I totally feel you. I used to be able to engage in conversations years ago with no issues and now it feels like an impossible task because I'm all up in my head. I have ADD and I'm prescribed an amphetamine medication which helps me have the confidence and focus to engage in talking but the side effects are too much for me so I stopped taking it. I'll feel the dopamine high for 4-5 hours but the mental crash afterwards makes my mood skydive. It also really suppresses my appetite and I'm already a slender dude. It sucks about the side effects otherwise I'd be taking it every day because of the speech improvement.