Cognitive Model Of Social Phobia Research Articles

Can Clark and Wells' (1995) Cognitive Model of Social Phobia be Applied to Young People?

AbstractSocial phobia is a common and disabling condition for both children and adults. In recent years Clark and Wells' (1995) cognitive model of social phobia has given rise to an effective treatment protocol for the condition in adults (e.g. Clark et al., 2003, 2006). The current study investigates the applicability of this model to younger people. One hundred and seventy-one 11–14 year-old participants completed questionnaires measuring social anxiety, depression, and the variables hypothesized to maintain social phobia in Clark and Wells' (1995) cognitive model: negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing. High socially anxious children scored significantly higher than low socially anxious children on all of the variables in Clark and Wells' model. Negative social cognitions, self-focused attention, safety behaviours, and pre- and post-event processing were all significant predictors of social anxiety, accounting for 48% of the variance in social anxiety. Furthermore, these variables showed specificity to social anxiety, predicting significantly more variance in social anxiety than in depression. Findings suggest that although Clark and Wells' (1995) model of social phobia was developed from research on adult populations, it may be equally applicable to younger people with social phobia.

Assessing post-event processing after social situations: a measure based on the cognitive model for social phobia

In their cognitive model of social phobia, Clark and Wells (1995) described a process called post-event processing that is characterized by prolonged ruminative and negative thinking about a past social event. Referring to this concept, Rachman and colleagues (2000) developed a questionnaire that has been used in several studies subsequently (Post-Event Processing Questionnaire (PEPQ)). Our aim was to examine a German version of the PEPQ and, where necessary, modify this measure. In Study 1 (N=130 students), we inspected the psychometric properties of the German version of the PEPQ. According to the item analyses, problematic items were identified and eliminated or reformulated. To map aspects of post-event processing that were missing in the original questionnaire, new items were developed. In Study 2, the psychometric properties of the revised instrument were analyzed in a sample of students (N=268).The revised instrument showed excellent internal consistency and a meaningful pattern of correlations with anxiety, depression, and dysfunctional self-consciousness. With regard to the factorial structure of the construct, our data suggest that a four-factorial model may be more appropriate than the one-dimensional structure proposed by Rachman and colleagues.

Images of the self in social anxiety: Effects on the retrieval of autobiographical memories

Cognitive models of social phobia propose that negative self-images play an important role in maintaining anxiety. This study examines the effect of holding a positive or a negative image in mind during a speech on the retrieval of autobiographical memories. Twenty high socially anxious participants performed a standard autobiographical memory task (AMT), which used positive, negative and neutral cue words. Participants performed the AMT twice: once after giving a speech holding a positive image and once while holding a negative image. Participants were more anxious and rated their performance worse in the negative image condition. Negative memories were retrieved faster in the negative image condition and positive memories were retrieved faster in the positive image condition. In the negative image condition, positive memories were retrieved more slowly than either negative or neutral memories. Inhibition and facilitation are proposed as two processes that could explain the effects of differently valenced imagery on autobiographical memory. The clear evidence for an inhibitory effect on positive autobiographical memories in the negative imagery condition is considered in relation to Brewin's [(2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765–784] retrieval competition hypothesis. The paper concludes with a brief discussion of the potential role of inhibition in imagery rescripting.

Modelling relationships between cognitive variables during and following public speaking in participants with social phobia

Cognitive models of social phobia predict that several cognitive processes will mediate the relationship between trait levels of social anxiety and the extent of anxiety experienced in a specific social-evaluative situation. The current study aimed to provide a test of these relationships. Over 200 clinical participants with social phobia completed measures of their general social anxiety and a week later performed a brief impromptu speech. They completed a measure of state anxiety in response to the speech as well as questionnaires assessing several cognitive constructs including focus of perceived attention, perceived performance, and probability and cost of negative evaluation. A week later, they completed measures of negative rumination experienced over the week, as well as a measure of the recollection of their perceived performance. Path analysis provided support for a model in which the cognitive factors mediated between general social anxiety and the degree of anxiety experienced in response to the speech. A second model supported the theory that negative rumination mediated between characteristic social anxiety and negative bias in the recollection of performance.

Exploring the relationship between fear of positive evaluation and social anxiety

Cognitive-behavioral theorists have proposed that fear of negative evaluation is the core feature of social anxiety [Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In: R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford Press; Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behavior Research and Therapy, 35, 741–756]. However, we have previously hypothesized that fear of evaluation in general is important in social anxiety, including fears of positive as well as negative evaluation, and we developed the Fear of Positive Evaluation Scale (FPES; Weeks, J. W., Heimberg, R. G., & Rodebaugh, T. L. (2007). The Fear of Positive Evaluation Scale: Assessing a proposed cognitive component of social anxiety disorder. Manuscript submitted for review.) to test this hypothesis. The present paper reviews several studies conducted for the purpose of extending the empirical examination of the construct of fear of positive evaluation (FPE). Consistent with hypothesis, FPE was positively associated with discomfort in response to receipt of positive social feedback and negatively associated with perceived accuracy of the feedback received. Furthermore, the FPES correlated significantly with several measures related to social anxiety, and lower correlations with measures of other constructs provided evidence of discriminant validity. Thus, findings from the present series of studies add to the developing support for the hypothesis that fear of positive evaluation is important in social anxiety.

Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor

Study one used a semi-structured interview to assess the use of safety behaviours in high and low socially anxious participants. As predicted from cognitive models, the high social anxiety group reported using a greater number of safety behaviours, more frequently, in a greater number of situations. Both the high and low social anxiety groups perceived their safety behaviours to be helpful. Study two involved experimentally manipulating the use of safety behaviours and self-focus and demonstrated the use of safety behaviours and self-focused attention to be unhelpful in a number of ways. Results support the role of safety behaviours and self-focused attention in the cognitive model of social phobia, and the value of dropping safety behaviours and reducing self-focus as therapeutic strategies in social phobia.

Private and public self-awareness in social anxiety

Clark and Wells’ [(1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D.A. Hope, & F. Schneier (Eds.). Social phobia: Diagnosis, assessment and treatment. New York: Guildford Press] cognitive model of social phobia proposes that self-focused attention and construction of the self as a social object maintain anxiety. This study examines the effect of two different self-focus manipulations (mirror and video) on public and private self-awareness, perspective taking, anxiety, and attributions. Thirty one high socially anxious participants (26 female, 5 male) with a mean age of 19.58 (SD=1.89) and 32 low socially anxious participants (21 female, 11 male) with a mean age of 20.47 (SD=3.69) took part in a conversation with a stooge. Public self-awareness increased in both groups but was higher overall in the high socially anxious group. Private self-awareness decreased for the low socially anxious group, but did not change for the high socially anxious group. High socially anxious participants were also more aware of their surroundings than low socially anxious participants. High socially anxious participants used the field perspective less, and experienced more anxiety. High socially anxious participants also made fewer internal attributions for the conversation going well and more for the conversation going badly than low socially anxious participants who did the opposite. The implications of the results for the cognitive model are discussed.

The spotlight effect and the illusion of transparency in social anxiety

[Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In: R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: diagnosis, assessment, and treatment (pp. 69–93). New York: Guildford Press] cognitive model of social phobia suggests that both public and private sources of information contribute to the construction of the self as a social object, which is thought to maintain the disorder. This study used two concepts developed in social psychology that might help to explain the processes that contribute to the development of this constructed self. These two concepts are the spotlight effect [Gilovich, T., Medvec, V. H., & Savitsky, K. (2000). The spotlight effect in social judgment: an egocentric bias in estimates of the salience of one's own actions and appearance. Journal of Personality and Social Psychology, 78(2), 211–222] and the illusion of transparency [Gilovich, T., Medvec, V. H., & Savitsky, K. (1998). The Illusion of transparency: biased assessments of others’ ability to read one's own emotional states. Journal of personality and social psychology, 75(2), 332–346]. Participants performed a memory task under either a low or a high social-evaluative condition. In the high social-evaluative condition, participants reported higher levels of the spotlight effect and more negative evaluation of task performance, compared to participants in the low social-evaluative condition. There were no differences between the two conditions in levels of the illusion of transparency. Surprisingly, however, in the low social-evaluative condition, participants reported higher levels of the illusion of transparency than the spotlight effect, whereas, in the high social-evaluative condition, they reported the opposite. Results suggest that the spotlight effect may be specific to social-evaluative concerns, whereas, the illusion of transparency may represent more general features of social anxiety concerns. Implications of the results for Clark and Wells’ cognitive model of social phobia model are discussed.

Post-event processing in social anxiety

Clark and Wells’ [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.

Phenomenal characteristics of autobiographical memories for social and non-social events in social phobia

Previous studies failed to show clear differences between people with social phobia and non-anxious individuals regarding the specificity and affective intensity of their autobiographical memories for social events. However, these studies did not assess the subjective experience associated with remembering. In this study, people with social phobia and non-anxious control participants recalled social and non-social events, and rated the phenomenal characteristics of their memories. The memories of people with social phobia for social events contained fewer sensorial details but more self-referential information than controls’ memories. In addition, people with social phobia remembered social situations from an observer perspective, viewing themselves as if from outside, to a greater extent than controls. By contrast, the two groups did not differ concerning their memories for non-social events. These findings are discussed in relation to cognitive models of social phobia.

Is post-event processing specific for social anxiety?

In their model of social phobia, Clark and Wells [1995. A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, London: The Guilford Press] introduced a process called “post-event processing” (PEP), which is characterized by prolonged rumination about past social situations. The present study examined to what extent PEP is specific for (a) social anxiety or (b) social situations. In a cross-sectional study, 217 participants reported about a social and a phobic event followed by negative thinking. PEP as well as its potential predictors such as social anxiety, general anxiety, and depression were measured by questionnaires. Results showed that social events were followed more often and by more intense PEP. Further confirming specificity, the fear of negative evaluation as an aspect of social anxiety was significantly associated with PEP for social but not for phobic situations, and vice versa; general anxiety predicted PEP only after phobic but not after social situations. Furthermore, PEP was elevated particularly for interaction (as opposed to performance) situations, indicating that the ambiguity of the situation may be an important predictor for prolonged processing.

Safety Behaviors and Social Performance in Patients With Generalized Social Phobia

The cognitive model of social phobia (Clark & Wells, 1995) suggests that safety behaviors, besides preventing disconfirmation of dysfunctional beliefs, cause significant impairment in social performance. To test this hypothesis, the current study investigated the relationship between observer-rated social performance, self-rated safety behaviors, and anxiety in 20 generalized social phobics, 14 controls with anxiety, and 17 controls without anxiety in two experimental tasks: a conversation with a stooge and a brief speech. Compared to the control groups, socially phobic patients displayed higher anxiety levels, reported more safety behaviors, and did not perform as well as the control groups in both tasks. There was a nonsignificant tendency of socially phobic patients to display more negative thoughts than both control groups. Differences in heart rate responses were not significant. A path analysis revealed that safety behaviors partially mediated the relation between diagnostic group and social performance deficit in both tasks. The results highlight the importance of safety behaviors for social performance deficit in social phobia.

Implicit views of the self in social anxiety

We investigated dysfunctional attitudes in high ( N=29) and low ( N=28) socially anxious participants following a social-threat activation task (being told to give a speech) using the implicit association task (IAT: [Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association task. Journal of Personality and Social Psychology, 74, 1464–1480]) and the Social Attitudes Questionnaire (SAQ: [Clark, D. M. (2001). Social Attitudes Questionnaire, revised. Unpublished manuscript, University of Oxford]). The study also looked at anticipatory thoughts about the speech using questionnaire (Social Cognitions Questionnaire (SCQ): [Wells, Stopa, & Clark (1993). The social cognitions questionnaire. Unpublished]) and think aloud methods. High socially anxious participants endorsed more negative attitudes on the SAQ. In the IAT both groups showed a bias towards associating positive words with self and negative words with other but this was weaker in the high socially anxious group than in the low. The high socially anxious group endorsed more negative thoughts about the speech on the SCQ, believed these thoughts more, and had more thoughts overall on the think-aloud task. There were no differences between the groups on the think-aloud task, but there was an interaction between level of depressive symptoms and thought valence. The results are considered in relation to other studies that have used an IAT to measure associations in social anxiety and in relation to Clark and Wells’ [(1995). A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope, & F. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment. New York: Guilford] model of social phobia.

Anticipatory processing plays a role in maintaining social anxiety

The cognitive model of social phobia by Clark and Wells (Social phobia: diagnosis, assessment and treatment) (1995) proposes that, while anticipating a social situation, individuals with social phobia engage in several biased cognitive processes which enhance anticipatory anxiety. Prior to giving a speech, high and low socially anxious individuals (N=40 per group) were instructed to either engage in anticipatory processing (think about what could go right or wrong in the impending situation, predict how they will appear to others and recall past similar situations) or perform a distraction task. Compared to high socially-anxious individuals whose anticipatory processing was inhibited, high socially-anxious participants engaging in anticipatory processing reported more anxiety feelings and predicted more negative overall appearance. High socially-anxious individuals also recalled more negative and less positive information about their public selves, but only when their anticipatory processing was inhibited rather than facilitated. For the low socially-anxious individuals there was no significant difference between the two anticipation conditions on measures of anxiety, self-perception, and memory for emotional information. The results are discussed in relation to the Clark and Wells model.

Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia

Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, we compared three alternative structural equation models: Model 1 assumes that PEC and ESC independently predict social anxiety; Model 2 assumes that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumes that PEC partially mediates the relationship between ESC and anxiety. We recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results support Model 3 and suggest that “costly” social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control.

Social interpretation bias and generalized social phobia: the influence of developmental experiences

Patients with generalized social phobia (N=42) and non-phobic community controls (N=42) engaged in a social interaction with an experimental assistant whose behavior was used to create either a positive or an ambiguous social environment. Participants then rated their own performance and their partner's behavior. As a group, social phobic patients displayed negatively biased self-judgments, but failed to display biased social interpretations. Among the social phobia group, a social developmental history marked by parental hostility was associated with negative interpretations of partner behavior and a history of parental overprotection was associated with less sensitivity to partner behavior. The results supported cognitive models of social phobia, which implicate negative learning experiences in the development of information processing biases.

Memory perspective and self‐concept in social anxiety: An exploratory study

The mental representation of self and observer perspective images are important maintaining factors in cognitive models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997). This study investigates Libby and Eibach's (2002) hypothesis that the observer perspective is used to recall memories that are incongruent with current self‐concept. A total of 60 participants (divided into high and low social anxiety groups) completed a questionnaire in which they described current self‐concept, recalled four memories of social occasions (two congruent, two incongruent), and rated memory age and vividness. Congruence was defined as memories that “fit” with current self‐descriptions. A qualitative analysis of self‐concept showed that both groups used a similar range of themes. High socially anxious participants recalled more observer perspective memories in the second incongruent memory. Congruence did not influence vividness, but public self‐consciousness did. The implications of the results are discussed and suggestions made for future research.

ANTICIPATORY PROCESSING IN SOCIAL ANXIETY

A psychometric study was conducted with the aim of collecting basic information about anticipatory processing and its relationship to social anxiety. A self-report measure of anticipatory processing was developed and utilized in a large student sample. The results confirmed that such processing is very common before an anticipated feared social event and a significant correlation (r=0.49) between anticipatory processing scores and social anxiety was found, which remained when trait anxiety and depression were controlled. A factor analysis indicated that all items of the measure except for two loaded significantly on one factor and accounted for the 47.3% of the variance. Socially anxious individuals in the study reported that their thoughts about the event were recurrent, intrusive, interfered with their concentration and increased their state of anxiety. Also, they reported that they wished they could avoid the situation. The results are discussed in terms of the Clark and Wells cognitive model of social phobia.

Face to face: visual scanpath evidence for abnormal processing of facial expressions in social phobia

Cognitive models of social phobia propose that cognitive biases and fears regarding negative evaluation by others result in preferential attention to interpersonal sources of threat. These fears may account for the hypervigilance and avoidance of eye contact commonly reported by clinicians. This study provides the first objective examination of threat-related processing in social phobia. It was predicted that hyperscanning (hypervigilance) and eye avoidance would be most apparent in social phobia for overt expressions of threat. An infrared corneal reflection technique was used to record visual scanpaths in response to angry, sad, and happy vs. neutral facial expressions. Twenty-two subjects with social phobia were compared with age- and sex-matched normal controls. As predicted, social phobia subjects displayed hyperscanning, (increased scanpath length) and avoidance (reduced foveal fixations) of the eyes, particularly evident for angry faces. The results could not be explained by either medication or co-morbid depression. These findings are consistent with theories emphasising the role of information processing biases in social phobia, and show promise in the application to treatment evaluation in this disorder.

Post-event rumination and negative self-appraisal in social phobia before and after treatment.

This study investigated the relationship between self-appraisals of performance, symptom severity and post-event rumination in social phobia, and evaluated the effect of treatment on these variables. A socially phobic group and a nonanxious control group performed an impromptu speech and were told that their performance would be evaluated. Participants appraised their performance immediately after the speech and 1 week later, and the frequency of post-event rumination during the week following the speech was assessed. The socially phobic group maintained the negative appraisals of their speech over the week, whereas the nonclinical group showed increased positivity about their performance The socially phobic group also engaged in more negative rumination than controls. Treatment improved perceptions of performance and reduced negative rumination. These results are discussed in the light of cognitive models of social phobia.