Social Phobia 375
table 9.9. Clinical example of Cognitive restructuring of anticipatory social anxiety
Anticipatory situation
Carol is informed by her supervisor that an office meeting is scheduled later that day to discuss the
need to upgrade the office computer system. There will be 15 of Carol’s coworkers present and the
supervisor will be asking each of them to speak about the problems they have encountered with the
present computer network.
Level of anticipatory anxiety
Carol rated her anxiety at 90/100, which increases as she approaches the meeting time.
Carol’s anticipatory social threat cognitions
••“I can’t get out of this meeting; I have to go.”
••“We’ll be seating around the board table and she’ll [supervisor] ask everyone for their opinion.”
••“The anxiety will build until finally she gets to me and I have to say something. By that time I’ll
be in panic mode.” [intolerance of anxiety]
••“Everyone will be staring at me. I’ll get really blushed, feel hot, my hands will tremble, and my
mind will go blank.”
••“I’ll feel so self-conscious about my anxiety that I won’t be able to give a clear answer.” [excessive
self-focused attention]
••“Everyone will wonder what’s wrong with me, how could I be so anxious around my work
colleagues. They’ll see me as weak, incompetent, and mentally ill.” [negative evaluation,
appearance to others]
••“I’ll feel so embarrassed by this fiasco that I won’t be able to face my colleagues for days. Going
to work will be a painful experience.” [expectation of embarrassment]Estimation ratings of likelihood and severity
Carol rated the above scenario as 70% likely to happen and the severity as 85% because it involved
coworkers who she would see everyday.
Challenging the social threat cognitions
- Confirming evidence—she has become extremely anxious at such meetings in the past; at least
one of her closer friends in the office commented that she seemed quite nervous; she recalls
feeling embarrassed for days after the meeting. - Disconfirming evidence—despite feeling like she was inarticulate, others seemed to understand
what she was saying at past meetings as indicated by their comments after she spoke; everyone
seemed to treat her the same after the meeting; when Carol mentioned to a coworker a couple
of weeks later how anxious she felt in the meeting, the coworker didn’t recall noticing Carol’s
anxiety; there are a couple of other coworkers who are shy and appear nervous at these meetings
and yet they are well liked and respected; when she is speaking, no one looks embarrassed or
disapproving, they seem to be paying attention. - Consequences—the immediate consequence is an escalation in anxiety and discomfort but there
have been no long-term, life-changing consequences to Carol’s anxiety at work meetings; people
have not changed how they treat her and within a week any embarrassment seems to subside. - Decatastrophizing—the therapist worked with Carol to write out the worst-case scenario that
could be associated with speaking out in a work meeting. She decided that the worst that could
happen is that she might have a full-blown panic attack and have to excuse herself from the
meeting. Her work colleagues would know something was wrong and then question her after
the meeting. Together Carol and her therapist worked on a possible response to how she would
handle other people’s reactions if she did leave a meeting prematurely because of panic. We also
worked on how she could stay in the meeting and ride out the panic attack as an alternative
response strategy.
(cont.)