Social Phobia 337
blushing, give an excuse for one’s red face by blaming it on a hot room or not feeling well,
or the like (D. M. Clark, 2001). These concealment strategies (i.e., safety behaviors) are
problematic because they can directly exacerbate anxious symptoms (e.g., person wears
a heavy sweater to conceal sweating but this raises body temperature and tendency to
sweat). In addition the behaviors prevent disconfirmation of the feared outcome (e.g.,
attributes nonoccurrence of negative evaluation to performance of the safety behavior),
maintain a heightened self- focused attention, and draw greater negative attention from
others (Wells & Clark, 1997). There is some evidence that socially anxious individu-
als realize the negative social effects of trying to conceal anxiety (Voncken, Alden, &
Bögels, 2006) but still tend to engage in safety behaviors (Alden & Bieling,1998).
Marked Distress and Interference
Anxiety or nervousness in social situations is common in the general population. In a
randomized community telephone survey of 526 adults, 61% reported feeling nervous
or uncomfortable in at least one of seven social situations with public speaking being
the most frequently endorsed situation (Stein, Walker, & Forde, 1994). Thus the marked
distress or interference criterion in DSM-IV-TR is needed to distinguish the more severe,
clinical forms of social phobia disorders from the milder subclinical variants of social
anxiety found throughout the nonclinical population (Heckelman & Schneier, 1995).
Clinician Guideline 9.1
Social phobia is characterized by a marked and persistent anxiety, even panic, most often
across numerous interpersonal and/or performance situations in which the person fears
scrutiny and negative evaluation by others that will lead to embarrassment, humiliation,
or shame. A key concern is that one’s interpersonal behavior, appearance, or expression of
anxiety will be negatively judged by others. Anticipatory anxiety can be intense, leading to
extensive avoidance of feared social situations, as well as production of involuntary inhibi-
tory responses and attempts to conceal anxiety when social interaction is unavoidable.Shyness and Social Phobia
There is considerable confusion about the relationship between shyness and social pho-
bia, with some emphasizing their common characteristics of high social anxiety and
fear of negative evaluation by others (Stravynski, 2007), whereas others note there are
important quantitative differences so that the two should not be considered synonymous
(Bruch & Cheek, 1995). Like social phobia, shyness has been described as anxiety, dis-
comfort, and inhibition in social situations and fear of negative evaluation by others,
especially authority figures (Heiser, Turner, & Beidel, 2003). Some have concluded that
social phobia is very similar to chronic shyness (Henderson & Zimbardo, 2001; Mar-
shall & Lipsett, 1994). Moreover, delineating clear boundaries between shyness and
social phobia has been difficult because (1) there is no consensus on the definition of
shyness; (2) they have many shared behavioral, cognitive, and physiological features; (3)
they arise from different research traditions with shyness studied by social, personality,