive-behavioral therapist (CBT). Through therapy, she learned several key principles.
Identifying Unhelpful Automatic Thoughts: Aicha learned to identify automatic thoughts that fueled her anxiety, including:
- “People will think I’m not as smart if I speak differently.”
- “I make others uncomfortable when they don’t understand me.”
- “If I mispronounce a word, they’ll laugh at me.”
- “Everyone else speaks perfectly, so I don’t belong here.”
- “My accent makes me different. I’ll never truly connect with them.”
Once these thoughts were identified, she could evaluate them more realistically and test whether they were actually true.
Avoidance and Other Safety Behaviors: Aicha also learned that avoidance—and subtle safety behaviors such as staying quiet, avoiding eye contact—maintain her anxiety. By avoiding opportunities to speak, she never gathered evidence that her fears might be exaggerated or inaccurate. With her therapist, she developed a fear and avoidance exposure hierarchy to test her beliefs in a structured and compassionate way.
Slowing Speech: Anxiety caused Aicha to speak more quickly, which made her accent more pronounced. By practicing slower speech and intentional pauses, she found that her pronunciation became clearer and her confidence increased.
Building Community: Connecting with other non-native English speakers helped Aicha feel less alone. She discovered that many shared similar fears, even those who appeared confident. This community offered encouragement and perspective. They reminded her that accents are often perceived as interesting or even attractive. One surgical nurse once told her, “I’d kill to have an accent like yours.”
Accent Modification Training: Aicha also worked with a speech-language pathologist for accent modification. Importantly, the goal was not to eliminate her accent. Instead, the focus was on making specific phonetic adjustments to improve clarity and ease of communication. This further reduced her anxiety in high-stakes interactions.
Final Thoughts
Aicha’s experience illustrates how social anxiety can emerge for non-native speakers, even those who are highly intelligent, accomplished, and fluent. Speaking a non-dominant language may involve accents, pronunciation differences, or occasional grammatical errors. For individuals who are especially sensitive to judgment or rejection, these differences can become a powerful trigger for social anxiety.
Research and clinical experience suggest that a combination of cognitive-behavioral therapy (CBT), social support, and (when desired) accent modification training can be highly effective. With the right tools and support, non-native speakers can find their voices, challenge unhelpful beliefs, and engage more fully in both their professional and personal lives. If you’re a non-native speaker struggling with anxiety, working with a CBT therapist familiar with social anxiety can help.
References:
American Speech-Language-Hearing Association. (n.d.). Accent Modification.
Clark DM & Wells A (1995). A cognitive model of social phobia. In Heimberg RG, Liebowitz MR, Hope DA & Schneier FR (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). Guilford Press.
Ethnologue. (2024). Demographics. SIL Global.
Gluszek, A & Dovidio, JF (2010). Speaking with a nonnative accent: Perceptions of bias, communication difficulties, and belonging. Journal of Language and Social Psychology, 29 (2), 224–234.
Heimberg, RG & Becker RE (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. Guilford Press.
Lev-Ari S & Keysar B. (2010). Why don’t we believe non-native speakers? The influence of accent on credibility. Journal of Experimental Social Psychology, 46 (6), 1093–1096.
Pappamihiel, N. E. (2002). English as a second language students and English language anxiety. Bilingual Research Journal, 26(2), 327–348.
