Public and Private Self-Consciousness and Social Phobia

The relationship between public and private self-consciousness and self-report questionnaires, clinician ratings, and various measures derived from an individualized simulation of an anxiety-provoking situation was examined in a sample of men and women seeking treatment for social phobia. As predicted, public, not private, self-consciousness was generally related to self-report and naive observer ratings of anxiety and to behavioral disruption during the simulation. The predicted relationship between public self-consciousness and how accurately subjects evaluated their performance in the anxiety-provoking situation was marginally supported. Hypotheses regarding the relationship between private self-consciousness and self-reported anxiety during an anxiety-provoking situation, and between private self-consciousness and the correspondence between physiological assessment and self-report, were not supported. The discussion focuses on methodological issues and the theoretical implications of the relationship between self-consciousness and social anxiety

Avoidant Personality Disorder and the Generalized Subtype of Social Phobia

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics

The Pattern of Subjective Anxiety during In-session Exposures across Therapy for Clients with Social Anxiety Disorder

Exposure-based therapies have been considered the most efficacious treatments for social anxiety disorder (i.e., Gould et al., 1997). The majority of the theory behind exposure-based treatments rely on Foa and colleagues’s (Foa, Huppert, & Cahill, 2005; Foa & Kozak, 1986) emotional processing theory. However, there has been less research examining the way that emotional processing occurs across actual treatment sessions for clients with social anxiety disorder. This study utilized longitudinal data analytic methods to examine the changes in subjective anxiety during the first three exposure sessions in group and individual cognitive-behavioral therapy for social anxiety disorder. The results of this study provide preliminary evidence that while anxiety generally decreases across each exposure, some individuals experience considerable fluctuations in anxiety during a single exposure. Additionally, early exposures may be experienced differently than later exposures. Overall, this study highlights the importance of more fine-grained analyses to better understand the mechanisms underlying exposure-based therapy

Attentional Focus and Causal Attributions in Social Phobia: Implications from Social Psychology

This article reviews the social psychological literature on attentional focus and causal attributions as they apply to social phobia. Excessive self-focused attention is increased by physiological arousal, interferes with task performance under some conditions, increases the probability of internal attributions, and intensifies emotional reactions. Social anxiety is also associated with a reversal of the self-serving bias for causal attributions. Implications of these findings for the maintenance and treatment of social phobia are discussed

Social Anxiety and the Recall of Interpersonal Information

Sixty subjects classified as high or low in social anxiety participated in a structured heterosocial interaction under conditions of either high or low social-evaluative threat. Following the interaction, subjects were asked to recall detailed information about the interaction partner’s appearance and the content of the conversation. Socially anxious subjects recalled less information and made more errors in recall than nonanxious subjects. Contrary to prediction, social-evaluative threat did not affect recall. Anxious subjects also reported greater self-focused attention during the interaction. High self-focused attention was associated with superior recall for nonanxious subjects but associated with more frequent omission errors for anxious subjects. Results support cognitive-behavioral formulations of social anxiety which propose that socially anxious individuals engage in self-focused thinking which may impair their ability to process social information

States of Mind Model and Cognitive Change in Treated Social Phobics

The applicability of Schwartz and Garamoni’s (1986, 1989) States of Mind (SOM) model for assessing the influence of cognitive-behavioral therapy on cognitive functioning was evaluated with social phobics. The SOM model states that a positive dialogue (i.e., a 2:1 ratio of positive to negative thoughts) is optimal for effective coping. Social phobics receiving either a cognitive-behavioral or educational-supportive group treatment were compared for SOM change, as were subjects meeting criteria for improvement or nonimprovement. Also the study compared the predictability of the SOM ratio with a ratio based on percent of negative thoughts. Subjects in both treatments evidenced negative monologue (i.e., a preponderance of negative thoughts) at pretreatment. A significant Treatment × Time interaction showed that, although the groups did not differ at posttreatment, those in the cognitive treatment reached positive dialogue at a 6-month follow-up while the other group did not. Improvers also attained positive dialogue at follow-up while nonimprovers did not. The SOM and the negative thought ratios performed similarly in predicting most outcome measures, suggesting that neutral thoughts (the only distinction between the two) serve little function for persons with problems of social phobia

Scoring Error of Social Avoidance and Distress Scale and its Psychometric Implications

An error in the scoring instructions of the Social Avoidance and Distress Scale (SAD), one of the most popular instruments to measure social anxiety, is discussed

Evaluating the States of Mind Model: Comparison to an Alternative Model and Effects of Method of Cognitive Assessment

Two studies were conducted evaluating aspects of the States of Mind (SOM) Model proposed by Schwartz (1986; Schwartz & Garamoni, 1986, 1989) with a sample of social phobic subjects. First, the SOM ratio [positive thoughts/(positive + negative thoughts)] based on a thought-listing task was compared to a ratio based on Kendall and Hollon’s (1981) “power-of-nonnegative-thinking” model [negative thoughts/(positive + negative + neutral thoughts)], and the relationship of each ratio to criterion measures was assessed. The two ratios were highly correlated and related to several criterion measures, raising questions about the role of neutral thoughts in the internal dialogue. Second, SOM ratios derived from a thought-listing task and from the Social Interaction Self-Statement Test (SISST) were compared to assess the reactivity of the SOM ratio and classification scheme to method of cognitive assessment. In that study, large differences were detected. SISST SOMs were less likely to classify subjects in the more pathological SOM categories and more likely to be significantly related to criterion measures. Findings are discussed in the context of the validity of the SOM model and the effects of cognitive assessment methodology on the magnitude of derived self-statement ratios

The Validity of the Social Avoidance and Distress Scale and the Fear of Negative Evaluation Scale with Social Phobic Patients

Turner, McCanna and Beidel’s (1987) recent evaluation of the Social Avoidance and Distress Scale (SADS) and the Fear of Negative Evaluation Scale (FNE) with anxiety disordered patients concluded that the SADS and FNE lacked discriminant validity and may be inappropriate for subject selection or outcome evaluation in studies of social phobia . This paper raises some concerns with the interpretation of the data presented by Turner et al. (1987) and presents additional data from studies in our laboratories that may qualify their conclusions. It is asserted that (a) the SADS and FNE are not appropriate for diagnostic screening of social phobic patients, (b) Turner et al.’s findings may have been the result of clinically meaningful social anxiety in several of the anxiety disorders, (c) significant differences among the anxiety disorders may have been hidden by heterogeneity among patients who receive the diagnosis of social phobia. and (d) the distribution of FNE scores in Turner et al.’s sample may have been unusually depressed

Working Alliance for Clients with Social Anxiety Disorder: Relationship with Session Helpfulness and Within-Session Habituation

It has been suggested that a strong working alliance encourages clients to take risks during therapy (Raue, Castonguay, & Goldfried, 1993). This encouragement may be important for clients who fear negative evaluations as they engage in risk-taking elements of therapy. This study examined the relationship between working alliance, session helpfulness, and measures of emotional processing in 18 clients undergoing cognitive behavior therapy (CBT) for social anxiety disorder. Results indicate a positive correlation between client-rated, but not observer-rated, working alliance and session helpfulness. Moderate levels of working alliance were associated with higher initial anxiety and deeper within-session habituation. Overall, a strong alliance was associated with clients engaging with the session and finding the session helpful. Implications for the use of CBT for social anxiety are discussed