Self-focused attention in social phobia and social anxiety

Abstract

Self-focused attention is an awareness of self-referent information and is present in many emotional disorders. This review concentrates on the role of self-focused attention in social anxiety with particular reference to the Clark and Wells [Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. R. G. Heimberg, M. Liebowitz, D. A. Hope, & S. Scheier (Eds.), Social phobia: diagnosis, assessment and treatment. New York: Guilford.] model of social phobia. According to Clark and Wells, self-focused attention is an important maintaining factor in the disorder because it increases access to negative thoughts and feelings, can interfere with performance, and prevents the individual from observing external information that might disconfirm his or her fears. Clark and Wells also propose that socially phobic individuals construct a distorted impression of themselves, based on internally generated information, that takes the form of a visual image (often seen from the perspective of an observer) or felt sense. This paper describes the model and then reviews other theories of self-focused attention, and empirical evidence on self-focused attention. Two types of evidence are reviewed: one, studies that have been conducted from a variety of theoretical perspectives that have relevance either to social anxiety in general or to the Clark and Wells model in particular; two, studies that were designed as a direct test of Clark and Wells' predictions. The final section of the review summarizes the conclusions and suggests areas for future examination.

Introduction

Social phobia is defined by DSM-IV as “a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possibly scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing.” (American Psychiatric Association [APA], 1994, p. 416). Recent epidemiological studies suggest lifetime prevalence rates of 4.9% for males and 9.5% for females (Wittchen, Stein, & Kessler, 1999). Social fears that do not meet full diagnostic criteria are present both in other psychiatric disorders and in the general population. Furmark et al. (1999) and Pollard and Henderson (1988) both found that more than 20% of the population report irrational social fears. The Clark and Wells (1995) model of social phobia has influenced both theoretical understanding of the disorder and improved the success of its treatment (Clark, 2001). This review concentrates on one aspect of the model, namely the role given to self-focused attention in the maintenance of social phobia and anxiety.

Self-focused attention is not unique to social anxiety and plays an important role in a number of emotional disorders (Hartman, 1983). The review begins with a definition of self-focused attention and a brief summary of its role in psychopathology in general. Next, we outline the cognitive model of social phobia (Clark & Wells, 1995) with particular emphasis on self-focused attention and social anxiety. The next section describes two theories developed in social psychology—objective self-awareness (Duval & Wicklund, 1972) and cybernetic theory of self-regulation (Carver & Scheier, 1981)—that examine self-focused attention and we discuss their relevance to social anxiety and to the cognitive model. The following section concentrates on empirical evidence for the role of self-focused attention in social anxiety and on the effects of changing self-focus therapeutically. We then return to the cognitive model of social phobia (Clark & Wells, 1995) and examine their ideas about construction of the self as social object, imagery in social phobia and the role of the observer perspective. The review concludes with a discussion of theoretical and empirical questions about the role of self-focused attention in social phobia, and social anxiety.