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Testing Form (Appendix 6.5) can be used to record critical observations from exposure
exercises (see also Hope et al., 2000, for suggestions on exposure in social phobia).
The following example illustrates how exposure-based empirical hypothesis testing
was incorporated into Gerald’s treatment. In his social anxiety hierarchy Gerald rated
calling an old friend as moderately anxious (40/100). His automatic anxious thoughts
were “I feel guilty for not calling him in such a long time,” “He doesn’t want to hear
from me,” “I’ll be bothering him,” and “I’ll feel so anxious, why bother doing it?” After
correcting the negative interpretations through a cognitive restructuring exercise, Ger-
ald and the therapist role- played the telephone call to the friend. They brainstormed var-
ious conversational topics that Gerald could employ with this friend in order to counter
Gerald’s verbal inhibitions. Coping statements from the cognitive restructuring exercise
were employed to correct negative expectations and encourage tolerance of anxiety.
After practicing the social interaction in session, Gerald was able to commit himself to
the homework assignment, which involved calling his friend. He returned to the next
session exuberant about the assignment. He called his friend and contrary to his expec-
tations his friend was very receptive. In fact he made plans to have dinner together with
Gerald the following week. Moreover, Gerald discovered that his anxiety was not as
crippling as he had predicted and that his ability to carry on a conversation was better
than expected. The exercise proved to be an important turning point in therapy because
Gerald experienced disconfirmation of his anxious thinking.
Clinician Guideline 9.21
Repeated exposure to social anxiety situations is critical for providing evidence that dis-
confirms the faulty appraisals and beliefs of threat and vulnerability that maintain social
a n x ie t y.Cognitive Interventions for Postevent Processing
The prominence of postevent processing will vary across individuals with social phobia.
For those who engage in considerable rumination about past social experiences, poste-
vent processing must be targeted early in treatment. Much of the critical information
about the client’s idiosyncratic form of postevent processing can be obtained from the
case formulation (see previous discussion).
After obtaining a clear description of the client’s postevent thought content, the ther-
apist should inquire about the perceived costs and benefits of engaging in this repeated
reappraisal of past social performances and their outcome (D. M. Clark, 2001). For
some clients the disadvantages of reevaluating past social encounters may be obvious,
whereas other socially anxious clients believe such reanalysis helps them prepare for
similar events in the future. For example, Henry was unsuccessful with a job interview
he had with a very prestigious company many years ago. It was quite clear that his anxi-
ety during the interview was so intense that he did not perform well. However, years
later he continued to ruminate about the failed interview as proof that he was not smart
enough, that “he had been found out.” Another client would think back to past difficul-
ties when making reports at quarterly shareholder meetings, trying to figure out how