Cognitive Therapy of Anxiety Disorders

Social Phobia 361

Clinician Guideline 9.13

Address biased and maladaptive anticipatory processing by emphasizing the use of planning

and rehearsal of anticipatory strategies that focus on how to improve social performance and

resist the urge to avoid.

Cognitive assessment anD Case formulation

Various critical reviews have been published on the cognitive and symptom measures
specifically developed for social anxiety (e.g., D. B. Clark et al., 1997; Heimberg &
Turk, 2002; Hofmann & Barlow, 2002; Turk, Heimberg, & Magee, 2008). In this sec-
tion we focus on a few of the more common symptom measures as well as a couple of
specific questionnaires that assess the cognitive profile of social phobia. We begin with a
brief consideration of standardized instruments for social phobia and end with a frame-
work for case formulation derived from the current model.

Diagnostic Interview and Clinician Ratings

The ADIS-IV (Brown et al., 1994) is recommended over the SCID-IV (First et al., 1997)
when administering a structured diagnostic interview for social phobia. Reliability stud-
ies (Brown et al., 2001) indicate that the ADIS-IV Lifetime Version achieved high inter-
rater reliability for diagnosis of social phobia (kappa = .73) and for dimensional ratings
of situational fear (r = .86), avoidance (r = .68), and severity of general interference or
distress (r = .80). If a clinician rating scale is desired, the Liebowitz Social Anxiety Scale
(LSAS; Liebowitz, 1987) is recommended. It has good psychometric properties, with a
LSAS Total cutoff score of 30 distinguishing social phobia from nonclinical individuals
(Fresco et al., 2001; Heimberg et al., 1999; Mennin et al., 2002). The LSAS is reprinted
in the original article as well as in Heimberg and Turk (2002).

Symptom Questionnaires

Social Phobia Scale and Social Interaction Anxiety Scale

The 20-item Social Phobia Scale (SPS) and 20-item Social Interaction Anxiety Scale
(SIAS) are companion scales developed by Mattick and Clarke (1998) to assess fear of
being observed by others while doing routine tasks and fear of more general social inter-
action. Both scales have good internal consistency (Cronbach alphas range from .88 to
.94), high 12 week test– retest reliability of .92 (SIAS) and .93 (SPS), strong concurrent
validity, and adequate convergent validity with interview-based indices of social anxiety
as well as measures of negative cognition (Brown, Turovsky, et al., 1997; Cox, Ross,
Swinson, & Direnfeld, 1998; Mattick & Clarke, 1998; Osman, Gutierrez, Barrios, Kop-
per, & Chiros, 1998; Ries et al., 1998). Social phobics score significantly higher than
other anxiety disorder groups or nonclinical controls (e.g., Brown et al., 1997; Mattick
& Clarke, 1998), and the SPS and SIAS are sensitive to cognitive- behavioral treatment
effects (Cox et al., 1998). Peters (2000) reported that a cutoff score of 26 on the SPS
and 36 on the SIAS were optimal for discriminating social phobia from panic disorder,