A Cognitive Perspective on Social Phobia

1. A Cognitive Perspective on Social Phobia Triple Threat Sheila Krogh-Jespersen Alicia Briganti Victoria Cox

2. Outline • The Cognitive Model • Empirical Studies of the Cognitive Model • A theory Derived Cognitive Treatment and Effectiveness

3. The Cognitive Model • Assumptions: • Excessively high standards of social performance • Conditional beliefs concerning the consequences of performing a certain way • Unconditional negative beliefs about the self

4. Self as a Social Object: • Self-monitoring • Feeling anxious is the same as looking anxious • Observer perspective imagining • “Felt self”

5. Safety Behaviors: • Many are internal mental processes • Variety of behaviors in one situation • Creation of symptoms • Increase in self-focus • Draw attention • Confirmation of fears

6. Before & After: • Before: • Thoughts focus on negative past experiences • After: • Notice negative responses • Associate with previous failures

7. Testable Hypotheses of the Cognitive Model • Social phobics interpret external social events in an excessively negative fashion. e.g., Amir, Foa, & Coles, 1998 • Social phobics show enhanced self-focused attention and reduced processing of external social cues when anxious in social situations. e.g., Bruch, Heimburg, Berger, & Collins, 1989; Mellings & Alden, 2000

8. Testable Hypotheses of the Cognitive Model, cont. • Social phobics generate distorted observer-perspective images of how they think they appear to others. e.g., Hackman, Suraway, & Clark, 1998; Hackman, Clark, & McManus, 2000 • In-situation safety seeking behaviors and self-focused attention prevent disconfirmation of social phobics’ negative beliefs and maintain social phobia. e.g., Morgan & Raffle, 1999

9. Testable Hypotheses of the Cognitive Model, cont. • In-situation safety behaviors and self-focused attention contaminate social interactions by making social phobics less appealing to others. e.g., Alden & Bieling, 1998 6. Social phobics (reduced) processing of external social cues is biased in favor of detection and recall of cues that could be interpreted as signs of disapproval from others. e.g., Veljaca & Rapee, 1998

10. Testable Hypotheses of the Cognitive Model, cont. • Social phobics engage in negatively biased anticipatory processing before entering feared social situations and engage in prolonged, negatively biased, post-event processing. e.g., Hinrichsen & Clark, 2000; Rachman, Gruter-Andrew, &Shafran, 2000

11. Attentional Biases in Anxiety Patients • Highly anxious people are more responsive & attentive to cues of threat. Initial experiments show high anxious Ss revealing greater ---- • In (T,NT pairs) of words or faces, detect dot faster when located at T spot. See spider quicker in array. • Emotional Stroop interference to T vs NT words • Choosing T over NT meaning of ambiguous words whether spoken (dye, die) or written (growth) • But these are correlations, and perhaps not causal for creating susceptibility to anxiety disorder.

12. Creating Anxiety by Creating an Attentional Bias Towards Threats • Give lots of training on: location of dot target is same as preceding threat (or NT) word; or • Ambiguous word always has the threatening meaning, e.g, BATTER primes for As_ _ lt (Assault) or Pa- ca_ke (Pancake). • During a later randomized tests in a stressful task, Ss showed the Threat bias AND a greater increase in anxious mood (due to the stress task) following these several methods of inducing bias. • Note: Social phobics try to avoid their threatening cues, e.g., not looking at faces of other people.

13. Stages of Treatment • Therapeutic Relationship • Idiosyncratic Model

14. An idiosyncratic model

15. Stages of Treatment • Manipulate the Model • Video Feedback • Shift of Attention • Therapeutic Relationship • Idiosyncratic Model

16. Exposure Assignment Record Sheet

17. Thoughts and Assumptions • Pre and post event thinking • Assumptions about behavior

18. Results • Preliminary results promising • Fear of Negative valuation Scale • Post-treatment improvement mean of 11 points • Follow-up improvement mean of 15 points