Social Phobia 371
repeated practice in effortfully processing positive social information the tendency to
selectively evaluate social situations in a threatening manner is weakened and social
anxiety reduced.
As part of educating the client into the cognitive model, the therapist should elicit
specific goals that the individual would like to achieve from therapy. In their self-help
manual The Shyness and Social Anxiety Workbook, Antony and Swinson (2000b) sug-
gest that individuals write down how social anxiety has affected their relationships,
work or education, and daily functioning. This is followed by specifying the costs and
benefits of overcoming one’s social anxiety and then setting 1-month and 1-year goals
for change. We believe this is a critical part of the education process that could improve
compliance with the exposure exercises. Many individuals with social phobia are reluc-
tant to commit to treatment because of the heightened anxiety expected from exposure.
A firm appreciation of the long-term benefits of exposure-based treatment will increase
treatment motivation and compliance. In fact Hope et al. (2006) have adopted the slo-
gan “Invest anxiety in a calmer future” to emphasize that facing one’s fear today can
lead to later long-term payoffs. By specifying the costs of social anxiety and the goals for
change, the therapist can encourage clients to “keep their eye on the target” when treat-
ment becomes particularly challenging. Chapter 3 in the client workbook entitled Man-
aging Social Anxiety: A Cognitive- Behavioral Therapy Approach contains an excellent
discussion on the causes of social anxiety, the role of dysfunctional thinking, and the
rationale for CBT of social phobia (Hope et al., 2000).
Before concluding the education phase, a social anxiety hierarchy should be con-
structed based on a range of anxiety- provoking situations recorded in the Daily Social
Anxiety Self- Monitoring Sheet (Appendix 9.1). Furthermore, the Exposure Hierarchy
(Appendix 7.1) can be useful for hierarchically arranging social situations from least
to most anxiety- provoking. Construction of an exposure hierarchy was discussed in
Chapter 7 (see section on graduated vs. intense exposure) and the guidelines outlined
in that section will apply to development of a social anxiety hierarchy. It is important
to generate a range of 15–20 social situations that occur fairly frequently, with a higher
proportion of situations in the moderate to high anxiety range.
Gerald accepted the cognitive explanation for his long- standing and severe social
phobia. In particular we focused on the important role played by anticipatory anxiety
which led to a strong urge to avoid as much social interaction as possible. We noted that
he became excessively self- conscious of his facial appearance and limited conversational
skills in social situations, and was convinced that he appeared inadequate and disturbed
to others because of his natural social inhibitions. He assumed that others must think
negatively about him because they would observe his intense anxiety. Certain core
beliefs became apparent such as “other people can see right through me,” “people are
naturally negative and critical of others,” “my anxiety is so intense that it is intolerable
and obvious to others,” and “I am better off alone, away from other people.” However,
Gerald also realized that the more socially isolated he became, the more severe his clini-
cal depression. His long-term goal was to gain sufficient confidence in social situations
that he could start dating, whereas his more immediate goal was to reestablish connec-
tions with past friends and acquaintances. Since calling “old friends” on the telephone
and arranging to meet them at a pub was moderately anxiety- provoking, we started
exposure to these situations.