Social Phobia 347
social performance as an important maintenance factor (Beck et al., 1985, 2005; D.
M. Clark & Wells, 1995; Kimbrel, 2008; Rapee & Heimberg, 1997; Rapee & Spence,
2004). In the cognitive models, impaired social performance is considered a consequence
of anxiety in the social situation. For example, D. M. Clark and Wells (1995) mention
a number of negative social behaviors that result from feeling anxious around others
such as gaze avoidance, an unsteady voice, shaky hands, behaving less friendly toward
others, avoiding self- disclosure, and the like. Beck et al. (1985, 2005) mention various
automatic inhibitory behaviors that will negatively affect social performance. Rapee
and Spence (2004) distinguish between interrupted social performance that is due to
heightened anxiety versus poor social skills, which is a fundamental lack of social abil-
ity (e.g., poor conversational skills, unassertiveness, passivity, submissiveness). The role
of social skill deficits has an important treatment implication. If positive social skills are
absent, then social skills training will be an important component in treatment.
There is little doubt that the experience of heightened anxiety in social evalua-
tive situations significantly disrupts social performance. What is less certain is whether
individuals with social phobia either lack social knowledge or an internalized ability to
perform socially which itself contributes to the development of social phobia (Rapee &
Spence, 2004). Certainly individuals with social phobia perceive themselves to be less
effective socially than nonanxious individuals (e.g., Alden & Philips, 1990; Stangier,
Esser, Leber, Risch, & Heidenreich, 2006). Also when performance in social situations
is rated by external observers, individuals with social phobia tend to exhibit less warmth
and interest, are more visibly anxious, are less dominant, generate fewer positive verbal
behaviors, and generally exhibit poorer overall performance than nonanxious compari-
son groups (e.g., Alden & Bieling, 1998; Alden & Wallace, 1995; Mansell, Clark, &
Ehlers, 2003; Rapee & Lim, 1992; Stopa & Clark, 1993; Walters & Hope, 1998).
However, individuals with social phobia consistently appraise their social performance
more negatively than external observers (e.g., Abbott & Rapee, 2004; Alden & Wal-
lace, 1995; Mellings & Alden, 2000; Rapee & Lim, 1992; Stopa & Clark, 1993). Also,
it is well established that socially anxious individuals do not always exhibit maladaptive
social behavior. Alden and Taylor (2004) note that occurrence of maladaptive behaviors
depends on the social context, with socially anxious individuals more likely to exhibit
poor social performance when anticipating an evaluative or ambiguous situation.
We can conclude that actual deficits in social skills probably play, at most, a minor
role in the etiology of social phobia (Rapee & Spence, 2004). At the same time it is clear
that socially anxious individuals do perform more poorly in certain social settings,
primarily as a consequence of their heightened anxiety and automatic inhibitory behav-
ior. However, the situational specificity of this performance deficit as well as the well-
documented negative self- evaluative bias indicates that cognitive factors play a greater
role in the development and maintenance of social phobia than behavioral deficits.
Clinician Guideline 9.6
Individuals with social phobia may have more negative social experiences because of less
positive reactions from others due to deficiencies in their social behaviors when anxiety is
elevated in social evaluative or unfamiliar social settings. However, their negative subjective
evaluation of their social performance is greatly exaggerated and is the main contributor to
the persistence of their social anxiety.