Social Phobia 381
rather than from how they imagine they appeared to others. This will allow the client
to focus on the external cues in social situations that contradict the exaggerated threat
and failure interpretations.
Clinician Guideline 9.22
Employ cognitive restructuring and behavioral assignments to correct biased recall of past
social experiences that characterize the postevent ruminative processing in social phobia.
Encourage individuals to take a field perspective when reevaluating their past social experi-
ences.Efficacy of Cognitive Therapy for Social Phobia
In their original publication of empirically supported treatments, Chambless et al.
(1998) concluded that CBT for social phobia was probably an efficacious treatment (see
also Chambless & Ollendick, 2001). Since then a number of treatment outcome reviews
have concluded that CBT produces immediate and enduring treatment effects for social
phobia (e.g., Butler et al., 2006; Hollon et al., 2006; Hofmann & Barlow, 2002). For
example, Rodebaugh, Holaway, and Heimberg (2004) concluded that CBT produces
moderate to large effect sizes, that group and individual treatment yields similar results,
and that combined cognitive restructuring plus exposure might confer a slight advantage
over exposure alone, although the difference is nonsignificant. Beidel and Turner (2007)
offered a more negative outlook, concluding that group CBT produced higher responder
rates for specific (67–79%) than generalized (18–44%) social phobia. However, Turk et
al. (2008) were more optimistic, claiming that three out of four individuals with social
phobia will realize a clinically significant gain from an intensive trial of exposure and
cognitive restructuring.
Cognitive restructuring and exposure are key components of the cognitive therapy
for social phobia presented in this chapter. For this reason our brief and highly selective
review focuses on a few key studies that include both cognitive restructuring and expo-
sure in their treatment package. In one of the first major outcome studies on CBT for
social phobia, 133 patients with DSM-IV social phobia from two sites were randomly
assigned to twelve 2½ hour sessions of group CBT, an educational- supportive group
(attention control psychotherapy), 15 mg of phenelzine (Nardil) alone, or matching pla-
cebo tablets (Heimberg et al., 1998). At 12-week posttreatment the medication and
group CBT conditions were significantly more effective than the pill placebo or atten-
tion control conditions with 75% of completers in each group classified as responders.
At 6-month follow-up 50% of the phenelzine responders relapsed compared to only
17% of the CBT responders (Liebowitz et al., 1999).
D. M. Clark and colleagues conducted a series of outcome studies on their version
of CBT for social phobia. In one study 71 patients with social phobia were randomly
assigned to group CBT, individual CBT, or a wait list condition (Stangier, Heidenre-
ich, Peitz, Lauterbach, & Clark, 2003). At posttreatment both types of CBT were sig-
nificantly better than the wait list group but individual CBT proved superior to group
CBT at both posttreatment and 6-month follow-up. In a randomized placebo- controlled
trial, 61 patients with generalized social phobia were assigned to 16 individual weekly