384 TREATMENT OF SPECIFIC ANXIETY DISORDERS
Cognitive therapy for social phobia seeks to reduce social anxiety and avoidance by
correcting faulty social threat attention and interpretation biases, reversing the excessive
self-focus on internal cues, eliminating reliance on safety strategies to conceal anxiety,
increasing tolerance of anxiety and a tendency to be inhibited, and decreasing poste-
vent rumination. A review of the treatment outcome literature indicates that cognitive
therapy that includes both cognitive restructuring and repeated exposure to anxious
social situations produces clinically significant and enduring improvement in 75% of
individuals who complete treatment.
Despite the substantial advances made in our understanding of the cognitive basis
of social phobia and its treatment, a number of key issues remain for future investiga-
tion. It is unclear whether the information- processing bias apparent when first encoun-
tering a social threat situation (i.e., “online inferences”) is different from the processing
bias that occurs when social phobia individuals reflect back on social interactions (i.e.,
“offline inferences”). Also, is the main problem in social phobia heightened accessibil-
ity of negative social threat or diminished processing of positive social information?
Less is known about the role of safety behaviors and inhibitory behaviors, the nature
of postevent processing, and the causal status of faulty information processing in social
phobia. Finally, the cognitive approach to social phobia would be further advanced by
more psychometric research on self- report measures that specifically assess the negative
cognitions and beliefs of social phobia, and randomized controlled trials with longer
follow-up periods in order to determine the long-term effectiveness of cognitive therapy
for social phobia.