Phone call anxiety: 6 things it could mean

“Is everything okay?”

This is a fairly typical response I get when I call a friend for a chat. 

“Yes, everything’s fine,” I reply, somewhat taken aback by the alarm in their voice. “Why do you ask?”

Invariably, the recipient of my innocuous call reminds me that I’m one of the few people in their lives—often along with their parents—who actually still use a phone. And they add that getting a call can bring them the same sense of dread as a bad, breaking news alert. 

As a therapist, I have a keen interest in why a world-changing communication device—invented way back in 1876—is a cause for anxiety in the 21st Century. 

Here’s what I’ve learned about why so many folks—including people I’ve worked with in my practice—feel some degree of panic when they hear their phone chirp or feel it vibrate. And I’ll discuss some of the mental disorders that a life-disrupting fear of a ringing phone can be a symptom of. Put your phone on silent and read on. 

The roots of phone call anxiety 

I’m just old enough to remember when a phone wasn’t something you carried around in your pocket—but a heavy, wired device anchored to the wall in your home. It had a dial and was loud and jarring enough to be heard from whatever room you were in, so ignoring it was impossible. Silencing the thing would literally mean yanking the cord out of the wall. Moreover, there was absolutely no telling who was on the other end before you picked it up. There was no caller ID: Phone numbers were printed in a big book and distributed to everyone who lived within several miles of you. 

On the face of it, it seems like the phone experience should be a lot less scary these days. So why all the anxiety? Let’s look at some possible reasons. 

1. You don’t have a lot of practice. The rise of texting as a primary communication method has led to a decrease in the frequency of phone calls, and that, for my money, has contributed to a lot of the increased anxiety surrounding them. As phone calls become less common, they start to feel more significant and high-stakes. The lack of practice and familiarity with handling phone conversations exacerbates this anxiety. You might feel less prepared and more uncertain about the dynamics of verbal communication, which leads us rather neatly to another factor at play…

2. You have less control over the conversation. Phone calls require real-time responses that leave little room for the measured contemplation that texts or emails allow. This can be daunting if you prefer to craft your communications carefully. In therapy sessions, I’ve seen how this lack of control can exacerbate anxiety in people who value preparation and deliberation in their interactions, leading to a preference for text-based communication.

3. You worry about coming off badly. This is a common thread in phone call anxiety, where people fear judgment or criticism during calls. In my practice, I’ve observed patients who over analyze the tone, pauses, and responses in phone conversations, fearing disapproval or rejection. This anxiety often ties back to deeper issues of self-esteem and social confidence. It’s particularly pronounced in interactions with authority figures, or in situations with perceived high stakes, like job interviews or important business calls.

4. You’ve had negative experiences in the past. These can have a lasting impact, leading to generalized phone call anxiety. Whether it’s a traumatic event, or a series of uncomfortable calls, such experiences can condition you to associate all phone calls with stress. 

5. Performance anxiety. Similar to public speaking, phone call anxiety can stem from a fear of not sounding competent or articulate. This is common in professional contexts where clear and confident communication is valued. People I’ve worked with often worry about being perceived as less capable, leading to a vicious cycle of anxiety and avoidance.

6. Finally, phone communication is simply different these days. Good or neutral news is now often relegated to a text message, while bad news is often still delivered by a live call. Therefore, the ringing of a phone could set off a reaction of, “Oh no, what now?”

When phone call anxiety could harm your mental health

As I mentioned before, plenty of people I know—particularly those who are younger and grew up in a time when texting has always been an option—have expressed some degree of discomfort with getting an old-fashioned phone call out of the blue, leading me to conclude that a certain degree of phone call anxiety is common, and usually isn’t a big problem. But if your phone call anxiety is intense and even life-disrupting, it could signal any one of a handful of mental disorders. 

Let’s take a look at some of them now. 

Social Anxiety Disorder (SAD) involves a pervasive fear of social interactions, where phone calls can be a significant trigger. Treatment typically involves cognitive-behavioral therapy to address negative thought patterns and exposure therapy to reduce avoidance.

Generalized Anxiety Disorder (GAD). This is characterized by excessive worry, making phone calls a source of intense anxiety. Treatment often combines cognitive-behavioral therapy with medications like selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs).

Depression can affect communication preferences, making phone calls seem overwhelming. A combination of psychotherapy, medication, and lifestyle changes might help reduce depressive feelings.

Schizophrenia. This disorder can make phone calls challenging due to symptoms like auditory hallucinations or paranoia. Treatment typically involves antipsychotic medication and therapy.

Obsessive-Compulsive Disorder (OCD): OCD affects about 2.5% of the global population. Though it’s often (erroneously) considered a benign preoccupation with hygiene or order, it can appear in various ways.

OCD hijacks the brain through a cycle of intrusive thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions). To reduce the anxiety your obsessions provoke, you perform compulsions—also referred to as “safety-seeking behaviors”—to prevent the outcome you fear. But the relief you may feel is only temporary, and the cycle repeats. This cycle is driven by abnormal activity in brain regions responsible for decision-making and error detection, particularly the orbitofrontal and anterior cingulate cortex. 

What does this have to do with phone calls? Well, if you have OCD, you might experience intrusive, persistent worries about making mistakes, saying something inappropriate, or being negatively judged during calls. 

These obsessive thoughts provoke significant anxiety and distress. To alleviate this discomfort, you might engage in compulsive behaviors such as excessively rehearsing conversations, seeking reassurance after calls, or avoiding phone calls altogether. 

Obsessions about phone calls and compulsions performed to reduce the anxiety they create can negatively impact people with OCD in several ways. 

Avoiding calls can result in missed opportunities, strained relationships, and workplace challenges, but constant stress and worry about potential calls can also lead to an increased risk of developing anxiety or depression. Moreover, a compulsive need to rehearse or overthink conversations depletes mental energy, reducing productivity and quality of life. In short, this cycle of fear and avoidance can make even simple tasks like answering a phone call a source of immense distress and disruption and, left untreated, can become debilitating. Luckily, there’s a treatment that’s considered the gold-standard approach for treating OCD, as it’s effective in up to 80% of people who undergo it. It’s called exposure and response prevention (ERP) therapy.   

About exposure and response prevention (ERP) therapy

ERP is a highly effective form of cognitive-behavioral therapy specifically designed to treat OCD. It works by systematically exposing you to the thoughts, images, objects, and situations that trigger your OCD symptoms in a safe and controlled environment. The critical element is the “response prevention” part, which involves resisting the urge to perform your usual compulsive behaviors in response to your triggers. Over time, this process helps reduce the power of your OCD symptoms by teaching you that anxiety and discomfort naturally decrease without the need for compulsions, breaking the cycle of OCD.

In ERP, the exposures are highly individualized, so it’s hard to say what exposures might look like for you. Drawing from my experience working with people whose OCD symptoms are triggered by phone call anxiety, exposures could include things like: 

Making a brief call. You might be asked to have a short, scripted call with a friend or a relative, so you learn how to tolerate the anxiety without hanging up or excessively preparing beforehand.

Answering an unknown number. As you progress to more challenging tasks, you may practice picking up calls from unknown numbers, and staying on the line even if it feels uncomfortable (unless it’s a scammer or robocall, of course).

Leaving voicemails. This can help you address the fear of saying something imperfectly without the chance to correct it immediately.

Each of these exposures is designed to confront your fear in a gradual, systematic way, helping you build confidence and reduce the anxiety—and maladaptive coping strategies—associated with phone calls.

Start getting better today

If you think you might have OCD and are interested in learning how it’s treated with ERP, please reach out to a qualified professional with specialized training and experience treating OCD.

Remember, you’re taking a significant step toward reclaiming your life from OCD. With the right therapist and ERP, you’re setting yourself on a path toward meaningful progress and improved well-being. You’re not alone in this journey—and there is hope for positive, lasting change.