Review articleSelf-focused attention in social phobia and social anxiety
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.
Section snippets
Self-focused attention
Self-focused attention has been defined as “an awareness of self-referent, internally generated information” (Ingram, 1990, p. 156). The content of such awareness can include body state information such as awareness of physical states, or awareness of thoughts and emotions including personal beliefs and attitudes. Self-referent information may include memories of past feelings, attitudes, or events, which can impact upon the person's self-concept in the present. Ingram (1990) proposed a model
The Clark and Wells model of social phobia
Clark and Wells' (1995) propose that when a socially phobic individual enters a social situation, a set of assumptions are activated that produce anxiety. According to the model, the symptoms of anxiety together with the strategies adopted to cope with that anxiety can become further perceived sources of danger, leading to a series of vicious cycles that maintain the disorder. For example, socially phobic individuals often have unrealistically high performance standards and distorted beliefs
Theories of self-focused attention
This section of the review describes two prominent theories of self-focused attention that may help us to explicate the processes underlying self-focused attention in the cognitive model outlined above. Duval and Wicklund (1972) proposed a theory of “objective self-awareness,” which was later expanded by Carver and Scheier (1981), into their “cybernetic theory of self-regulation.” These theories were not originally concerned with social anxiety, or with any other form of psychopathology, but
Effects of self-focused attention on anxiety, thinking and behavior
Self-focused attention has been linked to social anxiety, poor social performance, increased anxiety, and negative self-judgments in a number of studies (Woody, Chambless, & Glass, 1997). In a study on individuals with social phobia, Woody (1996) looked at self-focus in relation to anxiety and performance. Half the participants were in a passive role, sitting in front of an audience while someone else was speaking, whereas some were in an active role, giving a presentation. Self-focus was
Construction of the self as a social object and the observer perspective
The Clark and Wells' (1995) model of social phobia described earlier gives a key role to the process of attentional self-focus in maintaining the disorder. In the model, self-focused attention prevents the individual noticing disconfirmatory external information and is part of a wider process that Clark and Wells describe as the construction of the self as a social object. They propose that an impression of the self is constructed by the person using somatic sensations, thoughts, and feelings
Conclusions and future directions
There is compelling evidence that self-focused attention is an important process in many emotional disorders. However, although self-focused attention, or self-awareness as it is sometime described, is not a pathological state per se, it is clear from the studies on nonclinical populations that self-focused attention can have a significant impact on anxiety and performance. The literature also suggests that there may be different types of self-focused attention—witness the distinction between
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