Social anxiety disorder sufferers are more likely to blush and have higher heart rates. Charles Darwin described blushing as “the most peculiar and the most human of all expressions.”  Blushing is mainly caused by cervical sympathetic outflow from the spinal cord. 

Endoscopic thoracic sympathectomy(ETS) to treat facial blushing was realised serendipitously by patients reporting incidental relief from facial blushing following ETS for excessive sweating.  A recent study has shown that ETS may be associated with a greater reduction of blushing and higher degrees of satisfaction in comparison to medication or no treatment.

However Cognitive Behaviour Therapy (CBT),  was not included as part of the comparision treatments.

1. Darwin C. The Expression of the Emotions in Man and Animals. 200th Anniversary Edition. New York: Oxford University Press; 1872/2009.
2. Gerlach AL, Wilhelm FH, Gruber K, Roth WT. Blushing and physiological arousability in social phobia. J Abnorm Psychol. 2001;110:247–258.
3. Enrique Jadresic, MD; Claudio Súarez, MD; Estela Palacios, MD; Fernanda Palacios, PS; and Patricia Matus. Evaluating the Efficacy of Endoscopic Thoracic Sympathectomy for Generalized Social Anxiety Disorder with Blushing Complaints: A Comparison with Sertraline and No Treatment—Santiago de Chile 2003–2009. Innov Clin Neurosci. 2011;8(11):24–35