Social Phobia 373
••“Were you thinking about how anxious you would feel in the situation?” “Are
there any particular ways your anxiety might be evident to others?” “Did you
have an image or could you imagine what you would be like in the situation?”
“Were you thinking about how hard it would be to conceal your anxiety from
others?” “What would happen if people knew you were anxious?”
••“Were you thinking about how you would perform in that situation or that you
would be quite inhibited?” “If so, how do you imagine you would come across to
others; what behaviors would they focus on?” “How do you think you’d embar-
rass yourself?” “If so, how would you act in an embarrassing manner?”
••“As you are thinking about this anticipated event, what is the worst outcome you
can imagine?” “Has that ever happened to you in the past?” “If so, what was it
like?”
••“Are you thinking about the impression you are likely to make on others?” “What
do you imagine other people in that situation will end up thinking about you?”
“How will you appear to them?”Socratic questioning about the anticipated social threat will yield information on
(1) perceived intolerance of anxiety in the situation, (2) how the client will embarrass
or humiliate herself in front of others, and (3) how she thinks she will be perceived by
others. Once this information is obtained, the therapist asks for probability and sever-
ity ratings on each aspect of the social threat judgments. For example, the client would
rate the probability (0–100) as well as the severity that anxiety in the situation will be
intense, that she will embarrass herself in the situation, and that others will conclude
that she is “stupid” or “incompetent.”
Once the core social threat interpretation has been specified, evidence gathering,
cost– benefit analysis, and decatastrophizing can be used to challenge the client’s faulty
anticipatory thinking. These interventions have been discussed thoroughly in Chapter 6.
For evidence gathering, the therapist asks for any information that confirms the social
threat thinking as well as opposing information that disconfirms or at least questions the
veracity of the anxious anticipatory cognitions. The Testing Anxious Appraisals: Look-
ing for Evidence form (Appendix 6.2) can be helpful. A cost– benefit intervention would
explore the actual costs (negative consequences) and benefits (both immediate and long
term) associated with exposure to the anticipated social event (use Cost– Benefit Form in
Appendix 6.3). Finally, decatastrophizing can be employed in which the client is asked
to imagine the feared negative outcome. After generating the worst-case scenario, the
client can be asked (1) “Would it really be as terrible as you think?”, (2) “What is the
most likely immediate and long-term impact on you?”, (3) “What could you do to mini-
mize the negative impact of embarrassment?”, and (4) “How often do people embarrass
themselves in front of others and yet somehow survive without life- changing negative
effects?” In addition identifying errors in thinking (see discussion in Chapter 6) is an
important part of challenging anxious thinking (use Common Errors and Biases in
Anxiety handout and Identifying Anxious Thinking Errors Form, Appendix 5.6).
After challenging the faulty social threat thinking, the cognitive therapist works
with the client on generating an alternative way of anticipating the forthcoming social
situation. Again this has been discussed in Chapter 6. The Alternative Interpretations
Form (Appendix 6.4) can be used to strengthen acceptance of a more realistic alterna-
tive interpretation. The alternative interpretation will probably acknowledge that the