358 TREATMENT OF SPECIFIC ANXIETY DISORDERS
self- reported anxiety or actual physiological response (Mauss et al., 2004). In a series
of experimental studies, Bögels and Lamers (2002) found that focusing attention on
the self increases social anxiety whereas focusing attention on the task reduces social
anxiety. Similarly socially phobic individuals told that their pulse rate had increased
while anticipating a social interaction experienced greater anxiety and more negative
beliefs during a threatening social encounter (Wells & Papageorgiou, 2001; see Bögels
et al., 2002, for contrary findings). More recently George and Stopa (2008) used a
mirror and a videocamera to manipulate self- awareness during a standard conversa-
tion and found that high socially anxious students could not shift their attention away
from internal aspects of themselves during the conversation in the same manner as
evident in the low socially anxious group. Overall, then, there is considerable evidence
that socially anxious individuals engage in excessive self- monitoring and misinterpret
this interoceptive information in a manner that increases their social anxiousness (see
Hofmann, 2005).
Another body of research has investigated how individuals evaluate their social
performances and how these evaluations compare to their actual level of performance
as determined by observers. In various studies individuals with social phobia rated their
own public performance on a social evaluative task (e.g., impromptu speech) as sig-
nificantly worse than observers, although the observers tended to rate the performance
of the highly anxious group as worse than the low socially anxious individuals (e.g.,
Abbott & Rapee, 2004; Alden & Wallace, 1995; Hirsch & Clark, 2007; Mellings &
Alden, 2000; Rapee & Lim, 1992). In their review Heimberg and Becker (2002) con-
cluded that individuals with social phobia do exhibit performance deficits in social eval-
uative situations but they also evaluate their performance much more negatively than
others. We can conclude that research support for Hypothesis 4 is strong, with social
phobia characterized by an internal attentional bias and exaggerated negative interpre-
tation of interoceptive cues indicative of anxiety, loss of control, and inadequate public
performance.
Clinician Guideline 9.10
Cognitive therapy addresses excessive and deleterious self- evaluative monitoring of one’s
internal state in social situations by redirecting the socially anxious person’s attention out-
ward to encourage increased processing of salient feedback cues in the environment.Hypothesis 5
Feared social situations will provoke in the socially phobic individual maladaptive
compensatory and safety responses aimed at minimizing or suppressing the expression of
an xiety.
Although only a few studies have investigated safety behavior in social phobia,
there is emerging evidence for its role in the persistence of social anxiety. Alden and
Bieling (1998) found that when socially anxious individuals used safety behaviors dur-
ing a standard conversation (e.g., talked briefly and selected nonrevealing topics) they