366 TREATMENT OF SPECIFIC ANXIETY DISORDERS
elicit anxiety and avoidance. The therapist should review the self- monitoring form with
the client to obtain ratings on degree of avoidance associated with each recorded situ-
ation.
In our case example Gerald identified a host of performance-based and social inter-
action situations at work and home that elicited significant anxiety. For example, taking
a walk alone caused mild anxiety (20/100) because he might meet someone he knew,
going to the market caused moderate anxiety (40/100) because there was an increased
chance he would have to talk to a familiar person, and presenting a plan at a work meet-
ing caused intense anxiety (100/100) because he anticipated that his anxiety would be
so severe that his mind would go blank, he would stutter, and he would really “screw
up” in front of people. Gerald identified 27 social situations that caused him mild to
intense anxiety, each one associated with moderate to strong urge to avoid.
Three Phases of Social Anxiety
There can be considerable variability across individuals in the relative importance of the
three phases of social phobia. For some individuals, like Gerald, anticipatory anxiety
was almost constantly elevated whenever he left his house because there was always a
chance he might meet someone he knew and would have to carry on a conversation.
For others anticipatory anxiety may be less prominent because their social anxiety is
confined to a few situations that occur only occasionally (e.g., making a presentation,
answering questions in a meeting). Although one might expect exposure to social situ-
ations to be invariant across individuals, this is not the case. Avoidance may be so
extensive in some individuals that they rarely are confronted with anxious social situ-
ations. Moreover, we would expect that some degree of postevent processing would be
evident in most individuals with social phobia, but here again some patients are much
more ruminative about their past social performance than others. For these individuals,
continually reliving their past embarrassment will play a critical role in the persistence
of social anxiety. Interestingly, postevent processing was not a major component of Ger-
ald’s social anxiety. Instead anticipatory anxiety was very intense and led to a pervasive
pattern of avoidance of any potential social interaction.
table 9.6. (c o n t .)
Elements of case
conceptualization Key questions
Assess autobiographical
memory recall for past
social experiences.
••Does the individual engage in rumination over past “social failures”?
Obtain a description of these past negative experiences.
••Is there any evidence of biased negative reappraisal of past social
performance and its outcome? Is the individual able to recall positive
aspects of past social experiences?
••How much shame or embarrassment is associated with past social
experiences?Formulate the core
social self-schemas that
constitute vulnerability
for social anxiety.
••What beliefs do individuals hold about how they are seen by others in social
situations? What is the “self as social object” or “mental representation of
self as seen by the audience”? (See Table 9.5 for other core schemas in social
an x iet y.)