Issues in the application of cognitive and behavioral strategies to the treatment of social phobia

Abstract

This paper is concerned with practical issues. It focuses on the clinical application of behavioral and cognitive strategies in the treatment of social phobia and on how they may be combined. These issues are of particular interest in the case of social phobia because the disorder has an important cognitive aspect: the fear of negative evaluation. Four general issues which are relevant to the application of both behavioral and cognitive-behavioral methods are discussed first: defining the problem, identifying available resources, agreeing on goals and presenting the rationale for treatment. Behavioral and cognitive strategies are then discussed separately. In both cases knowledge of standard techniques is assumed. The paper concentrates on strategies for overcoming difficulties in applying these techniques to social phobias, on counteracting general biases in thinking and on dealing with specific cognitive features of social phobia. Procedures are described in sufficient detail to illustrate how they should be applied, using as many examples drawn from clinical practice as possible. It is argued that, in theory, behavioral and cognitive techniques should combine particularly well in the case of social phobia. Practical experience and present research findings support this view.