The Essential Handbook of Social Anxiety for Clinicians by W. Ray Crozier & Lynn E. Alden

Author:W. Ray Crozier & Lynn E. Alden
Language: eng
Format: mobi
Tags: Social Psychology, Psychology, 0470022671.pdf, General
ISBN: 9780470022672
Publisher: Wiley
Published: 2005-03-10T22:00:00+00:00

Chapter 9

A Cognitive Perspective on

Social Phobia

David M. Clark

the cognitive model

Processing in Social Situations

Processing of the self as a social object

Safety behaviours

Somatic and Cognitive Symptoms

Processing of External Social Cues

Processing before and after a Social Situation

empirical studies of the cognitive model

Hypotheses

Conclusions

a theory derived cognitive treatment

Therapeutic Relationship

Deriving an Idiosyncratic Version of the Model

Manipulation of Self-focused Attention and Safety Behaviours

Video and Audio Feedback

Shift of Attention and Interrogation of the Social Environment

Dealing with Anticipatory and Post-event Processing

Dealing with Assumptions

effectiveness of the cognitive treatment

acknowledgements

references

The persistence of social phobia is a puzzle. Individuals with other phobias such

as claustrophobia, height phobia, and small animal phobias are able to success-

fully avoid most encounters with their phobic object, and it is generally thought

The Essential Handbook of Social Anxiety for Clinicians.

Edited by W. Ray Crozier and Lynn E. Alden.

© 2005 John Wiley & Sons Ltd.

194

DAVID M. CLARK

that this avoidance is the main reason for the persistence of their fears. In con-

trast, the nature of modern society is such that patients with social phobia often

have to enter feared social situations. This distinction is recognized in recent versions of the Diagnostic and Statistical Manual for Mental Disorders (APA, 1987, 1994) where avoidance is necessary for the diagnosis of all phobias except for

social phobia where it is specified that the phobia situation must be either

“avoided or endured with intense distress” (APA, 1994, p. 417; emphasis added).

Why does social phobia persist despite regular exposure to feared social situa-

tions? The present chapter provides an overview of a recent cognitive model of

social phobia (Clark & Wells, 1995; Clark, 1997; Wells, 1997, 1998; Wells & Clark, 1997) that was specifically developed to explain such persistence.1 Following a

description of the model, research testing key aspects of the model is summa-

rized, a treatment programme which aims to reverse the maintenance processes

specified in the model is outlined, and preliminary evaluations of the treatment

and its components are reviewed.

THE COGNITIVE MODEL

For the purpose of exposition, the model is divided into two parts. The first part

concerns what happens when a social phobic enters a feared social situation. The

second concerns what happens prior to entering, and after leaving a social

situation.

Processing in Social Situations

Figure 9.1 illustrates the processes that Clark and Wells suggest occur when a

social phobic enters a feared social situation. On the basis of early experience,

patients with social phobia develop a series of assumptions about themselves and

their social world. The assumptions can be divided into three categories:

•

Excessively high standards for social performance, e.g., “I must not show any signs of weakness”, “I must always sound intelligent and fluent”, “I should

only speak when other people pause”, “I should always have something inter-

esting to say”.

•

Conditional beliefs concerning the consequences of performing in a certain

way, e.g., “If I disagree with someone, they will think I am stupid/will reject me”, “If my hands shake/I blush/or show other signs of anxiety, people will

think I am incompetent/odd/stupid”, “If I am quiet, people will think I am

boring”, “If people get to know me, they won’t like me”.

1 The Clark and Wells model draws heavily on the writings of earlier theorists, especially

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