346 TREATMENT OF SPECIFIC ANXIETY DISORDERS
adversities such as lack of a close relationship with an adult, marital conflict in fam-
ily of origin, frequent moving, running away from home, failing grades, and the like
and increased risk for anxiety disorders in adulthood including social phobia (Chartier,
Walker, & Stein, 2001; Kessler et al., 1997; Stemberger et al., 1995). Rates of social
phobia among survivors of child physical or sexual assault range from 20 to 46%, with
PTSD, GAD, and specific phobias being more prevalent (Pribor & Dinwiddie, 1992;
Saunders et al., 1992). Higher levels of childhood emotional abuse (Gibb, Chelminski,
& Zimmerman, 2007) and adverse childhood life events such parental marital breakup;
family conflict; negative parenting styles such as overprotection, verbal aggression, and
rejection; and parental psychopathology have been linked to an increased risk for social
phobia (e.g., Lieb et al., 2000; Magee, 1999).
If fears of social situations are acquired, we might expect social phobia to be associ-
ated with a higher rate of adverse social experiences. In their review paper Alden and Tay-
lor (2004) concluded that individuals with social phobia have fewer and more negative
social relationships throughout their life and their interpersonal style elicits more nega-
tive responses from others that create a self- perpetuating interpersonal cycle of events.
Whether adverse social events play a defining role in the etiology of social phobia is less
certain. Certainly other people tend to judge socially anxious individuals more negatively
and less desirably than nonsocially anxious individuals (Alden & Taylor, 2004). Harvey,
Ehlers, and Clark (2005) administered a Learning History Questionnaire to 55 individu-
als with social phobia, 30 individuals with PTSD, and 30 nonpatient controls. The social
phobia group reported that their parents were significantly less likely to encourage them
to engage socially, were more emotionally cold, and were less likely to warn them about
the dangers of social events than the nonclinical group. Furthermore, problems with peer
group and not fitting in with their peers were among the most common experiences that
participants reported with the development of social phobia. Interestingly, only 13%
of the social phobia sample said that a conditioning event was a primary reason for the
onset of their social phobia and only four out of 12 variables investigated were signifi-
cant to social phobia versus PTSD. Kimbrel (2008) concluded it is unclear whether peer
neglect and exclusion are a cause or a consequence of social anxiety.
In summary, negative social experiences, particularly during the formative years of
childhood and adolescence, probably contribute to the development of social phobia. It
is also likely that shy and socially anxious individuals experience more negative social
events than less anxious individuals, in part because their interpersonal style elicits
less positive response from others (Alden & Taylor, 2004). However, it is doubtful that
socially phobic individuals experience more qualitatively traumatic interpersonal events
or become socially phobic in response to a single traumatic social event. Instead of envi-
ronmental or social factors, we contend that cognitive responses to social experiences
will be the distinguishing feature of social phobia. In other words, the most critical fac-
tor in the etiology of social phobia may be the negative interpretation that shy or socially
anxious individuals generate about their social interactions with others.
Social Skills Deficits
There has been much debate in the literature on whether social phobia is character-
ized by deficits in social skills or whether the main difference is that individuals with
social phobia perceive their performance in social situations more negatively (Hofmann
& Barlow, 2002). Various etiological models of social phobia have included impaired