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Introduction
Clark and Wells (1995) proposed a cognitive model of social phobia that attempts to explain the maintenance of the disorder, and account for why individuals with social phobia fail to benefit from the naturalistic exposure that is provided by their everyday interactions with other people. In this model, social phobia is seen as resulting from problematic beliefs about oneself and one's social world, which lead individuals with social phobia to interpret social situations in an excessively negative fashion. Negative interpretations (danger appraisals) are then maintained by the four processes outlined below. The first is (a) increased self-focused attention, which is linked to a decrease in the observation of other people and their responses. The individual may also (b) use misleading internal information (feelings and self-images) to make excessively negative inferences about how they appear to others. They may extensively use (c) safety behaviours (including overt avoidance) that are intended to prevent feared catastrophes, but that have the consequences of maintaining negative beliefs, increasing feared symptoms, and making the individual come across to others in ways that are likely to elicit less friendly responses. Finally, the individual may (d) engage in negatively biased pre and post-event processing. In this model safety behaviours are conceptualized as anything the individual does or avoids doing in order to prevent their social fears from being realized. For example, someone who fears other people noticing how anxious they are in social situations may use overt avoidance, such as avoiding social situations or not speaking in the situation. Alternatively, they may use more subtle forms of avoidance, such as avoiding eye contact or planning and rehearsing what to say, in order to prevent their fear of appearing anxious from being realized. See Figure 1 for a summary of the model.Figure 1.
Clark and Wells' (1995) cognitive model of social phobia
There is empirical support for most of the hypotheses embedded within Clark and Wells' (1995) model (see Clark, 2001 for a review). The model has been used to develop a 14-session cognitive therapy protocol for treating social phobia in adults, which has been demonstrated to have particularly large effect sizes in a number of randomized controlled trials (Clark et al., 2003, 2006; Stangier, Heidenreich, Peitz, Lauterbach and Clark, 2003).
The prevalence...