Social Phobia 333
cant interpersonal contact at work (he would start work at 7:00 a.M. and quit
at 2:00 p.M. in order to minimize contact with others), (2) unwillingness to
get involved with people, (3) fear of intimate relationships, (4) inhibition in
new interpersonal relationships because of inadequacy feelings, (5) perceived
inferiority to others, and (6) reluctance to engage in any new, even relatively
mundane, social activities for fear of embarrassment. Gerald received 19 ses-
sions of cognitive therapy that focused specifically on his social evaluative anx-
iety, inhibitory behavior, and extreme avoidance. Therapy targeted Gerald’s
maladaptive beliefs about negative social evaluation by others, his reliance on
escape and avoidance to manage anxiety, and graded in vivo exposure to mod-
erately anxious social situations.This chapter presents the cognitive theory and treatment of generalized social pho-
bia as first described in Beck et al. (1985, 2005). We begin with a discussion of the
diagnostic and phenomenological characteristics of social phobia. This is followed by
a description of a more elaborated cognitive theory of social phobia as well as a review
of its empirical support. We then propose a cognitive approach to assessment and treat-
ment of social phobia. The chapter concludes with a review of the empirical status of
cognitive therapy and CBT for generalized social phobia.
DiagnostiC ConsiDerationsDiagnostic Overview
The core feature of social phobia is a “marked and persistent fear of social or per-
formance situations in which embarrassment may occur” (DSM-IV-TR; APA, 2000,
p. 450). Although anxious feelings are common to most people when they enter novel,
unfamiliar, or social- evaluative situations like a job interview, the person with social
phobia invariably experiences intense fear or dread, even when anticipating the possibil-
ity of exposure to various common social situations. The anxiety stems from a fear of
scrutiny and negative evaluation from others that will lead to feelings of embarrassment,
humiliation, and shame (Beck et al., 1985, 2005). The perceived cause of the embarrass-
ment usually centers on some aspect of self- presentation such as exhibiting a symptom(s)
of anxiety, speaking awkwardly, making a mistake, or acting in some other humiliating
manner (Heckelman & Schneier, 1995). As a result the person with social phobia tends
to be highly self- conscious and self- critical in the feared social situation, often exhibit-
ing involuntary inhibitory behaviors such as appearing stiff and rigid or being verbally
inarticulate, which results in detrimental social performance and the unwanted atten-
tion of others.
Social phobia is closely related to simple phobia because the fear occurs only in
situations in which the person must do something in the context of being observed and
possibly evaluated by others (Hofmann & Barlow, 2002). The person with social phobia
who experiences intense anxiety while eating, speaking, or writing in front of unfamil-
iar people has no difficulty engaging in these behaviors when alone or with family and
close friends. Although Marks and Gelder (1966) first described the syndrome of social
phobia (see also Marks, 1970), it was not until DSM-III (American Psychiatric Associa-
tion, 1980) that it was incorporated as a separate diagnostic entity. The core diagnostic
criteria have remained constant throughout subsequent DSM revisions with the excep-