364 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Other Cognition Measures
A number of new measures have recently been developed to assess thought content in
social phobia. One that holds particular promise is the 21-item Social Thoughts and
Beliefs Scale (STABS) that assesses negative cognitions of social comparison and inepti-
tude in social situations (Turner, Johnson, Beidel, Heiser, & Lydiard, 2003). It has high
test– retest reliability and significantly differentiates social phobia from other anxiety
disorders. A copy of the STABS can be found in the original article. A second cognitive
measure is the 20-item Appraisal of Social Concerns (ASC) that assesses degree of per-
ceived threat associated with various experiences relevant to social anxiety (Telch et al.,
2004). The measure correlates with other cognition and symptoms measures of social
anxiety and is sensitive to treatment effects. A copy of the instrument can be found in
the original article.
Clinician Guideline 9.15
Unfortunately, there is no standardized measure of negative cognition in social phobia that
has widespread acceptance or validation. The BFNE-II comes closest to being a measure of
negative social evaluative thoughts and beliefs that has general applicability. The SISST can
be used to assess cognitions relevant to social interactional anxiety. The STABS holds prom-
ise as providing the most direct questionnaire assessment of negative cognitions in social
phobia but more research is needed before it can be an accepted into clinical practice.Case Conceptualization
A cognitive case formulation explicates the key cognitive and behavioral processes
responsible for heightened anxiety during the anticipatory, exposure, and postevent
processing phases of social phobia. The case formulation follows the general format
we outlined in Chapter 5 with particular application to the unique cognitive processes
proposed in the cognitive model of social phobia (see Figure 9.1). Table 9.6 presents
the main elements of the cognitive case conceptualization for social phobia as well as
examples of questions that can be used to assess each construct.
Situational Analysis
The cognitive therapist begins by identifying the full range of social situations that
the client finds anxiety- provoking and may avoid. It is important to identify mildly
anxious situations as well as those that elicit intense anxiety and avoidance. In addi-
tion it is often helpful to determine whether there are some social situations that are
not anxiety- provoking and what features of these situations make them safe for the
individual. In Table 9.6 we listed a number of other characteristics of anxious social
situations that should be assessed. The ADIS-IV and symptom measures like the SPAI
can be useful in obtaining this information. Furthermore, self- monitoring forms like the
Situational Analysis Form (Appendix 5.2) or the Daily Social Anxiety Self- Monitoring
Form (Appendix 9.1) will provide valuable information on the social situations that