Social phobia: the role of in-situation safety behaviours in maintaining anxiety and negative beliefs

One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are mtended to avert feared catastrophes but that also prevent disconfirmation of their fears. This hypothesis was tested in a single case series of eight socially phobic patients. All patients received one session of exposure alone and one session of exposure plus decrease in "safety " behaviors in a counterbalanced within-subject design. Exposure plus decreased safety behaviors was significantly better than exposure alone in reducmg within-situation anxiety and belief m the feared catastrophe. Other factors that may moderate exposure effects are also discussed. Exposure is an effective treatment for social phobia. However, the improvements obtained with exposure alone are relatively modest (Butler, Cullington, Munby, Amies, & Gelder, 1984; Mattick & Peters, 1988), and in everyday life individuals with social phobia are repeatedly exposed to social situations without marked reductions in anxiety. From a cognitive perspective, these observation