Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-18T19:02:12.842Z Has data issue: false hasContentIssue false

7 - CBT for Social Anxiety Disorder

from Part One - Cognitive Behavioral Therapy for Anxiety Disorders

Published online by Cambridge University Press:  06 January 2022

By
Henrik Nordahl  and
Adrian Wells
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
Get access

Summary

Clark and Wells advanced a cognitive model of social anxiety disorder (SAD) that has received substantial empirical support. The model accounts for the persistence of SAD with reference to a set of specific cognitive behavioral mechanisms involving feedback cycles that are responsible for maintaining the problem. Cognitive behavioral therapy (CBT) derived from this model aims to address these mechanisms, which include, among others, maladaptive self-processing and styles of coping consisting of safety behaviors and anticipatory and post-event processing. The treatment is recognized as the treatment of choice in clinical guidelines. We present the Clark and Wells’s model of SAD in detail and describe how SAD can be treated with CBT. Furthermore, we address topics such as clinical management and assessment, research supporting CBT for SAD, and further developments based on the metacognitive model.

Keywords

social anxiety disordersocial phobiacognitive behavioral therapycognitive therapycognitive modelself-regulatory executive function modelbeliefsself-attentionsafety behaviorsmetacognition
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 115 - 135
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended Reading

Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. R. (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). Guilford Press.Google Scholar
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1, 368–376.Google Scholar
Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley & Sons.Google Scholar
Wells, A. (2007). Cognition about cognition: Metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice, 14, 18–25.CrossRefGoogle Scholar
Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.Google Scholar

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.Google Scholar
Baker, S. L., Heinrichs, N., Kim, H. J., & Hofmann, S. G. (2002). The Liebowitz social anxiety scale as a self-report instrument: A preliminary psychometric analysis. Behaviour Research and Therapy, 40, 701–715.Google Scholar
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.Google Scholar
Borge, F. M., Hoffart, A., Sexton, H., Clark, D. M., Markowitz, J. C., & McManus, F. (2008). Residential cognitive therapy versus residential interpersonal therapy for social phobia: A randomized clinical trial. Journal of Anxiety Disorders, 22, 991–1010.Google Scholar
Brown, T. A., & Barlow, D. H. (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5L): Lifetime Version. Client interview schedule. Oxford University Press.Google Scholar
Brown, T. A., Di Nardo, P. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). Psychological Corporation.Google Scholar
Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47, 1–18.Google Scholar
Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. The British Journal of Psychiatry, 176, 379–386.CrossRefGoogle ScholarPubMed
Clark, D. M., Butler, G., Fennell, M., Hackmann, A., McManus, F., & Wells, A. (1995). Social behaviour questionnaire [Unpublished manuscript].Google Scholar
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., … & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.CrossRefGoogle ScholarPubMed
Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, H., … & Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: A randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058–1067.CrossRefGoogle ScholarPubMed
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). Guilford Press.Google Scholar
Connor, K., Davidson, J., Churchill, L., Sherwood, A., Weisler, R., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. British Journal of Psychiatry, 176(4), 379–386. doi:10.1192/bjp.176.4.379CrossRefGoogle ScholarPubMed
Davidson, J. R., Miner, C. M., De Veaugh-Geiss, J., Tupler, L. A., Colket, J. T., & Potts, N. L. S. (1997). The brief social phobia scale: A psychometric evaluation. Psychological Medicine, 27, 161–166.CrossRefGoogle Scholar
Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory, Journal of Consulting and Clinical Psychology, 43(4), 522–527.CrossRefGoogle Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). User’s guide for the Structured Clinical Interview for DSM-IV axis I disorders. SCID-I: Clinician version. American Psychiatric Publishing.Google Scholar
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured clinical interview for DSM-5: Research version (SCID-5 for DSM-5, research version; SCID-5-RV). American Psychiatric Association.Google Scholar
Gkika, S., Wittkowski, A., & Wells, A. (2017). Social cognition and metacognition in social anxiety: A systematic review. Clinical Psychology & Psychotherapy, 25, 10–30.Google Scholar
Gregory, B., & Peters, L. (2017). Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review. Clinical Psychology Review, 52, 1–18.Google Scholar
Hinrichsen, H., & Clark, D. M. (2003). Anticipatory processing in social anxiety: Two pilot studies. Journal of Behavior Therapy and Experimental Psychiatry, 34, 205–218.Google Scholar
Ingul, J. M., Aune, T., & Nordahl, H. M. (2014). A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. Psychotherapy and Psychosomatics, 83, 54–61.CrossRefGoogle ScholarPubMed
Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., … & Ritter, V. (2013). Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: A multicenter randomized controlled trial. American Journal of Psychiatry, 170, 759–767.CrossRefGoogle ScholarPubMed
Leigh, E., & Clark, D. M. (2016). Cognitive therapy for social anxiety disorder in adolescents: A development case series. Behavioural and Cognitive Psychotherapy, 44, 1–17.Google Scholar
Leigh, E., & Clark, D. M. (2018). Understanding social anxiety disorder in adolescents and improving treatment outcomes: Applying the cognitive model of Clark and Wells (1995). Clinical Child and Family Psychology Review, 21, 388–414.CrossRefGoogle Scholar
Liebowitz, M. R. (1987). Social phobia. In Klein, D. F. (Ed.), Anxiety. Karger, 141–173.Google Scholar
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefGoogle ScholarPubMed
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1, 368–376.CrossRefGoogle ScholarPubMed
Mörtberg, E., Clark, D. M., Sundin, Ö., & Åberg Wistedt, A. (2007). Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: A randomized controlled trial. Acta Psychiatrica Scandinavica, 115, 142–154.Google Scholar
National Institute for Health and Care Excellence. (2013). Social anxiety disorder: recognition, assessment and treatment of social anxiety disorder (Clinical guideline 159). http://guidance.nice.org.uk/CG159Google Scholar
Ng, A. S., Abbott, M. J., & Hunt, C. (2014). The effect of self-imagery on symptoms and processes in social anxiety: A systematic review. Clinical Psychology Review, 34, 620–633.CrossRefGoogle ScholarPubMed
Nordahl, H., Nordahl, H. M., Hjemdal, O., & Wells, A. (2017). Cognitive and metacognitive predictors of symptom improvement following treatment of social anxiety disorder: A secondary analysis from a randomized controlled trial. Clinical Psychology and Psychotherapy, 24(6), 1221–1227.CrossRefGoogle ScholarPubMed
Nordahl, H., Nordahl, H. M., Vogel, P. A., & Wells, A. (2018). Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role? Clinical Psychology and Psychotherapy, 25, 457–464.Google Scholar
Nordahl, H. M., Vogel, P. A., Morken, G., Stiles, T. C., Sandvik, P., & Wells, A. (2016). Paroxetine, cognitive therapy or their combination in the treatment of social anxiety disorder with and without avoidant personality disorder: A randomized clinical trial. Psychotherapy and Psychosomatics, 85, 346–356.CrossRefGoogle ScholarPubMed
Nordahl, H. M., & Wells, A. (2017). Social anxiety and work status: The role of negative metacognitive beliefs, symptom severity and cognitive-behavioural factors. Journal of Mental Health, 29(6), 665–669.CrossRefGoogle ScholarPubMed
Nordahl, H., & Wells, A. (2018). Metacognitive therapy for social anxiety disorder: An A-B replication series across social anxiety subtypes. Frontiers in Psychology, 9, 540.Google Scholar
Piccirillo, M. L., Dryman, M. T., & Heimberg, R. G. (2015). Safety behaviors in adults with social anxiety: Review and future directions. Behavior Therapy, 47, 675–687.Google Scholar
Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38, 611–617.CrossRefGoogle ScholarPubMed
Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological Medicine, 38, 15–28.CrossRefGoogle ScholarPubMed
Scheier, M. F., & Carver, C. S. (1985). The Self‐Consciousness Scale: A revised version for use with general populations. Journal of Applied Social Psychology, 15, 687–699.CrossRefGoogle Scholar
Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W., & Clark, D. M. (2003). Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research and Therapy, 41, 991–1007.Google Scholar
Stangier, U., Schramm, E., Heidenreich, T., Berger, M., & Clark, D. M. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: A randomized controlled trial. Archives of General Psychiatry, 68, 692–700.Google Scholar
Turner, S. M., Beidel, D. C., Dancu, C. V., & Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 35–40.CrossRefGoogle Scholar
Vogel, P. A., Hagen, R., Hjemdal, O., Solem, S., Smeby, M. C. B., Strand, E. R., Fisher, P., Nordahl, H. M., & Wells, A. (2016). Metacognitive therapy applications in social phobia: An exploratory study of the individual and combined effects of the attention training technique and situational attentional refocusing. Journal of Experimental Psychopathology, 7, 608–618.CrossRefGoogle Scholar
Wampold, B. E., Flückiger, C., Del Re, A. C., Yulish, N. E., Frost, N. D., Pace, B. T., … & Hilsenroth, M. J. (2017). In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy. Psychotherapy Research, 27, 14–32.Google Scholar
Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A., & Clark, D. M. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and Behavioral Practice, 24, 245–255.CrossRefGoogle ScholarPubMed
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448–457.CrossRefGoogle ScholarPubMed
Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21, 273–280.Google Scholar
Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley & Sons.Google Scholar
Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.Google Scholar
Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my mind’s eye?: Perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631–634.Google Scholar
Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Erlbaum.Google Scholar
Wells, A., & Papageorgiou, C. (1998). Social phobia: Effect of external attention on anxiety, negative beliefs and perspective taking. Behavior Therapy, 29, 357–370.Google Scholar
Wells, A., & Papageorgiou, C. (2001). Brief cognitive therapy for social phobia: A case series. Behaviour Research and Therapy, 39, 713–720.Google Scholar
Wells, A., Stopa, L., & Clark, D. M. (1993). Social cognition questionnaire [Unpublished manuscript]. Department of Psychiatry, University of Oxford, Warnerford Hospital.Google Scholar
Wittchen, H. U., & Fehm, L. (2003). Epidemiology and natural course of social fears and social phobia. Acta Psychiatrica Scandinavica, 108, 4–18.Google Scholar
Wong, Q. J., Gregory, B., & McLellan, L. F. (2016). A review of scales to measure social anxiety disorder in clinical and epidemiological studies. Current Psychiatry Reports, 18, 38–53.Google Scholar
Wong, Q. J., & Moulds, M. L. (2009). Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxious individuals. Behaviour Research and Therapy, 47, 861–867.CrossRefGoogle ScholarPubMed
Wong, Q. J., Moulds, M. L., & Rapee, R. M. (2014). Validation of the self-beliefs related to social anxiety scale: A replication and extension. Assessment, 21, 300–311.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×