380 TREATMENT OF SPECIFIC ANXIETY DISORDERS
she could improve her public speaking skills. Whatever the case, it is important that the
client realizes that in the end postevent rumination is a maladaptive cognitive strategy
that contributes to the persistence of social anxiety because it ultimately reinforces the
perception that social situations are threatening. The Cost– Benefit Form (Appendix 6.3)
is useful in this regard.
Cognitive restructuring is a second intervention for postevent processing. The client
is asked to describe in detail his recollection of any past social experiences that continue
to come to his mind on a fairly regular basis. The therapist focuses on memories that
recur repeatedly or that are interpreted as clear evidence of social threat, embarrass-
ment, or ineptitude. Memory of a specific past social experience is targeted and the
therapist determines what the client concludes from this event about social threat, how
he appeared to others, his performance in that situation, and the personal consequences
of the social encounter. The therapist then evaluates the accuracy of the client’s recol-
lection through evidence gathering and inductive reasoning to emphasize the possibil-
ity that the client’s recall of the past event is marred by biased appraisals of threat and
vulnerability. An alternative evaluation of the past experience is formulated that offers
a more realistic perspective on the experience. The client is then encouraged to repeat-
edly challenge the negative memory with the possibility of the more benign alternative
whenever he starts ruminating on the past social event—that is, to engage in “cognitive
debriefing” in which performance is evaluated in terms of meeting predefined goals
rather than evaluated on the basis of one’s emotional response (Brozovich & Heim-
berg, 2008). Cognitive restructuring was employed with Henry to evaluate whether his
unsuccessful job interview was due to lack of intelligence. In fact there was considerable
evidence that he was a highly intelligent and gifted computer programmer. Gradually
he came to believe in the possibility that intense anxiety during the interview caused
him to underperform in that situation. This represented a more benign interpretation
because anxiety was something he could counter, whereas lack of intelligence meant he
was doomed to failure and disappointment.
Cognitive restructuring should be followed up with behavioral assignments that
seek out disconfirming evidence for the negative recall of past experiences. For exam-
ple, the client could be asked to survey friends, family members, or coworkers who
were present at a social event to determine their recollection. The client’s recollection
of the event could be compared to how others recall the experience in order to highlight
areas of discrepancy. Another exercise involves videotaping an in- session role play of
some social situation. The client provides an evaluation of her anxiety, her social per-
formance, and how inhibited she appears in the role play. Two weeks later the therapist
asks the client to recall what she remembers about the role play and to evaluate her
anxiety, performance, and appearance based on the memory. The two sets of evalu-
ations are then compared. The objective of this exercise is to highlight how negative
biases creep into memory when socially anxious individuals remember their past social
experiences.
Finally, cognitive restructuring can be used to encourage the client to shift from
an observer perspective on their past social experiences (i.e., seeing oneself as if from
an external point of view) to a field perspective (i.e., as if looking out through one’s
own eyes). D. M. Clark (2001) emphasizes that this shift in perspective is necessary for
focusing on information that is inconsistent with a negative self-image. In other words,
clients are encouraged to remember past social situations from their own perspective