Social Phobia 365
table 9.6. elements of the Cognitive Case formulation for social phobia
Elements of case
conceptualization Key questions
Specify range of feared
social situations.
••What are the most commonly feared social situations?
••How often do they occur (i.e., daily, weekly, rarely)?
••Determine average level of anxiety and extent of avoidance associated with
each situation.
••Are the feared situations primarily performance, social interaction, or a
mixture?
••Which situations provoke the most anxiety?
••Which situations are most important for improving the client’s daily
functioning?Determine relative
contribution of the three
components.
••How often are anticipatory anxiety, exposure, and postevent processing
associated with each fear social situation?
••What is the usual duration of each phase (i.e., hours, days, or weeks)?
••What is the average level of anxiety associated with each phase?
••What is the consequence or outcome associated with each phase of anxiety?
••What role does each phase play in the persistence of the person’s social
anxiety?Assess for explicit threat
interpretation bias
and anxious thoughts/
images.
••What is the nature of the perceived threat associated with each fear
situation?
••What external social cues or perceived audience feedback reinforces the
social threat?
••What is the worst scenario or catastrophe associated with a social threat
situation?
••What is the client’s estimated likelihood of a catastrophe or other negative
outcome happening in the social situation?
••Obtain examples of the automatic anxious thoughts and images that
occur during anticipation, exposure, or postprocessing of a feared social
situation.
••Is the client able to process any competing or more positive information
when feeling anxious about a social situation?Assess heightened
self-focused attention,
intolerance of anxiety,
and awareness of
inhibitory behaviors.
••What is the extent of excessive self-consciousness and self-focused
awareness in social situations?
••What physical sensations, behaviors, thoughts, or feelings are self-
monitored when anxious?
••How are these internal cues interpreted negatively? What’s so awful or
catastrophic about this unwanted internal state?
••How important is it to conceal this internal state from others in the social
situation?
••What aspects of social performance does the individual self-monitor? What
is his evaluation of his social performance? How does he think he is seen by
others in the social setting (i.e., the “audience”)?
••What inhibitory behaviors are present during exposure to anxiety-
provoking social situations? What is their effect on social performance and
their contribution to perceived loss of control?Determine the role of
safety strategies and
anxiety suppression.
••What mental or behavioral safety strategies does the individual use to
reduce anxiety or prevent a negative evaluation by others?
••What is the perceived effectiveness of these safety responses? Is the client
able to report any negative consequences of her safety behaviors?
••What is the person’s tolerance of anxiety in social settings? How important
is it to conceal anxiety from others?
••What is the discrepancy between a person’s desired level of social
performance and her perceived actual level of performance?
(cont.)