Cognitive Therapy of Anxiety Disorders

Social Phobia 349

The cognitive basis of anticipatory social anxiety will primarily involve effort-

ful, elaborative processes as the individual intentionally thinks about the approaching

social event. Preexisting maladaptive social self- schemas will be activated that involve

beliefs of perceived social inadequacy, the distressing nature of anxiety, the imagined

negative judgments of others, and the inability to meet expected social performance

standards. The negative social self- schemas will tend to dominate the socially anxious

person’s thinking of the impending social event. His thinking will selectively focus on

the possible threatening aspects of the situation. Gerald, for example, would think

about people looking at him and trying to initiate conversations with him which he

interpreted as highly threatening. The possibility of acceptance by others and posi-

tive social performance were completely discounted. At the anticipatory phase socially

anxious individuals also evaluate themselves as vulnerable and incapable of meeting

the perceived social performance expectations of the impending task. Memory of past

social situations, especially those similar to the future event, will be biased for retrieval

of experiences that involved intense social anxiety and embarrassment, leading to an

exaggerated expectation of threat and personal vulnerability in the anticipated social

event. This will initiate a worry process as the individual becomes preoccupied with

the threat and danger of the approaching social event. The expected probability and

severity of a negative outcome will become magnified the longer the individual is stuck

in this anxious ruminative process. Gerald experienced intense worry when a meeting

was scheduled at work. All he could think about was the terrible anxiety he felt in past

meetings and the relief experienced when he was able to find an excuse for not attend-

ing.

(preferred outcome)

Contextual Cues

Effortful Processing

uInterpretative

threat bias

uPersonal

vulnerability

appraisal

uBiased memory

retrieval

uWorry

Heightened Anxiety

and

Strong Urge to Avoid

Anticipatory Phase Situational Exposure

Heightened Anxiety and Exposure to

Provoking Situation

AUTOMATIC

ACTIVATION OF

MALADAPTIVE SOCIAL

SELF-SCHEMAS OF

THREAT

Secondary,

Elaborative

Reappraisal

Outcome

Elevated anxiety,

even panic, disrupted

social performance,

and urge to escape

Postevent

Processing

Biased recall

and

interpretation of

past social

performance

and outcome

Heightened self-

focus attention

Ineffective

safety

Automatic behaviors

Inhibitory

Behaviors Shame and Feelings of

Embarrassment

figure 9.1. Cognitive model of social phobia.