Behav. Res. Ther. Vol. 35, No. 8, pp.

741-756, 1997
Pergamon © 1997 ElsevierScience Ltd. All rights reserved
Printed in Great Britain
PII: S0005-7967(97)00022-3 0005-7967/97 $17.oo + o.oo

A COGNITIVE-BEHAVIORAL MODEL OF ANXIETY IN

SOCIAL PHOBIA

RONALD M. RAPEE* and R I C H A R D G. HEIMBERG

School of Behavioural Sciences, Macquarie University, Sydney, N.S.W. 2109, Australia and
Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA
19122-6085, U.S.A.

(Received 27 January 1997)

Summary--The current paper presents a model of the experience of anxiety in social/evaluative situ-
ations in people with social phobia. The model describes the manner in which people with social phobia
perceive and process information related to potential evaluation and the way in which these processes
differ between people high and low in social anxiety. It is argued that distortions and biases in the pro-
cessing of social/evaluative information lead to heightened anxiety in social situations and, in turn, help
to maintain social phobia. Potential etiological factors as well as treatment implications are also dis-
cussed. © 1997 Elsevier Science Ltd

INTRODUCTION
Social phobia refers to persistent fears of situations involving social interaction or social per-
formance or situations in which there is the potential for scrutiny by others (American
Psychiatric Association, 1994). More than 13% of the population meet diagnostic criteria for
social phobia at some point in their lives (Kessler et al., 1994). Life interference and impairment
associated with social phobia may be severe (Rapee, 1995; Schneier et al., 1994) and, in ad-
dition, many people report interference from related problems such as performance anxiety or
test anxiety (Beidel & Turner, 1988). People with social phobia typically report high rates of de-
pression (Schneier, Johnson, Hornig, Liebowitz & Weissman, 1992; Stein, Tancer, Gelernter,
Vittone & Uhde, 1990) and substance abuse (Kushner, Sher & Beitman, 1990; Schneier,
Johnson, Hornig, Liebowitz & Weissman, 1992), and markedly restricted socialisation (Dodge,
Heimberg, Nyman & O'Brien, 1987; Turner, Beidel, Dancu & Keys, 1986a) and career function-
ing (Phillips & Bruch, 1988; Turner et al., 1986a). Yet, social phobia has been slower than other
anxiety disorders to capture the attention of psychopathology researchers and funding bodies.
One possible reason may be that social phobia is sometimes difficult to conceptualize as a form
of psychopathology, given that up to 40% of the general population describe themselves as 'shy'
(Zimbardo, Pilkonis & Norwood, 1974). This is also reflected in the fact that social phobia was
not an officially defined nosological category until the publication of the DSM-III (American
Psychiatric Association, 1980) and only a decade ago, social phobia was described as the 'neg-
lected' anxiety disorder (Liebowitz, Gorman, Fyer & Klein, 1985). Nevertheless, over the past
several years, research into the nature and treatment of social phobia has increased dramatically.
In addition, a wealth of research exists on shyness and related concepts (e.g. communication ap-
prehension) in the counselling and social psychology literatures. At this stage of the research, a
synthesizing model may be of tremendous heuristic value. The model of social phobia described
in this paper extends earlier models (e.g. Carver & Scheier, 1988; Schlenker & Leary, 1982) and
owes much to similar current thinking (Clark & Wells, 1995).

*Author for correspondence.

741
742 Ronald M. Rapee and Richard G. Heimberg

PRELIMINARY ASSUMPTIONS
In the development of a model of any form of psychopathology, some fundamental assump-
tions must be made and, ideally, should be clearly spelled out.
The first assumption of the present model concerns the relationship of social phobia to shy-
ness and avoidant personality disorder. Much has been written about these issues (Brown,
Heimberg & Juster, 1995; Bruch & Cheek, 1995; Heimberg, 1996; Rapee, 1995; Turner, Beidel
& Townsley, 1990), and we will not review the arguments here. However, in developing the cur-
rent model, we take the position that social phobia and avoidant personality disorder are not
independent 'disease entities' or qualitatively distinct disorders, but rather that there exists a
continuum from low to extreme degrees of concern over social evaluation. In that context, 'shy-
ness' describes the low to middle range of the continuum, 'social phobia' describes the middle to
upper end of the continuum, and 'avoidant personality disorder' describes the upper to extreme
end of the continuum. In fact, the terms overlap considerably and distinguishing between them
may be a somewhat arbitrary exercise (Holt, Heimberg & Hope, 1992). In this paper, we refer
to 'social phobia' and the descriptors of the model will be aimed at people in the higher range
of the continuum. However, it should be understood that, like the disorder, the processing fea-
tures described in the model exist on a continuum and that the model could, therefore, be
applied to the entire range.
A similar assumption refers to the issue of subtypes of social phobia. The DSM-IV divides
social phobia into two more-or-less distinct subtypes. The generalized type refers to individuals
whose fears are evident in most social situations while a more restricted subtype (referred to as
'non-generalized' in DSM-IV, but often described as 'limited', 'specific', or 'circumscribed' in the
literature) has been described to identify those individuals who fear a lesser number of social
situations or who demonstrate specific fears of performing in front of other people (e.g. public
speaking). Whether these subtypes differ quantitatively or qualitatively has also been the subject
of considerable debate (Heimberg, Holt, Schneier, Spitzer & Leibowitz, 1993; Rapee, 1995).
However, even those who argue for a qualitative difference would agree that the basic nature of
the subtypes is essentially similar. Thus, in the present discussion, we assert that the similarities
far outweigh the differences and that the model, as described, can be applied equally to both
subtypes of social phobia. Any qualitative distinctions which may be identified through future
research may serve to elaborate the model at a later point.
Finally, we have chosen to focus our model on the anxiety experienced by an individual in a
socially threatening situation. We believe that this is an easier way to conceptualize the pathol-
ogy in social phobia. As a result, the basic model can really be used to illustrate what occurs to
any individual when he/she becomes anxious in a social situation. However, in the text, we have
tried to point to those aspects that we believe differentiate people high in trait social anxiety
(e.g. those with social phobia).

THE MODEL
A diagram of the model of anxiety in social evaluative situations is presented in Fig. 1. We
begin with the notion that people with social phobia assume that other people are inherently
critical, i.e. likely to evaluate them negatively (Leary, Kowalski & Campbell, 1988).
Furthermore, they attach fundamental importance to being positively appraised by others.
Within this framework, several processes may occur to generate and maintain social anxiety.
These processes are essentially similar regardless of whether a social/evaluative situation is actu-
ally encountered, is anticipated, or is retrospectively digested (brooded over).
On encountering a social situation, an individual forms a mental representation of his/her
external appearance and behavior as presumably seen by the audience and simultaneously
focuses his/her attentional resources onto both this internal representation and onto any per-
ceived threat in the social environment. The mental representation of appearance and behavior
is not actually an homonculus, but is a loosely integrated amalgam based on a variety of inputs.
These inputs include information retrieved from long-term memory (e.g. recollection of general
appearance, prior experience in the situation, etc.), internal cues (e.g. proprioception, physical
 A model of social phobia 743

PERCEIVEDAUDIENCE

PREFERENTIAL MENTALREPRESENTATION
ALLOCATIONOF ~ OF SELF AS SEEN BY
ATTENTIONALRESOURCES AUDIENCE

EXTERNALINDICATORS PERCEIVED
OF NEGATIVEEVALUATION INTERNALCUES

COMPARISONOF MENTALREPRESENTATION
OF SELFAS SEEN BY AUDIENCEWITH
APPRAISALOF AUDIENCE'SEXPECTEDSTANDARD

1
JUDGEMENTOF PROBABILITYAND CONSEQUENCEOF
NEGATIVEEVALUATIONFROM AUDIENCE

I
BEHAVIORAL COGNITIVE PHYSICAL
SYMPTOMS SYMPTOMS SYMPTOMS
OF ANXIETY OF ANXIETY OF ANXIETY

I I I
Fig. 1. A model of the generation and maintenance of anxiety in social/evaluative situations.

symptoms), and external cues (e.g. audience feedback). Attentional resources are allocated to
the salient aspects of the self image (generally those features which are relevant to the situation
and potentially negative) and also to monitoring of potential external threat. In the case of
social phobia, potential external threat refers to indicators of possible negative evaluation such
as frowns, signs of boredom, etc. In addition to allocation of attentional resources to these
external threats and the mental representation of one's appearance and behavior, the individual
simultaneously formulates a prediction of the performance standard or norm which he/she
expects the audience to utilise in the given situation. The representation of how the audience is
expected to view the individual and the appraisal of the audience's presumed situational stan-
dards are compared to provide an estimate of the audience's perception of the individual's cur-
rent performance (and, by extension, of the individual himself/herself). That is, a determination
is made of whether the individual is performing in a manner which meets the specific presumed
standard of a given audience in a given situation. The discrepancy between the person's percep-
tion of the audience's appraisal of his/her performance (appearance and/or behavior) and the
744 Ronald M. Rapee and Richard G. Heimberg

person's perception of the audience's standard for the evaluation of his/her appearance and/or
behavior, determines the perceived likelihood of negative evaluation from the audience and con-
sideration of the social consequences of the expected negative evaluation. The predicted negative
evaluation further elicits anxiety which has physiological, cognitive, and behavioral components
which subsequently influence the individual's mental representation of his/her appearance and/
or behavior as seen by the audience, and the cycle is renewed. The various components of the
model will now be described in detail.

T H E C O N C E P T OF A U D I E N C E
Anxiety is typically conceptualized as a response to perceived threat (Beck & Emery, 1985).
In social/evaluative situations, the primary threat stimulus is an audience and the primary threa-
tening outcome is negative evaluation from the audience*. It should be noted that the term
'audience' is not only used in its typical sense to denote a group of intentional observers, but
rather refers to any other person or group of people who may potentially perceive an indivi-
dual's appearance or behavior (including verbal utterances). A social-evaluative situation is any
situation where such an audience exists. Thus, an actual interaction with the audience need not
necessarily occur for anxiety to be generated. For example, many social phobics report an
increase in anxiety simply walking down the street and describe concerns that people are watch-
ing and evaluating them. Similarly, anxiety may increase when a social phobic enters a room
where another person is sitting, even if that person does not acknowledge his or her presence.
Nevertheless, these are considered to be social situations because there exists the potential for
interaction or observation and hence the potential for negative evaluation by the audience.

M E N T A L R E P R E S E N T A T I O N OF T H E S E L F AS SEEN BY T H E A U D I E N C E
People regularly monitor various aspects of their external appearance and behavior. This can
include monitoring of facial expressions, posture, actions, and so on and even monitoring of in-
ternal feelings that may manifest in outward appearance (e.g. hot feelings resulting in sweating).
We propose that input from such monitoring is combined with other data into a mental rep-
resentation of one's external appearance and behavior. Importantly, this mental representation
is not likely to be an objective record of one's appearance (some sort of 'internal photograph'),
but rather a distorted image, depending on the predominant input, the individual's weighting of
that input, and a variety of other factors. Further, it is not a representation of how one actually
views oneself, but is based on how the individual believes the audience views him or her at any
given moment.
The specific inputs that influence the mental representation require empirical investigation.
However, a number of sources seem likely. First, the individual probably has a pre-existing
image, stored in long-term memory and based on feedback from others, actual images of the
self (e.g. from mirrors, photographs, etc.), and prior experiences in a given situation. This infor-
mation in long-term memory would provide the 'baseline image' in the absence of other input.
Moment-to-moment modifications of the mental representation would then be derived from
both internal and external cues. For example, internally, proprioceptive information will provide
data about actions, posture, and facial expression. Information from the autonomic nervous sys-
tem will indicate potentially visible aspects of arousal such as blushing, sweating, and so on.
External feedback would come primarily in the form of verbal and nonverbal signals from the
audience. Importantly, such social feedback is often indirect and ambiguous, lending itself easily
to distortion. Given the suggestion that attentional resource allocation in social phobics is gener-
ally primed toward negative evaluative information (see below), the processing of external feed-
back by social phobics will frequently have a negative bias.

*One can also frequently uncover more 'underlying~, idiosyncraticconsequences such as lack of support or abandon-
ment.
 A modelof social phobia 745

As an example, imagine an individual who enters a room where several people are seated.
Upon first entering, he/she activates a mental representation of how he/she is seen by the people
in the room which is primarily composed of the baseline record (i.e. from long-term memory
stores). This representation would include data about his/her typical appearance combined with
more recent information (e.g. he/she may not have had time to get a haircut recently or he/she
may have gained weight). In addition, on a moment-to-moment basis, the mental representation
of how he/she is seen by the others in the room may be calibrated depending on how he/she is
feeling or acting (e.g. he/she may notice himself/herself sweating or may not be able to find a
chair to sit in) as well as interpreted comments or looks from the others in the room. Thus the
mental representation will be in a constant state of flux, depending on the momentary input. In
addition, the weighting of the input and the allocation of attentional resources will be biased
toward more salient information. For example, if the individual was especially concerned about
appearing 'wooden', then any experienced tension or tightness would be excessively weighted in
the mental representation.
The mental representation of one's external appearance or behavior is presumably more nega-
tive for a person with social phobia than for people who are not socially anxious. This negative
view of how others see one's appearance or behavior may be the result of actual deficits (e.g.
disfigurement, social skills deficits), distorted perceptions of one's appearance or behavior as
seen by others, or both. Importantly, the social phobic individual's view of himself/herself is
probably not veridical. Allocation of attentional resources toward stimuli which elicit negative
evaluation means that the socially anxious individual will focus on and exaggerate those features
of the mental representation of his/her appearance or behavior to others which are most likely
(from an idiosyncratic perspective) to elicit criticism or ridicule. Thus, the representation will
include exaggerated images of one or more features of the individual: those which he/she finds
most salient and threat eliciting.
One of the most important aspects of an individual's behaviour that is portrayed in the men-
tal representation is likely to be his/her social performance. There is growing evidence that, com-
pared to nonclinical Ss, people with social phobia and other highly socially anxious people
perceive their own performance in social situations more poorly, even after differences in actual
performance are taken into account (Glasgow & Arkowitz, 1975; Rapee & Lim, 1992; Stopa &
Clark, 1993). This underestimation appears to be more strongly associated with social anxiety
than with related conditions such as depression (Rapee & Lim, 1992) or other anxiety disorders
(Stopa & Clark, 1993). Importantly, the tendency to underrate performance is specific to one's
own performance, since social phobics have not been found to differ from low anxious people in
their appraisals of other people's performance (Rapee & Lim, 1992; Stopa & Clark, 1993). In
addition, it appears to be specific to social/evaluative situations and is not found on non-social
tasks (Efran & Korn, 1969). One of the interesting findings with respect to social phobics'
underestimations of their own performance is that this phenomenon is not intractable. More
realistic perceptions of performance have been found following both video feedback of perform-
ance (Rapee & Hayman, 1996) and cognitive behavioral therapy for social phobia (Hope,
Heimberg & Bruch, 1995).
In addition to inaccurate perceptions of performance, accurate perceptions of 'poor' perform-
ance would also provide powerful input to the mental representation indicating an inept appear-
ance to the audience. There is a wealth of evidence to suggest that anxiety is associated with
decreased performance on complex cognitive tasks, and it appears that concerns about evalu-
ation are largely responsible for this effect (Eysenck, 1979; Sarason, 1975). Thus, there will be
some situations (involving complex cognitive tasks) in which individuals with social phobia actu-
ally perform worse than other individuals. For example, there is evidence that individuals high
in test anxiety (described as a type of social phobia in DSM-IV) do worse on academic tasks
than do individuals low in test anxiety (Seipp, 1991).
Despite these arguments, whether individuals with social phobia actually perform more poorly
than others on social interaction tasks is a controversial issue, and empirical evidence has been
mixed. Studies comparing socially anxious Ss with low anxious Ss on social performance tasks
have variously found that the anxious individuals perform more poorly on both global and
specific indices of behavior (Twentyman & McFall, 1975), perform more poorly on global but
746 Ronald M. Rapeeand Richard G. Heimberg

not specific indices (Arkowitz, Lichtenstein, McGovern & Hines, 1975; Borkovec, Stone,
O'Brien & Kaloupek, 1974), or do not differ (Burgio, Glass & Merluzzi, 1981; Clark &
Arkowitz, 1975; Rapee & Lim, 1992). Perhaps more interestingly, some studies have demon-
strated worse performance for socially anxious Ss in certain situations but not others (Beidel,
Turner & Dancu, 1985; Pilkonis, 1977b). One suggestion is that the degree of structure in a
social situation may be an important determining variable. Situations that involve more clearly
defined social rules (e.g. a speech) are less likely to produce a difference in social performance
between social phobics and others than are situations that involve unclear social structure (e.g. a
party).
In addition to perceptions of social performance, there is also evidence that socially anxious
Ss overestimate the degree to which their anxiety is visible to others (Alden & Wallace, 1995;
Bruch, Gorsky, Collins & Berger, 1989a; Halford & Foddy, 1982; McEwan & Devins, 1983).
Given that concern over the visibility of one's anxiety to others is part of the diagnostic defi-
nition of social phobia (American Psychiatric Association, 1994), this is an important cognitive
bias. To some extent, this inaccurate perception may be mediated by prior experiences rep-
resented (accurately or inaccurately) in long term memory. However, a major source of the per-
ceptual bias may involve input from internal sensations (McEwan & Devins, 1983). For
example, autonomic arousal in a social situation (such as a feeling of heat) may be depicted in
the mental representation as a clearly visible experience (e.g. rivers of sweat). Along similar
lines, some research has indicated that shy individuals rate themselves as less physically attrac-
tive than do people low in shyness (Montgomery, Haemmerlie & Edwards, 1991) despite the
fact that shyness does not correlate with ratings of physical attractiveness made by observers
(Jones, Briggs & Smith, 1986). Thus, empirical evidence to date, seems to support the suggestion
that people with social phobia have negative mental representations of their appearance and
behavior, especially in social situations.

ATTENTIONAL RESOURCE ALLOCATION

There is fairly consistent evidence that anxious individuals preferentially allocate attentional
resources to threat (Dalgleish & Watts, 1990). Evolutionary models point to the importance of
detecting potential threat as early as possible in protection of the organism from harm (Ohman,
1996), and so models of anxiety have predicted that detection of threat and mobilization of
attentional resources occur at a very early stage of processing (Ohman, 1996; Williams, Watts,
MacLeod & Mathews, 1988). Given that it is an anxiety disorder, this general pattern should
also be true of social phobia. Thus, it is predicted that social phobia will be characterized by
rapid and extensive allocation of attentional resources to the detection of threat. However, in
contrast to other forms of anxiety, we predict that social phobia will also be characterized by an
allocation of attentional resources to monitoring of the mental representation of the external
self and, in particular, onto those perceived features of the self which may be associated by the
person with an increased risk of negative evaluation. Thus, the individual with social phobia is
frequently caught in the equivalent of a 'multiple-task paradigm' in which he/she must closely
monitor potential external threat and simultaneously monitor the potentially threat-eliciting
aspects of her/his supposed external appearance or behavior, as well as reserving some atten-
tional resources for the proper completion of the task at hand. As a result, social phobics' per-
formance on tasks which require extensive processing resources should be poor, especially in
situations where threat potential is high. Each aspect of attention will be discussed below.
As discussed earlier, social threat takes the form of potential negative evaluation from others.
Thus, individuals with social phobia will scan the environment for any signs of impending nega-
tive evaluation, will detect such signs rapidly, and will have difficulty disengaging attention from
them. Along similar lines, several authors have pointed to the evolutionary significance of social
fears (Ohman, 1986), and some comprehensive ethological models of social phobia have been
developed (Cloitre & Shear, 1995; Mineka & Zinbarg, 1995; Trower & Gilbert, 1989).
According to these models, social phobia in humans is directly related to agonic, conspecific
threat interactions in animals. The purpose of the anxiety is to avoid unnecessary challenge of
 A model of social phobia 747

the dominant group member while submissive behaviors allow the subordinate to remain in the
safety of the group (Trower & Gilbert, 1989). Propensity to social anxiety is, therefore, a phylo-
genetically evolved phenomenon in which the individual is continually primed to detect threat
from a dominant conspecific and to respond with submission. As part of this constant readiness,
pre-attentive priming mechanisms are important for the rapid detection of threat (Ohman,
1996).
Several empirical methods have provided support for the suggestion that social phobics allo-
cate considerable attentional resources to the detection of negative evaluative threat. The most
widely used method has been the modified Stroop task in which negative evaluation words (e.g.
'stupid') and matched neutral words have been presented in various colors. The S's task is to
ignore the meaning of the word and name the color in which the word is printed as rapidly and
accurately as possible. Studies have consistently demonstrated that social phobics take signifi-
cantly longer to color-name negative evaluation words than neutral or physical threat words
(Holle, Heimberg & Neely, in press; Hope, Rapee, Heimberg & Dombeck, 1990b; Mattia,
Heimberg & Hope, 1993; McNeil, Ries, Taylor, Boone, Carter, Turk & Lewin, 1995). While the
Stroop effects may be produced by a variety of factors, these results are commonly interpreted
to indicate that the attentional resources of people with social phobia are more strongly
attracted by negative evaluation information (Hope et al., 1990b). Similar conclusions have been
drawn in a recent study in which people with generalized social phobia were shown to allocate
more attention to the area on a computer screen occupied by a negative evaluation word than
to the area occupied by a neutral word (Asmundson & Stein, 1994). From a different direction,
at least one study has suggested that socially anxious Ss attend less to non-evaluative infor-
mation about potential interaction partners than do non-anxious Ss (Heimberg, Acerra &
Holstein, 1985).
In addition to monitoring potential external threat, social phobics will also pay attention to
the mental representation of their external appearance or behavior as presumably seen by the
audience. In most cases, however, this mental representation remains below awareness. On
entering (or anticipating) a social situation, attentional resources are allocated to it and some
degree of one's perceived external appearance moves into consciousness. It is predicted that this
effect will be more extensive in people with social phobia. Thus, they should perform more
poorly on complex cognitive tasks because less attentional resources are available for task per-
formance*, and they should also be more anxious if their appraisal of how others are seeing
them is poor (most often the case). Therefore, we would predict that in situations when the men-
tal representation of how one is being perceived by others is worse than 'reality', then increasing
attentional focus to this internal representation will increase anxiety, whereas increasing atten-
tion to an objective external representation will reduce anxiety. In other words, when objective,
external feedback which is less negative than the internal representation is provided (e.g. via
video feedback), anxiety is reduced (Rapee & Hayman, 1996).
Additional evidence comes from studies which have asked Ss to report on the central focus of
their attention while engaging in social interaction. The amount of time reportedly spent focus-
ing on the self has been found to positively relate to the degree of social anxiety (Hope,
Heimberg & Klein, 1990a; Melchior & Cheek, 1990). In addition, in the study by Hope et al.
(1990a), the self-report of self-focused attention was supported by the finding that socially
anxious Ss recalled less information about their partner.
From a trait perspective, several studies have demonstrated a positive association between
public self consciousness (Buss, 1980) and trait social anxiety (Bruch et al., 1989a; Fenigstein,
Scheier & Buss, 1975; Hope & Heimberg, 1988; Pilkonis, 1977a). Similarly, individuals with
social phobia have been found to score higher on a measure of public self consciousness than
nonclinical Ss and individuals with other anxiety disorders (Bruch & Heimberg, 1994; Bruch,
Heimberg, Berger & Collins, 1989b; Pilkonis, 1977a), and this difference has not been found on
a measure of private self consciousness (a tendency to focus directly on internal features) (Hope
& Heimberg, 1988).

*However, in some cases, owing to their strong desire to portray a positive image, individuals with social phobia will be
able to compensate for the redirection of attentional resources via increased motivation (see Eysenck, 1979).
748 Ronald M. Rapeeand RichardG. Heimberg

The precise link between public self consciousness and the current model is difficult to define,
largely owing to several problems with the construct of public self consciousness (Makris &
Heimberg, 1995). Whereas public self-consciousness has been referred to as a focus onto the self
(implying attentional resources allocated to monitoring one's actual external features), the cur-
rent model emphasises the importance of a focus toward an internal representation of how one
is viewed by one's audience (which may or may not be accurate). Therefore, a major difference
between the theories is that while self consciousness theory might predict that social phobics
would be more accurate than others at determining their appearance, the current model predicts
that, under most conditions, they will be less accurate.

COMPARISON OF THE AUDIENCE'S PERCEIVED APPRAISAL WITH THE

EXPECTED AUDIENCE STANDARD
In addition to monitoring how she or he appears to others, the individual with social phobia
will also make predictions about the type and standard of performance which is expected of
her/him by the audience. This prediction will take into account both audience characteristics
and situational features. For example, socially anxious people report experiencing greater
anxiety in formal situations and opposite sex interactions (Dodge et al., 1987; Turner et al.,
1986a). Similarly, it is commonly found that the size and perceived importance of the audience
influence the degree of anxiety (Latane, 1981). In terms of the current model, these situational
variations in anxiety are argued to occur owing to variations in the performance standard which
the individual predicts that the audience holds for him/her. In other words, one may predict
that more important people will expect better performance than will less important people or
that better performance will be expected by an audience in a formal situation. To a large extent,
this will be an idiosyncratic judgement, but there are also likely to be many societally shared ex-
pectations. Some degree of indirect support for this suggestion is found in a demonstration that
the degree of anxiety in a social interaction is partly mediated by the S's perceptions of the posi-
tive attributes of his/her interaction partner (Mahone, Bruch & Heimberg, 1993). In order to
control the occurrence of threat (negative evaluation), the individual must be able to perform in
a way that leads to the achievement of the desired goal (i,e. 'adequate' performance for a given
situation). Thus, at this stage of the appraisal process, the individual compares his/her mental
representation of the performance/appearance which the audience is seeing with his/her predic-
tion of the audience's expected performance/appearance. The greater the shortfall in perform-
ance relative to expectation, the greater the anxiety (cf. Schlenker & Leary, 1982; Wallace &
Alden, 1991). As described earlier, the mental representation of how one is being seen by the
audience is updated as an ongoing process in which the individual continually receives input
from a variety of systems. In similar fashion, the predicted standards held by the audience in a
situation may change from moment to moment based on changing perceptions of the audience
and the demands of the situation. Thus, the discrepancy between these estimates will not necess-
arily be static. This may explain the commonly described fluctuations of anxiety in social situ-
ations. For example, for socially anxious Ss, positive feedback from an audience may raise the
standard which the S believes that the audience holds for him/her for subsequent performances,
presumably increasing experienced anxiety (Wallace & Alden, 1995).
Whether individuals with social phobia assume that others hold higher standards for them
than do non-phobic individuals is another complex question. While this is not a necessary pre-
diction of the model, such a finding would certainly be in keeping with it. The crucial aspect,
according to the current model (and others e.g. Schlenker & Leary, 1982), is the degree of dis-
crepancy between the presumed appearance or behavior as perceived by the audience and the
audience's assumed standards for evaluating this appearance/behavior. Because people with
social phobia believe that others perceive them negatively, this is sufficient to explain the greater
anxiety in social situations for individuals with social phobia compared to non-phobics.
However, if individuals with social phobia were also to believe that the audience expected a
higher standard, then this would produce an even greater discrepancy and hence increase
anxiety. The evidence from some studies using self-report measures is that social phobic and
 A modelof social phobia 749

non-phobic individuals do not differ significantly in the predictions of the performance standard
expected by an audience (Alden, Bieling & Wallace, 1994; Wallace & Alden, 1991, 1995).
However, Wallace and Alden (1991, 1995) have found that the standard that individuals with
social phobia believe that the audience (experimenter) holds for them is higher than that which
these Ss hold for themselves. It is possible that individuals with social phobia will be shown to
appraise an audience's standards for their behavior to be higher than that appraised by non-
phobics under certain conditions.

APPRAISAL OF L I K E L I H O O D AND CONSEQUENCES OF N E G A T I V E

EVALUATION
People with social phobia have consistently been found to score higher on questionnaire
measures of fear of negative evaluation than have people with other forms of psychopathology,
other anxiety disorders, or no mental disorder (Heimberg, Hope, Rapee & Bruch, 1988). In ad-
dition, measures of fear of negative evaluation have been found to correlate strongly with
measures of social anxiety and avoidance of social situations (Jones, Briggs & Smith, 1986;
Watson & Friend, 1969). Similarly, one study which involved in-vivo exposure to social situ-
ations in both high and low socially anxious Ss found that the only significant discriminator
between these groups in their response to the situations was the fear of negative social evalu-
ation (Asendorpf, 1987). Finally, changes in fear of negative evaluation have been found to be a
significant predictor of response to the cognitive-behavioral treatment of social phobia (Mattick
& Peters, 1988; Mattick, Peters & Clarke, 1989). Thus, concern over negative evaluation appears
to be an important aspect of social phobia. In agreement with the current model, several
authors have argued that this construct is central to conceptualisations of social phobia (e.g.
Butler, 1985; Turner, Beidel & Townsley, 1992).
The individual with social phobia will have a characteristic tendency to estimate the likelihood
and consequences of negative evaluation more highly than does a low socially anxious person.
This estimate would largely be based on the preceding stages of the model, but would also
involve a degree of response bias, that is, a consistent tendency to assume that negative evalu-
ation is likely in any social situation. (Leary, Kowalski & Campbell, 1988; Winton, Clark &
Edelmann, 1995).
There has been surprisingly little empirical investigation of estimates of the likelihood and
consequences of negative evaluation in socially anxious Ss. Nevertheless, a few studies have
demonstrated that socially anxious individuals report a greater expectancy for negative occur-
rences and a greater cost to these occurrences for themselves than do low anxious Ss (Foa,
Franklin, Perry & Herbert, 1996; Lucock & Salkovskis, 1988; Poulton & Andrews, 1994; Teglasi
& Fagin, 1984). Further, in the study by Foa et al. (1996), change in the estimate of the cost of
negative events was a better predictor of treatment outcome than was change in the estimate of
the likelihood of such events.

ANXIETY
According to the model, an anxious state will be experienced to the extent that negative evalu-
ation is seen as likely and is seen to have potentially serious consequences. In other words, the
greater the predicted probability and consequences of negative evaluation, the greater the
anxiety in the situation. As the prior stages of the model fluctuate for various reasons (e.g. audi-
ence feedback), so too will the expectation of negative evaluation and, in turn, the level of state
anxiety. Some support for this prediction has been provided in a recent study by Poulton and
Andrews (1994). Individuals with social phobia and non-phobic Ss were asked to appraise the
probability and cost of negative evaluation before, during, and following a speech. On a group
level, ratings of state anxiety were closely related to combined probability/cost estimates.
Anxiety is comprised of cognitive, behavioral, and physiological components. Indeed, somatic
(often visible) symptoms, negative thoughts, and subtle avoidance behaviors frequently occur in
response to anticipated negative evaluation. Further, socially anxious individuals will respond to
750 Ronald M. Rapee and Richard G. Heimberg

social/evaluative situations with higher levels of physiological responding, more negative

thoughts, and more avoidance behaviors than low anxious individuals (Beidel et al., 1985;
Turner, Beidel & Larkin, 1986b). According to the model, these components or consequences of
anxiety, in particular somatic symptoms and avoidance behaviors, can feed back to earlier stages
of the model and provide further influential input as described below.
The somatic symptoms which distinguish people with social phobia from people with other
anxiety disorders tend to be those which are visible to others such as blushing, twitching, sweat-
ing, and stammering (Amies, Gelder & Shaw, 1983; Solyom, Ledwidge & Solyom, 1986). In ad-
dition, people with social phobia also experience the full range of symptoms typically associated
with anxiety (Reich, Noyes & Yates, 1988). In turn, perception of these symptoms is likely to
affect the individual's mental representation of how he/she appears to the audience. According
to the model, the mental representation is dominated by those personal features felt to be es-
pecially salient with respect to potential negative evaluation. Thus, the feedback of somatic
symptoms will be modulated along these lines. In other words, the individual with social phobia
will over-represent those symptoms which are believed to have potential for negative evaluation
(e.g. sweating). Some of these effects will be based on distorted perceptions, perhaps owing to
externalisations of internal symptoms (e.g. believing others can 'see' your heart pounding).
However, some will also be based on reality since it is likely that socially anxious people do vis-
ibly show signs of anxiety (e.g. blushing, shaking, sweating).
In addition to the influence of somatic symptoms, the anxious individual in a social/evaluative
situation is likely to engage in a variety of subtle behaviors aimed at avoiding potential negative
evaluation (Beidel et al., 1985; Rapee, 1995; Wells, Clark, Salkovskis, Ludgate, Hackmann &
Gelder, 1995). It is important to note here that we are not referring to the obvious avoidance of
not even entering the situation, but to more subtle behaviors aimed at reducing the potential for
social interaction within a situation. These may include such behaviors as avoiding eye contact,
reducing verbal output or voice tone, and standing on the periphery of a group. Unfortunately,
these behaviors often have the effect of reducing effective social performance and in this way,
can facilitate a self-fulfilling prophecy. As a result, the social phobic receives further feedback,
both from his/her own monitoring of behavior and from the audience's verbal and nonverbal re-
sponses, that performance is inferior.
As described earlier, the mental representation of one's performance is not assumed to mirror
reality, but is more likely a distorted description wherein the more salient aspects of the self are
represented. For the social phobic, these will be aspects relevant to negative evaluation. As a
result, situational shifts in social anxiety are predicted to be different in individuals with social
phobia than in non-phobic individuals. When negative information is received from the audi-
ence, it will have greater weight for the individual with social phobia (since it will be more con-
sistent with their existing mental representation) and, as such, it will produce a greater increase
in anxiety. In contrast, positive information will hold less weight for the individual with social
phobia and will produce less of a shift in anxiety.
There is considerable evidence (discussed above) that the social performance of people with
social phobia is worse than that of nonclinical Ss. However, this is not a consistent finding, and
several studies have failed to find differences between socially anxious and nonanxious groups
on social performance in particular situations. According to the present model, a lack of social
skills is not a fundamental or invariant characteristic of individuals with social phobia. Instead,
deficits in social performance are expected to occur under many circumstances as a 'result' of
anxiety, sometimes owing to cognitive capacity limitations and frequently reflecting subtle avoid-
ance behaviors. Therefore, it is not unexpected that social performance will be highly variable
across situations since it will depend on the degree of anxiety elicited by the situation and also
by the degree of structure inherent in the situation (Pilkonis, 1977b). Nevertheless, the model
does allow for an individual to be deficient in social skills and we acknowledge the possibility
that where an individual has been chronically avoidant over a long period of time, skill develop-
ment may well have been hampered.
Despite the fact that we place a strong emphasis in the model on the effects of subtle avoid-
ance and subsequent social performance deficits, it should be pointed out that as with any
anxiety disorder, social phobia may also be characterised by more obvious avoidance. Clearly,
 A model of social phobia 751

failure to enter situations or escape soon after entry will reduce opportunities for appropriate
feedback and reduce opportunities for positive modification of the mental representation of per-
formance or expectations about the audience's standards.

ETIOLOGICAL CONSIDERATIONS

Consistent with conceptualizations of other anxiety disorders (e.g. Beck & Emery, 1985;
Clark, 1986; Rapee, 1991), the current model is based on the presumption that anxiety in a
social situation is a response to perceived threat. Individuals with social phobia differ from
those without social phobia in terms of the extent to which they appraise cues as predictive of
threat and the extent of threat predicted by a given cue. The model presented here provides a
breakdown of the cognitive processes which influence such threat appraisals. We may also wish
to speculate about the origins of these individual differences in threat appraisal.
There can be little doubt that there is a substantial genetic influence to anxious symptomatol-
ogy (Jardine, Martin & Henderson, 1984; Kendler, Neale, Kessler, Heath & Eaves, 1992). Twin
research provides us with information that a sizeable proportion of the variance in anxious
symptomatology and anxiety disorders can be accounted for by genetic input (Andrews, 1996).
However, such data tell us little about the precise nature of this genetic influence. Large twin-
studies have clearly indicated that most of the genetic component is common to all of the
anxiety disorders and most probably also to some forms of depression (Andrews, 1996; Kendler,
Heath, Martin & Eaves, 1987). In contrast, family studies frequently demonstrate diagnostic
specificity within families (Hudson & Rapee, in press). For example, a study by Fyer,
Mannuzza, Chapman, Martin and Klein (1995) found that individuals with social phobia were
more likely to have first degree relatives with social phobia than with panic disorder or simple
phobia. Combining these two sources of information suggests that a general tendency to inter-
pret situations as threatening may be genetically mediated while environmental family factors
may be of importance in channelling this processing style toward specific categories of cues (e.g.
social cues) (Hudson & Rapee, in press). Genetic factors may, therefore, be responsible for pro-
viding a tendency to preferentially allocate attentional resources toward danger but environmen-
tal factors may help to determine which cues receive attentional priority.
We would predict then, that the moulding of a general threat appraisal style into a specific
concern with social evaluation may be largely the result of experience with particular family fac-
tors. Several factors may provide good candidates, in particular, childrearing styles, modelling,
and restricted exposure.
There is a vast literature examining the association of an overprotective or overintrusive par-
enting style with anxious symptomatology (see Rapee, 1997 for a review). While studies have
varied greatly in terms of their methodological rigour and results have not always been totally
consistent, the data have broadly indicated that overcontrolling parenting is positively associated
with anxiety (Rapee, 1997). Few studies have distinguished types of anxiety, but those that have
tend to indicate a slightly more consistent relationship between overprotective parenting and
social phobia than with other anxiety disorders such as panic disorder (e.g. Arrindell, Kwee,
Methorst, van der Ende, Pol & Moritz, 1989; Bruch et al., 1989b; Rapee & Melville, 1997).
Excessive control from the parent is likely to reinforce for the child the message that 'I am not
competent or capable to help myself'. In terms of the current model, this could have effects at a
variety of points. Most specifically, however, it is likely to affect the mental representation of
how others presumably see one's performance, particularly the template held in long-term mem-
ory. By receiving the message that one's parents view one as not competent, the mental rep-
resentation of others' views of one's performance is likely to become strongly negatively biased.
Modelling factors may also be influential in the development of social fears. One or both
parents of offspring with social phobia are also likely to score high on social concerns (Bruch et
al., 1989b). As such, offspring may well internalize verbal and nonverbal messages from parents.
For example, in two studies (Bruch & Heimberg, 1994; Bruch et al., 1989b), it was found that
adult social phobics were more likely to retrospectively report that their parents placed great im-
portance on the opinions of others than were agoraphobics or nonclinical controls. In terms of
752 Ronald M. Rapeeand RichardG. Heimberg

the model, this is particularly likely to increase the perceived probability of negative evaluation
from others and also to provide information that others may hold high standards for one's per-
formance. In a recent study of anxious children, children with a variety of anxiety disorders
(including social phobia) were more likely to report responding to a social threat with avoidance
after discussing the situation with their parents than before (Barrett, Rapee, Dadds & Ryan,
1996). Micro-examination of these parent-child interactions indicated that anxious parents were
more likely to support avoidant responses in their children (Dadds, Barrett, Rapee & Ryan, in
press). These findings suggest that not only may parents emphasize negative evaluation from
others, but they may also be partly responsible for promoting avoidance behaviors as a method
of coping.
Finally, several studies have demonstrated that people with social phobia are more likely to
report that their parents did not encourage family socialization than are people with panic dis-
order or nonclinical controls (Bruch & Heimberg, 1994; Bruch et al., 1989b; Rapee & Melville,
1997). By promoting avoidance in this way, parents would again be emphasising the risk of
negative evaluation from others while poorly equipping the child to deal with it.

TREATMENT IMPLICATIONS
Treatment programs for social phobia generally share a number of common features including
cognitive restructuring to alter appraisals of threat, exposure to reverse patterns of overt avoid-
ance, and social skills training to improve social performance (Heimberg, 1989). Clearly, these
components should affect key points of the model and, as such, should be effective in the re-
duction of social anxiety. Empirical evaluations of treatment outcome certainly support this pre-
diction (Heimberg et al., 1990; Mattick & Peters, 1988; Turner, Beidel, Cooley, Woody &
Messer, 1994). However, it is also clear that most programs have relatively limited success and
that there is considerable room for further gains in the treatment of social anxiety, especially at
the higher ends of the continuum (generalized social phobia, avoidant personality disorder)
(Heimberg & Juster, 1995; Rapee, 1993).
There are several points in the model where specific interventions could potentially improve
treatment outcome.
According to the model, anxiety could be directly reduced and performance enhanced
(thereby indirectly reducing anxiety) if attentional resources were directed away from the mental
representation of how the person appears to the audience and indicators of negative evaluation
from the audience. These resources would be more effectively utilized if directed toward the task
at hand and onto more positive aspects of the audience. To date, no technique to produce such
effects has been adequately tested. However, some studies have demonstrated the value of atten-
tional training techniques in test anxiety and performance anxiety (Ribordy, Tracy & Bernotas,
1981; Wise & Haynes, 1983; Ziegler, 1994). More recently, a single case study has been used to
demonstrate the potential value of attentional training with an individual with social phobia
(Mulkens, Bogels & de Jong, 1995). The client's primary problem involved concern over blush-
ing, and the attentional training involved teaching him to allocate more attention to current
tasks and to the environment and away from his physical sensations. Over six sessions of atten-
tional training, there was a significant decrease in several measures including frequency of blush-
ing and avoidance of social situations.
The model also predicts that a less negative and, in most cases, more realistic mental represen-
tation of how the audience sees the individual will also reduce anxiety. Clearly, this is the focus
of much of the cognitive restructuring which is conducted in standard treatment programs. Both
clinical experience and empirical evidence suggest that specific cognitive restructuring is a valu-
able component of effective treatment programs for social phobia (Butler, 1985; Mattick &
Peters, 1988). Nevertheless, in most programs, only a small proportion of the cognitive restruc-
turing is likely to be directly aimed at adjusting the individual's perception of his/her appearance
or behavior as seen by the audience, the presumed standards expected by the audience, or the
discrepancy between the two. Effectiveness may be increased if this became a more central com-
ponent. In addition, explicit feedback from external sources may provide a more effective means
 A model of social phobia 753

o f altering the mental representation o f one's appearance/behavior. Some g r o u p treatment pro-

grams include extensive role plays in treatment and part o f this aspect includes performance
feedback f r o m peers ( H o p e et al., 1995). This c o m p o n e n t m a y be further enhanced via objective
feedback for example f r o m video, audio, or physiological recording. As described earlier, at
least one study has demonstrated that video feedback can help to alter the mental representation
o f appearance in a positive direction (Rapee & H a y m a n , 1996).
Instruction and feedback regarding subtle avoidance behaviors should also help to produce a
m o r e positive mental representation. According to the model, this should be similar in form to
the response prevention methods employed in the treatment o f obsessive compulsive disorder.
W h e n exposure is undertaken, participants need to be expressly forbidden to engage in subtle
avoidance behaviors (Wells et al., 1995). Thus, in contrast to m o s t social skills training pro-
grams, treatment would not focus on teaching the ' b o w s ' o f social skills, but in providing per-
mission and e n c o u r a g e m e n t to a b a n d o n comfortable but maladaptive social behaviors.

CONCLUSIONS

The preceding pages describe our attempt to provide a model for the maintenance o f social
phobia. There were several choice points at which we could have gone in different directions.
F o r example, we decided to examine the anxiety experienced in a given situation as our starting
point. In addition, we focused primarily on ways in which the individual processes information
and interacts with the world. F r o m our perspective, and based on the treatment and research
methods that are frequently used in this field, we believe that this a p p r o a c h provides the most
logical f r a m e w o r k for an understanding o f social phobia. O f course, there are several other per-
spectives that could have been chosen (e.g. social, biological) and our focus on a cognitive per-
spective in no way implies that these other perspectives are ' w r o n g ' .
Models o f p s y c h o p a t h o l o g y provide a shorthand description o f the ways in which various fac-
tors m a y interact to p r o d u c e the disorder. Hopefully, the model presented here can provide just
such a function. We believe that the current model provides several unique predictions and
therefore, can help to further our understanding o f social phobia. Whether, in the light o f future
research, the model requires modification or needs to be completely rewritten, it will have
achieved its aim if it provides impetus for further investigation and a way o f organising this in-
formation.

REFERENCES
Alden, L. E., Biding, P. J., & Wallace, S. T. (1994). Perfectionism in an interpersonal context: A self-regulation analysis
of dysphoria and social anxiety. Cognitive Therapy and Research, 18, 297-316.
Alden, L. E., & Wallace, S. T. (1995). Social phobia and social appraisal in successful and unsuccessful social inter-
actions. Behaviour Research and Therapy, 33, 497-506.
American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington,
DC: American Psychiatric Association.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington,
DC: American Psychiatric Association.
Amies, P. L., Gelder, M. G., & Shaw, P. M. (1983). Social phobia: A comparative clinical study. British Journal of
Psychiatry, 142, 174-179.
Andrews, G. (1996). Comorbidity in neurotic disorders: The similarities are more important than the differences. In
R. M. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 3-20). New York: The Guilford Press.
Arkowitz, H., Lichtenstein, E., McGovern, K., & Hines, P. (1975). The behavioral assessment of social competence in
males. Behavior Therapy, 6, 3-13.
Arrindell, W. A., Kwee, M. G. T., Methorst, G. J., van der Ende, J., Pol, E., & Moritz, B. J. M. (1989). Perceived par-
ental rearing styles of agoraphobic and socially phobic in-patients. British Journal of Psychiatry, 155, 526-535.
Asendorpf, J. B. (1987). Videotape reconstruction of emotions and cognitions related to shyness. Journal of Personality
and Social Psychology, 53, 542-549.
Asmundson, G. J. G., & Stein, M. B. (1994). Selective processing of social threat in patients with generalized social pho-
bia: Evaluation using a dot-probe paradigm. Journal of Anxiety Disorders, 8, 107-117.
Barrett, P. M., Rapee, R. M., Dadds, M. R., & Ryan, S. M. (1996). Family enhancement of cognitive style in anxious
and aggressive children: Threat bias and the FEAR effect. Journal of Abnormal Child Psychology, 24, 187-203.
Beck, A. T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Beidel, D. C., Turner, S. M., & Dancu, C. V. (1985). Physiological, cognitive and behavioral aspects of social anxiety.
Behaviour Research and Therapy, 23, 109-117.
754 Ronald M. Rapee and Richard G. Heimberg

Beidel, D. C., & Turner, S. M. (1988). Comorbidity of test anxiety and other anxiety disorders in children. Journal of
Abnormal ChiM Psychology, 16, 275 287.
Borkovec, T. D., Stone, N. M., O'Brien, G. T., & Kaloupek, D. G. (1974). Evaluation of a clinically relevant target
behavior for analog outcome research. Behavior Therapy, 5, 503-513.
Brown, E. J., Heimberg, R. G., & Juster, H. R. (1995). Social phobia subtype and avoidant personality disorder: Effect
on severity of social phobia, impairment, and outcome of cognitive-behavioral treatment. Behavior Therapy, 26, 467-
486.
Bruch, M. A., & Cheek, J. M. (1995), Developmental factors in childhood and adolescent shyness. In R. G. Heimberg,
M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 163-
184). New York: The Guilford Press.
Bruch, M. A., Gorsky, J. M., Collins, T. M., & Berger, P. A. (1989a). Shyness and sociability reexamined: A multicom-
ponent analysis. Journal of Personality and Social Psychology, 57, 904-915.
Bruch, M. A., Heimberg, R. G., Berger, P., & Collins, T. M. (1989b). Social phobia and perceptions of early parental
and personal characteristics. Anxiety Research, 2, 57-65.
Bruch, M. A., & Heimberg, R. G. (1994). Differences in perceptions of parental and personal characteristics between
generalized and nongeneralized social phobics. Journal of Anxiety Disorders, 8, 155-168.
Burgio, K. L., Glass, C. R., & Merluzzi, T. V. (1981). The effects of social anxiety and videotape performance feedback
on cognitions and self-evaluations. Behavioral Counselling Quarterly, 1. 288-301.
Buss, A. H. (1980). Self-consciousness and social anxiety. San Francisco: Freeman.
Butler, G. (1985). Exposure as a treatment for social phobia: Some instructive difficulties. Behaviour Research and
Therapy, 23, 651-657.
Carver, C. S., & Scheier, M. F. (1988). A control-process perspective on anxiety. Anxiety Research, 1, 17-22.
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461~,70.
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: The
Guilford Press.
Clark, J. V., & Arkowitz, H. (1975). Social anxiety and self-evaluation of interpersonal performance. Psychological
Reports, 36, 211-221.
Cloitre, M. & Shear, M. K. (1995). Psychodynamic perspectives. In M. B. Stein (Ed.), Social phobia: Clinical and
research perspectives (pp. 163-187). Washington, DC: American Psychiatric Press, Inc.
Dadds, M. R., Barrett, P. M., Rapee, R. M., & Ryan, S. M. (in press). Family process and child anxiety and aggression:
An observational analysis of the FEAR effect. Journal of Abnormal Child Psychology.
Dalgleish, T., & Watts, F. N. (1990). Biases of attention and memory in disorders of anxiety and depression. Clinical
Psychology Review, 10, 589-604.
Dodge, C. S., Heimberg, R. G., Nyman, D., & O'Brien, G. T. (1987). Daily heterosocial interactions of high and low
socially anxious college students: A diary study. Behavior Therapy, 18, 90-96.
Efran, J. S., & Korn, P. R. (1969). Measurement of social caution: Self-appraisal, role playing, and discussion behavior.
Journal of Consulting and Clinical Psychology. 33, 78-83.
Eysenck, M. W. (1979). Anxiety, learning, and memory: A reconceptualization. Journal of Research in Personality, 13,
363-385.
Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory.
Journal of Consulting and Clinical Psychology, 43, 522-527.
Foa, E. B., Franklin, M. E., Perry, K. J., & Herbert, J. D. (1996). Cognitive biases in social phobia. Journal of
Abnormal Psychology, 105, 433-439.
Fyer, A. J., Mannuzza, S., Chapman, T. F., Martin, L. Y., & Klein, D. F. (1995). Specificity in familial aggregation of
phobic disorders. Archives of General Psychiatry, 52, 564-573.
Glasgow, R. E., & Arkowitz, H. (1975). The behavioral assessment of male and female social competence in dyadic het-
erosexual interactions. Behavior Therapy, 6. 488-498.
Halford, K., & Foddy, M. (1982). Cognitive and social skills correlates of social anxiety. British Journal of Clinical
Psychology, 21, 17-28.
Heimberg, R. G. (1989). Cognitive and behavioral treatments for social phobia: A critical analysis. Clinical Psychology
Review, 9, 187-228.
Heimberg, R. G., Acerra, M. C., & Holstein, A. (1985). Partner similarity mediates interpersonal anxiety. Cognitive
Therapy and Research, 9, 443-453.
Heimberg, R. G., Hope, D. A., Rapee, R. M., & Bruch, M. A. (1988). The validity of the Social Avoidance and Distress
Scale and the Fear of Negative Evaluation Scale with social phobic patients. Behaviour Research and Therapy, 26,
407-410.
Heimberg, R. G., Dodge, C. S., Hope, D. A., Kennedy, C. R., Zollo, L. J., & Becker, R. E. (1990). Cognitive behavioral
group treatment for social phobia: Comparison with a credible placebo control. Cognitive Therapy and Research, 14,
1-23.
Heimberg, R. G., Holt, C. S., Schneier, F. R., Spitzer, R. L., & Leibowitz, M. R. (1993). The issue of subtypes in the
diagnosis of social phobia. Journal of Anxiety Disorders, 7, 249-269.
Heimberg, R. G., & Juster, H. R. (1995). Cognitive behavioral treatments: Literature review. In R. G. Heimberg, M. R.
Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 261-309).
New York: The Guilford Press.
Heimberg, R. G. (1996). Social phobia, avoidant personality disorder, and the multiaxial conceptualization of interperso-
nal anxiety. In P. Salkovskis (Ed.), Trends in cognitive and behavioural therapies (Vol. 1, pp. 43-62). Sussex, England:
John Wiley & Sons.
Holle, C., Heimberg, R. G., & Neely, J. H. (in press). The effects of blocked versus random presentation and semantic
relatedness of stimulus words on response to a modified Stroop task among social phobics. Cognitive Therapy and
Research.
Holt, C. S., Heimberg, R. G., & Hope, D. A. (1992). Avoidant personality disorder and the generalized subtype of social
phobia. Journal ~?fAbnormal Psychology, 101, 318-325.
 A model of social phobia 755

Hope, D. A., & Heimberg, R. G. (1988). Public and private self-consciousness and social phobia. Journal of Personali O'
Assessment, 52, 626-639.
Hope, D. A., Heimberg, R. G., & Klein, J. F. (1990a). Social anxiety and the recall of interpersonal information.
Journal of Cognitive Psychotherapy." An International Quarterly, 4, 185-195.
Hope, D. A., Rapee, R. M., Heimberg, R. G., & Dombeck, M. J. (1990b). Representations of the self in social phobia:
Vulnerability to social threat. Cognitive Therapy and Research, 14, 177-189.
Hope, D. A., Heimberg, R. G., & Bruch, M. A. (1995). Dismantling cognitive-behavioral group therapy for social pho-
bia. Behaviour Research and Therapy, 33, 637-650.
Hudson, J. L., & Rapee, R. M. (in press). The origins of social phobia. Behavior Modification.
Jardine, R., Martin, N. G., & Henderson, A. S. (1984). Genetic covariation between neuroticism and the symptoms of
anxiety and depression. Genetics Epidemiology, 1, 89-107.
Jones, W. H., Briggs, S. R., & Smith, T. G. (1986). Shyness: Conceptualization and measurement. Journal of Personality
and Social Psychology, 51, 629-639.
Kendler, K. S., Heath, A., Martin, N. G., & Eaves, L. J. (1987). Symptoms of anxiety and symptoms of depression:
Same genes, different environments?. Archives of General Psychiatry, 44, 451-457.
Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1992). The genetic epidemiology of phobias
in women: The interrelationship of agoraphobia, social phobia, situational phobia, and simple phobia. Archives of
General Psychiatry, 49, 273-281.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., Wittchen, H., & Kendler, K.
S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from
the national comorbidity survey. Archives of General Psychiatry, 51, 8-19.
Kushner, M. G., Sher, K. J., & Beitman, B. D. (1990). The relation between alcohol problems and the anxiety disorders.
American Journal of Psychiatry, 147, 685-695.
Latane, B. (1981). The psychology of social impact. American Psychologist, 36, 343-356.
Leary, M. R., Kowalski, R. M., & Campbell, C. D. (1988). Self-presentational concerns and social anxiety: The role of
generalized impression expectancies. Journal of Research in Personality, 22, 308-321.
Liebowitz, M. R., Gorman, J. M., Fyer, A. J., & Klein, D. F. (1985). Social phobia: Review of a neglected anxiety dis-
order. Archives of General Psychiatry, 42, 729-736.
Lucock, M. P., & Salkovskis, P. M. (1988). Cognitive factors in social anxiety and its treatment. Behaviour Research and
Therapy, 26, 297-302.
Mahone, E. M., Bruch, M. A., & Heimberg, R. G. (1993). Focus of attention and social anxiety: The role of negative
self-thoughts and perceived positive attributes of the other. Cognitive Therapy and Research, 17, 209-224.
Makris, G. S., & Heimberg, R. G. (1995). The scale of maladaptive self-consciousness: A valid and useful measure in the
study of social phobia. Personality and Individual Differences, 19, 731-740.
Mattia, J. I., Heimberg, R. G., & Hope, D. A. (1993). The revised Stroop color-naming task in social phobics. Behaviour
Research and Therapy, 31,305-313.
Mattick, R. P., & Peters, L. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cog-
nitive restructuring. Journal of Consulting and Clinical Psychology, 56, 251-260.
Mattick, R. P., Peters, L., & Clarke, J. C. (1989). Exposure and cognitive restructuring for social phobia: A controlled
study. Behavior Therapy, 20, 3-23.
McEwan, K. L., & Devins, G. M. (1983). Is increased arousal in social anxiety noticed by others? Journal of Abnormal
Psychology, 92, 417~21.
McNeil, D. W., Ries, B. J., Taylor, L. J., Boone, M. L., Carter, L. E., Turk, C. L., & Lewin, M. R. (1995). Comparison
of social phobia subtypes using Stroop tests. Journal of Anxiety Disorders, 9, 47-57.
Melchior, L. A., & Cheek, J. M. (1990). Shyness and anxious self-preoccupation during a social interaction. Journal of
Social Behavior and Personality, 5, 117-130.
Mineka, S., & Zinbarg, R. (1995). Conditioning and ethological models of social phobia. In R. G. Heimberg, M. R.
Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 134-162).
New York: The Guilford Press.
Montgomery, R. L., Haemmerlie, F. M., & Edwards, M. (1991). Social, personal, and interpersonal deficits in socially
anxious people. Journal of Social Behavior and Personality, 6, 859-872.
Mulkens, A. A. N., Bogels, S. M. & de Jong, P. J. (1995). Attentional training: A new treatment for fear of blushing.
Paper presented at the World Congress of Behavioural and Cognitive Therapies, Copenhagen, Denmark, July.
Ohman, A. (1986). Face the beast and fear the face: Animal and social fears as prototypes for evolutionary analyses of
emotion. Psychophysiology, 23, 123-145.
Ohman, A. (1996). Preferential preattentive processing of threat in anxiety: Preparedness and attentional biases. In R. M.
Rapee (Ed.), Current controversies in the anxiety disorders (pp. 253-290). New York: The Guilford Press.
Phillips, S. D., & Bruch, M. A. (1988). Shyness and dysfunction in career development. Journal of Counselling
Psychology, 35, 159-165.
Pilkonis, P. A. (1977a). Shyness, public and private, and its relationship to other measures of social behavior. Journal of
Personality, 45, 585-595,
Pilkonis, P. A. (1977b). The behavioral consequences of shyness. Journal of Personality, 45, 596-611.
Poulton, R. G., & Andrews, G. (1994). Appraisal of danger and proximity in social phobics. Behaviour Research and
Therapy, 32, 639-642.
Rapee, R. M. (1991). Generalized anxiety disorder: A review of clinical features and theoretical concepts. Clinical
Psychology Review, 11,419-440.
Rapee, R. M., & Lim, L. (1992). Discrepancy between self and observer ratings of performance in social phobics.
Journal of Abnormal Psychology, 101, 727-731.
Rapee, R. M. (1993). Recent advances in the treatment of social phobia. Australian Psychologist, 28, 168-171.
Rapee, R. M. (1995). Descriptive psychopathology of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope,
& F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 41-66). New York: The Guilford
Press.
756 Ronald M. Rapee and Richard G. Heimberg

Rapee, R. M. (1997). Potential role of childrearing practices in the development of anxiety and depression. Clinical
Psychology Review, 17, 47-68.
Rapee, R. M., & Hayman, K. (1996). The effects of video feedback on the self-evaluation of performance in socially
anxious subjects. Behaviour Research and Therapy, 34, 315-322.
Rapee, R. M. & Melville, L. F. (1997). Retrospective recall of family factors in social phobia and panic disorder.
Anxiety, 5.
Reich, J., Noyes, R., & Yates, W. (1988). Anxiety symptoms distinguishing social phobia from panic and generalized
anxiety disorders. Journal of Nervous and Mental Disease, 176, 510-513.
Ribordy, S. C., Tracy, R. J., & Bernotas, T. D. (1981). The effects of an attentional training procedure on the perform-
ance of high and low test-anxious children. Cognitive Therapy and Research, 5, 19-28.
Sarason, I. G. (1975). Anxiety and self-preoccupation. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and anxiety
(Vol. 2, pp. 27-44). New York: John Wiley & Sons.
Schlenker, B. R., & Leary, M. R. (1982). Social anxiety and self-presentation: A conceptualization and model.
Psychological Bulletin, 92, 641-669.
Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia: Comorbidity
and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282-288.
Schneier, F. R., Heckelman, L. R., Garfinkel, R., Campeas, R., Fallon, B. A., Gitow, A., Street, L., Del Bene, D., &
Liebowitz, M. R. (1994). Functional impairment in social phobia. Journal of Clinical Psychiatry, 55, 322-331.
Seipp, B. (1991). Anxiety and academic performance: A meta-analysis of findings. Anxiety Research, 4, 27-41.
Solyom, L., Ledwidge, B., & Solyom, C. (1986). Delineating social phobia. British Journal of Psychiatry, 149, 464-470.
Stein, M. B., Tancer, M. E., Gelernter, C. S., Vittone, B. J., & Uhde, T. W. (1990). Major depression in patients with
social phobia. American Journal of Psychiatry, 147, 637-639.
Stopa, L., & Clark, D. M. (1993). Cognitive processes in social phobia. Behaviour Research and Therapy, 31,255-267.
Teglasi, H., & Fagin, S. S. (1984). Social anxiety and self-other biases in causal attribution. Journal of Research in
Personality, 18, 64-80.
Trower, P., & Gilbert, P. (1989). New theoretical conceptions of social anxiety and social phobia. Clinical Psychology
Review, 9, 19-35.
Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986a). Psychopathology of social phobia and comparison to
avoidant personality disorder. Journal of Abnormal Psychology, 95, 389-394.
Turner, S. M., Beidel, D. C., & Larkin, K. T. (1986b). Situational determinants of social anxiety in clinic and nonclinic
samples: Physiological and cognitive correlates. Journal of Consulting and Clinical Psychology, 54, 523-527.
Turner, S. M., Beidel, D. C., & Townsley, R. M. (1990). Social phobia: Relationship to shyness. Behaviour Research and
Therapy, 28, 497-505.
Turner, S. M., Beidel, D. C., & Townsley, R. M. (1992). Social phobia: A comparison of specific and generalized sub-
types and avoidant personality disorder. Journal of Abnormal Psychology, 101,326-331.
Turner, S. M., Beidel, D. C., Cooley, M. R., Woody, S. R., & Messer, S. C. (1994). A multicomponent behavioral treat-
ment for social phobia: Social effectiveness therapy. Behaviour Research and Therapy, 32, 381-390.
Twentyman, C. T., & McFaU, R. M. (1975). Behavioral training of social skills in shy males. Journal of Consulting and
Clin&al Psychology, 43, 384-395.
Wallace, S. T., & Alden, L. E. (1991). A comparison of social standards and perceived ability in anxious and nonanxious
men. Cognitive Therapy and Research, 15, 237-254.
Wallace, S. T., & Alden, L. E. (1995). Social anxiety and standard setting following social success or failure. Cognitive
Therapy and Research. 19, 613-631.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical
Psychology, 33, 448-457.
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social phobia: The role of in-
situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26, 153-161.
Williams, J. M. G., Watts, F. N., MacLeod, C., & Mathews, A. (1988). Cognitive psychology and emotional disorders.
Chichester, England: John Wiley & Sons.
Winton, E. C., Clark, D. M., & Edelmann, R. J. (1995). Social anxiety, fear of negative evaluation and the detection of
negative emotion in others. Behaviour Research and Therapy, 33, 193-196.
Wise, E. H., & Haynes, S. N. (1983). Cognitive treatment of test anxiety: Rational restructuring versus attentional train-
ing. Cognitive Therapy and Research, 7, 69-78.
Ziegler, S. G. (1994). The effects of attentional shift training on the execution of soccer skills: A preliminary investi-
gation. Journal of Applied Behavior Analysis, 27, 545-552.
Zimbardo, P. G., Pilkonis, P. A., & Norwood, R. M. (1974). The silent prison of shyness (Office of Naval Research
Technical Report No. 2-17). Stanford, California: Stanford University.