356 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Other studies have found that individuals with social phobia are more likely than
nonanxious controls to take an observer perspective (i.e., seeing oneself from an exter-
nal point of view) when recalling more threatening social situations or immediately
after completing a social interaction role play (Coles, Turk, Heimberg, & Fresco, 2001;
Coles, Turk, & Heimberg, 2002). They are also more likely to engage in upward social
comparisons (Antony et al., 2005) and to experience the “spotlight effect” (i.e., ten-
dency to overestimate the extent that others see and attend to one’s external appearance)
in high social- evaluative situations (Brown & Stopa, 2007). All of these processes are
relevant to generation of a negative self-image in social phobia which reflects activation
of negative social self- schemas (i.e., “how I think I appear to others”).
Overall there is emerging evidence that a negative self-image involving the perspec-
tive of the other (i.e., “how I think others see me”) is a basic cognitive process in social
phobia. More recent studies suggest that manipulation of this social self- schema may
have causal effects on social threat inferences, subjective anxiety, and safety behaviors
that are central processes in the maintenance of social phobia. However, research on the
more automatic or implicit aspects of schema activation in social phobia have produced
inconsistent findings. At this point support for Hypothesis 2 is modest with many unan-
swered questions remaining about the structure and interrelations of the negative social
self schemas in social phobia.
Clinician Guideline 9.8
A central feature of cognitive therapy of social phobia is the precise specification and restruc-
turing of negative social self- schemas. This requires correction of the socially anxious per-
son’s inaccurate assumptions about how she thinks she appears to others.Hypothesis 3
During situational exposure, individuals with social phobia will exhibit an automatic
attentional bias for internal and external social threat information.
A central prediction of the cognitive model is that individuals with social phobia are
hypervigilant to social threat information that is congruent with their negative social
self- schemas (Beck et al., 1985, 2005). Thus attentional resources will be preferentially
directed toward schema- congruent social threat information, especially during expo-
sure to social situations.
Some of the earliest research on automatic attentional bias for threat in social pho-
bia employed the emotional Stroop task. As predicted, most studies found significantly
greater interference for social threat words (Becker et al., 2001; Grant & Beck, 2006;
Hope et al., 1990; Mattia et al., 1993), although negative results have also been reported
(e.g., Gotlib, Kasch, et al., 2004). Findings from dot probe detection experiments indi-
cate that social phobia is characterized by faster response latencies to probes followed
by social threat cues (Asmundson & Stein, 1994; Vassilopoulos, 2005). Moreover, these
results have been confirmed in a modified version of the experiment in which the probe is
preceded by an angry or threatening, happy, or neutral facial expression (Mogg, Philip-
pot, & Bradley, 2004; Mogg & Bradley, 2002), although Gotlib, Kasch, et al. (2004)