Social Phobia 377
In order for the videotaped role play to be effective, the socially anxious client must
be asked how she thinks she appeared to others in the video before actually viewing the
tape and then to view her videotaped performance as though watching a stranger. In
this way the client can learn that her evaluation of how she thinks others perceive her is
negatively biased. Thus the main purpose of videotaped feedback is to provide correc-
tive information for the client’s faulty assumption of making a negative impression on
others by being anxious or inhibited.
Live and videotaped role plays provide an excellent introduction to in vivo expo-
sure to anxious social situations. The therapist can introduce increasingly more anxious
social situations into the role-play sessions. Within- session role plays can be assigned as
homework in which a spouse or family member becomes the observer. This will increase
the chance that therapeutic effects from role plays will generalize to the actual social
situation.
A case illustration of the therapeutic benefits of role plays was Erin, a 32-year-
old financial planner. Erin suffered considerable anxiety in her job because she had
great difficulty being assertive with customers. When they would make unreasonable
demands, she would agree to an early deadline for completing their work even though it
would be impossible to meet the deadline given her current workload. Erin was terrified
of anger and criticism from her customers, so she quickly agreed to an unreasonable
deadline in order to avoid conflict. When Erin first role- played her usual interaction
with demanding customers, it was clear she was excessively focused on her own feelings
of discomfort and inhibitions such as avoiding eye contact or refraining from asking the
customer questions that might suggest possible confrontation. Her automatic thoughts
were “I getting very uncomfortable, I need to get this guy out of my office,” “He seems
to be getting quite angry at me,” and “I’ll just agree now and figure out what to do
later.” The therapist worked with Erin on an alternative, more assertive response to
demanding customers that helped her set more realistic deadlines while not allowing
her anxiety to dictate her response. It took many repeated role plays in session and as
homework assignments with her spouse acting as a “demanding customer” before Erin
was ready to try this at work.
Clinician Guideline 9.19
Employ role plays or behavioral rehearsal as an integral part of cognitive therapy to reduce
heightened self- focused attention, reliance on safety behaviors, negative evaluation of social
performance and inhibitory behavior, and long-held assumptions of negative impression on
others.Cognitive Restructuring of Faulty Threat Appraisals during Exposure
Prior to initiating within- session and between- session exposure to socially threatening
situations, it is important that the cognitive therapist correct biased threat interpreta-
tions, excessive self- focused attention, and emotional reasoning by completing cogni-
tive restructuring thought records on the moderate- and high- anxiety situations in the
hierarchy. The same cognitive restructuring protocol as described for anticipatory social