Academic journal article Journal of Cognitive Psychotherapy

Cognitive Behavioral Therapy for Social Anxiety Disorder

Academic journal article Journal of Cognitive Psychotherapy

Cognitive Behavioral Therapy for Social Anxiety Disorder

Article excerpt

Social anxiety disorder, a once neglected disorder (Liebowitz, Gorman, Fyer, & Klein, 1985), has been increasingly recognized as an important clinical problem. This recognition has led to a surge of research, including numerous studies focusing on approaches to treatment. In this article, we briefly describe cognitive-behavioral treatments for social anxiety disorder (also known as social phobia), provide a critical evaluation of their effectiveness, and discuss the characteristics of patients which may influence response to treatment.

Social anxiety disorder is characterized by an extreme fear of social or performance situations. Individuals with social anxiety disorder fear that they will do or say something humiliating or embarrassing in such situations (or that they will look visibly anxious), resulting in negative evaluation by others (American Psychiatric Association, 1994). Frequently feared situations include public speaking, going to parties, meeting strangers and talking to people in authority (Holt, Heimberg, Hope, & Liebowitz, 1992).


Current cognitive models of social anxiety disorder (Clark & Wells, 1995; Rapee & Heimberg, 1997) suggest that when socially anxious persons find themselves in social situations, their attention shifts such that they view themselves from the perspective of the audience or observer. They then compare how they believe the audience views them and their performance to the expectations that they perceive the audience holds for them. Because socially anxious persons are very likely to assume that others hold them to strict and exacting standards, the chances that they will judge their performance to fall short of expectations are quite high. The likelihood of this outcome is increased by socially anxious persons' tendency to allocate disproportionate resources to negative social cues in the environment (e.g., noticing the one bored or critical member of an audience to the exclusion of others). Because socially anxious persons believe that others are inherently critical, negative evaluation and other negative social consequences (rejection, loss of social status, etc.) are inevitable outcomes of failure to meet the perceived standards of the audience.

Once socially anxious persons perceive that they have been negatively evaluated by the audience-based on their own internal representation of self as seen by the audience, cues they glean from the environment, or memories of similar failed situations in the past-they begin to experience behavioral, cognitive and physical symptoms of anxiety. These symptoms serve as further "proof that they will be or are being negatively evaluated by others. Furthermore, anxiety symptoms provide input into the internal representation of the self as seen by the audience, adjusting it downward, and increasing its perceptions that the next time it finds itself in a socially threatening situation, the chances of social failure are even higher. This cycle can also occur in anticipation of threatening situations, as the person imagines himself or herself failing to meet the expected standards of the audience-to-be.

Inherent in these models of social anxiety is an emphasis on both cognitive and behavioral components of the disorder. These models have greatly informed (and been informed by) the development of cognitive-behavioral interventions, which emphasize the interdependence of the socially anxious person's dysfunctional belief system and patterns of behavioral avoidance. Therefore, for current purposes, we concentrate on approaches to treatment that attempt to change behavior and reduce anxiety at least partially through the use of techniques that target negative thinking and distorted beliefs, most typically in combination with graduated exposure to feared social situations. Depending on how one defines the term "cognitive-behavioral," however, there are a number of treatment strategies that may be included in this domain. …

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