It has been hypothesized that effective psychological treatment for social phobia changes the person's representation of the self in a more positive direction. In order to test this hypothesis, we analyzed 506 thoughts that were endorsed by 23 social phobic individuals while anticipating socially stressful situations before and after exposure therapy. Treatment efficacy was assessed with the Social Phobia and Anxiety Inventory (SPAI) [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, 1, 35–40)]. Subjects endorsed significantly fewer negative self-focused thoughts after treatment (on average 8.7% of the thoughts) than before treatment (26.5%, p<0.005). These changes were highly correlated with pre–post difference scores in the social phobia subscale of the SPAI (r=0.74, p<0.0001). Implications of the results for the cognitive model of social phobia will be discussed.
Contemporary theories of social anxiety and social phobia emphasize the role of cognitive processes and the focus of attention (Clark et al., 1995, Leary and Kowalski, 1995 and Rapee and Heimberg, 1997; Turner, Beidel, Cooley, Woody & Messer, 1994). A number of studies suggest that social phobic individuals focus their attention towards themselves when confronted with fearful social situations (Beidel et al., 1985, Cacioppo et al., 1979, Glasgow and Arkowitz, 1975, Glass et al., 1982, Hope et al., 1989 and Stopa and Clark, 1993). Studies have also shown that self-focused attention impairs performance in individuals with social phobia (Hope & Heimberg, 1988) and test-anxious individuals in a social-evaluative situation (Carver, Peterson, Follansbee & Schier, 1983), possibly because self-focus detracts attentional resources necessary from optimal task performance (e.g., Ingram, 1990).
Effective psychological treatments seem to be associated with changes in the patient's focus of attention when confronted with social situations. For example, Woody, Chambless and Glass (1997) reported a decrease in self-focused attention during the course of cognitive-behavioral group treatment in social phobic individuals. However, external focus of attention remained unchanged. Another study by Wells and Papageorgiou (1998) showed that exposure therapy combined with instructions to focus on the external environment is more effective than standard exposure therapy. These results are consistent with the notion that self-focused attention is part of social phobics' coping attempts to prevent an embarrassing and humiliating situation which interferes with the processing of information that could provide disconfirming evidence against their negative beliefs (Wells et al., 1995). It has therefore been hypothesized that effective psychological intervention changes the person's representation of the self in a more positive direction (e.g. Rapee & Heimberg, 1997).
Measuring self-focused attention is complicated. Some studies operationalized self-focused attention as decreased attention to other tasks or diminished performance (e.g. Daly et al., 1989, Hofmann et al., 1997 and McNeil et al., 1995). However, this method provides little information about the actual focus of attention or its valence. Other studies have attempted to directly assess self-focused attention through self-report instruments (Woody et al., 1997; Wells & Papageorgiou, 1998). However, this assessment technique is also problematic because attention is necessarily altered in order to answer the question (Woody et al., 1997). Moreover, the existing instruments either assess the focus of attention (Woody et al., 1997) or the valence of thoughts (Glass et al., 1982) but not both which makes it difficult to determine whether social phobics focus on positive or negative aspects of themselves or the situation. Some authors have therefore employed thought-listing techniques to study self-focused attention. When using these techniques, subjects are typically asked to either articulate or write down their thoughts related to a simulated social situation (e.g. Cacioppo et al., 1979, Davison et al., 1997, Heimberg et al., 1990, Kendall et al., 1981, Stopa and Clark, 1993 and Schwartz and Garamoni, 1989).
The purpose of the present study was to investigate changes of attentional focus and changes in the valence of thoughts associated with psychological treatment for social phobia by employing the thought listing technique. The cognitive model of social phobia predicts that effective therapy leads to more task-focused thoughts, less negative self-focused thoughts and more positive self-focused thoughts when being confronted with a stressful social situation (Clark et al., 1995, Rapee and Heimberg, 1997 and Wells and Papageorgious, 1998).
