Probability and Cost Biases in Social Phobia: Nature, Specificity, and Relationship to Treatment Outcome
Nelson, Elizabeth A., Lickel, James J., Sy, Jennifer T., Dixon, Laura J., Deacon, Brett J., Journal of Cognitive Psychotherapy
Social phobia is maintained in part by cognitive biases concerning the probability and cost of negative social events. More specifically, individuals with social phobia tend to believe that negative social events are extremely likely to occur, and that if such events were to happen, the consequences would be awful or unbearable. The aim of the present review is to critically evaluate research on the nature and specificity of probability and cost biases in social phobia. Changes in probability and cost estimates during treatment and their relationship to treatment outcome are detailed. The review concludes with a discussion of how current cognitive behavioral interventions target these biases. Directions for future research are proposed.
Keywords : social phobia; cognitive biases; cognitive behavioral treatment; review
Theoretical models of social phobia (e.g., Clark & Wells, 1995; Rapee & Heimberg, 1997 ) emphasize the importance of biased cognitive processing in the development and maintenance of anxiety disorders. Indeed, it is thought that most fears are driven by faulty appraisals concerning the expectation or anticipation of potential future harm (e.g., Beck, Emery, & Greenberg, 1985 ). Carr (1974) proposed that these perceptions of threat are composed of estimates of the probability of the event (i.e., the likelihood a given event will occur) and the cost of the event (i.e., the negative consequences associated with the event).
Several theorists (e.g., Beck, 1976; Rapee & Heimberg, 1997 ) have identified mechanisms by which probability and cost biases may exert their influence. Social phobia is characterized by social fears-concerns about social embarrassment, humiliation, and subsequent rejection by others ( American Psychiatric Association, 2000 ). Beck (1976) suggested that cognitive biases exacerbate and perpetuate these social fears via biased processing of social information. Specifically, overestimates of the probability and cost of negative social events result in the perception of social situations as dangerous. As a result, individuals with such fears tend to be hypervigilant to cues of social rejection. Individuals with social phobia often attend to internal cues that may elicit social disapproval (e.g., sweating, blushing), thereby resulting in a failure to encode information from the external environment (e.g., Rapee & Heimberg, 1997 ). As such, biased accounts of social interactions (e.g., "I was nervous and sweating so the speech must have gone poorly") are encoded into memory. This biased information processing results in inflated estimates of the probability of negative social events, as past social encounters are viewed as failures. It also creates exaggerated cost estimates, as individuals with social phobia interpret negative social events catastrophically. In short, probability and cost biases are believed to result in greater availability of social threat information in memory, increased attentiveness to social threat cues, and inflated estimates of the probability and cost of negative social events.
Some authors (e.g., Foa & Kozak, 1986 ) have theorized that cost bias may be particularly important in the maintenance of social phobia. Whereas many anxiety disorders are characterized by overestimates of the probability of rather serious negative events (e.g., heart attack, death of a loved one), social phobia is unique in that mildly negative social events are viewed catastrophically. Though the relative importance of probability and cost biases is detailed in later sections, clearly both are needed to create a threat appraisal. Without the perception of negative consequences, an extremely likely event would not create fear, and without the possibility of an event occurring, a catastrophic consequence would not create fear.
Despite the importance of probability and cost biases in social phobia, a comprehensive appraisal of this literature is lacking. …