16 0 ASSESSMENT AND INTERVENTION STRATEGIES
in social settings meant that she was in greater danger of not functioning well and more
likely to draw the attention of others. Finally, she tended to think of anxiety from an all-
or- nothing perspective with certain situations associated with social threat and so intol-
erable, whereas other situations were entirely safe (e.g., working alone in her office).
Assessment of Secondary Reappraisal
Sharon exhibited a number of deliberate coping strategies in response to her social anxi-
ety. She would try to physically relax in social situations by engaging in deep, controlled
breathing, she tried to answer questions via e-mail in order to avoid face-to-face inter-
action with work colleagues, she would procrastinate about such things as asking her
supervisor for clarification on an issue, and she was quiet and withdrawn in meetings,
saying as little as possible. She also tried to suppress her feelings to hide any sense of dis-
comfort. The intentional use of alternative means of communication with others (e.g.,
e-mail) had a prominent safety- seeking function. These strategies were all somewhat
effective in reducing her social anxiety. Sharon was concerned that if she changed her
approach to social anxiety if might make her work life more stressful.
Worry played a secondary role in Sharon’s social anxiety. She worried on a daily
basis about the possible social interactions she might encounter, whether she would
experience a lot of anxiety throughout the day, and whether she would be socially
incompetent as a result. She also worried outside the work setting that the extra stress
and anxiety she was feeling at work might have a negative effect on her health and well-
being. Sharon’s cognitive coping strategies to control her anxiety were quite limited
other than the use of reassurance and rationalization that everything will be fine and
self- instructions to control her anxiousness. She concluded she was generally ineffective
in controlling the anxiety and that the best strategy was to minimize social contact as
much as possible. Interestingly, this perspective on social threat and vulnerability was
evident even when she was not anxious and alone.
Treatment Goals
Based on our cognitive case conceptualization, the following goals were developed in
Sharon’s treatment plan:
••Decatastrophize her misinterpretation and maladaptive beliefs about blushing
and the consequent negative evaluation of others.
••Modify the belief that anxiousness in social settings must be controlled because
it will lead to dire negative outcomes such as social incompetence (i.e., reappraise
the probability and severity of threat).
••Reduce avoidance and increase exposure to socially anxious situations.
••Eliminate maladaptive defensive and coping strategies such as speaking too quickly
when anxious, reliance on deep breathing, and self- rationalization focused on
convincing herself there is no threat.
••Reduce the negative effects of worry about being anxious whenever social inter-
action is anticipated.
••Improve assertiveness and other verbal communication skills when interacting
with authority figures such as a supervisor.