348 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Cognitive theory of soCial phobiaDescription of the Model
A theoretical account of social phobia must consider three features that are unique
to this disorder. First, feelings of embarrassment and shame are often the dominant
negative emotions that result from a social encounter rather than anxiety alone (Beck
et al., 1985, 2005; Hofmann & Barlow, 2002). Second, the intense anxiety associated
with social situations often elicits automatic inhibitory behaviors and attempts to
conceal anxiety that has the unfortunate effect of disrupting social performance and
causing the catastrophe the socially phobic person fears most: the negative evaluation
of others (Beck et al., 1985, 2005). Unlike panic disorder in which the catastrophe
repeatedly fails to occur (e.g., a heart attack), the perceived catastrophe in social
phobia often happens because of the disruptive effects of anxiety. And third, anxi-
ety itself becomes a secondary threat as individuals with social phobia believe they
must conceal anxiety in order to avoid negative evaluation by others. The theoretical
account discussed below proposes a number of cognitive processes and structures
that can explain these features of social phobia and its persistence. The model draws
heavily on the cognitive theory of evaluative anxieties described in Beck et al. (1985,
2005) as well as the significant contributions of D. M. Clark and Wells (1995), and
Rapee and Heimberg (1997). The following account recognizes three phases to social
anxiety; the anticipatory phase, actual exposure to the social situation, and postevent
processing. Figure 9.1 illustrates this refined and elaborated cognitive model of social
phobia.
The Anticipatory Phase
In most instances there is some forewarning of an impending social encounter that for
individuals with social phobia can elicit almost as much anxiety as exposure to the
actual social interaction. This anticipatory phase could be triggered by a variety of
informational or contextual cues such as being told of a future social task, reviewing the
entries in one’s work diary, or being in a location that reminds a person of a future social
event (e.g., walking past the boardroom where the meeting will be held). The length of
the anticipatory phase could vary from a few minutes to many days or even weeks. We
would expect anxiety to intensify as the feared social event becomes more imminent,
which is consistent with Riskind’s (1997) concept of looming maladaptive style. More-
over, the more intense the anticipatory anxiety, the more likely it is that avoidance will
be the preferred outcome. Pervasive avoidance of social interaction is the hallmark of
social phobia because it is considered the most effective way to eliminate anticipatory
anxiety. Consequently, individuals feel a strong urge to avoid when anticipating a future
social event even though they recognize its detrimental effects (e.g., failing to return a
call from your investment broker).
In our case illustration Gerald frequently experienced intense anticipatory anxiety
whenever he even suspected the possibility of a social encounter. He would immediately
begin strategizing how he could avoid the social situation and maintain his isolation
from others. However, avoidance is not always possible and so the anxiety experienced
during this phase will mean that the socially phobic individual enters the social situation
in a state of heightened anxiety.