Social Phobia 367
Explicit Social Threat Bias
An automatic attentional bias for social threat as well as selective evaluation of social
threat cues that result in overestimated appraisals of the probability, severity, and con-
sequences of negative evaluation by others is a core proposition in the cognitive model
of social phobia. The Apprehensive Thoughts Self- Monitoring Form (Appendix 5.4) and
the Anxious Reappraisal Form (Appendix 5.10) can be used to obtain information on
the client’s social threat bias. In addition the Social Situation Estimation Form (Appen-
dix 9.2) is useful for obtaining online estimates of threat in social situations. There are
three critical facets of the social threat bias that the clinician must assess.
- What is the client’s common “social threat theme” that is evident across all anx-
ious social situations? What is the “catastrophe” or worst-case scenario that the
individual fears? - Estimates of the probability and severity of this dreaded outcome or its vari-
ant should be obtained for each anxious situation. Is there evidence of biased
probability and severity expectations? If so, what external social information
supports the interpretation? Is the client able to access positive information that
challenges the social threat evaluation? - What automatic anxious thoughts or images does the individual experience
when anticipating or participating in an anxious situation? These thoughts and
images will provide valuable information on the perceived social threat and the
maladaptive social self- schemas activated when socially anxious.
Whenever Gerald was around people, he would search for evidence that people
were looking at him, especially at his face. He was particularly self- conscious that they
might be looking at the redness of his face and thinking “This guy doesn’t look after
himself, what’s his problem?” Gerald rated the probability that people were looking at
him as very high (80/100) and the severity of their negative evaluation as very upsetting
(75/100). Some situations, such as talking to the office staff at work, were associated
with low probability and severity estimates, whereas other situations, such as carrying
on a conversation with an acquaintance at the pub, was associated with high estimates.
In the treatment sessions, exposure and cognitive restructuring began with social situa-
tions that elicited moderate levels of threat estimation.
Self- Focused Attention and Involuntary Inhibition
Excessive self- monitoring of an anxious internal state, the occurrence of inhibitory
behaviors, and poor social performance are critical processes that are assessed in the
cognitive case formulation. The cognitive therapist must determine the frequency and
extent of self- monitoring that occurs during exposure to anxious social situations. To
what extent do individuals become self- conscious in the social situation? How com-
pletely self- absorbed do they become? Are they aware of anything in their external
environment or is their focus entirely internal? Are there particular physical sensations,
symptoms, thoughts, or behaviors that become the object of their self-focus? Are they
conscious of being overly inhibited in the social situation? What perceived negative con-
sequence is associated with the self- monitored symptom or inhibition? For example, an