Cognitive restructuring (CR) is commonly used to treat social phobia, although its contribution to treatment efficacy has not been established. CR requires the person to think about and discuss feared social events with his or her therapist and thus entails some degree of exposure to social stimuli. CR also is thought to enhance the efficacy of therapeutic exposure exercises (EXP). Four predictions were tested based on this model: Relative to a control intervention matched for the exposure inherent in CR, CR is more effective in (1) reducing social phobia, (2) reducing negative social cognitions, (3) increasing positive cognitions, and (4) enhancing the effects of subsequent EXP. People with generalized social phobia (N= 60) were randomly assigned to CR followed by EXP or to a control intervention followed by EXP. Support was found for predictions 1 to 3, but not 4.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association. (APA) . (1987). Diagnostic and statistical manual of mental disorders (3rd rev. ed.; DSM-III-R). Washington, DC: Author.
2.
American Psychiatric Association. (APA) . (1994). Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV). Washington, DC: Author.
3.
Beck, A. T. , & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
4.
Beck, A. T. , Freeman, A., & Associates. (1990). Cognitive therapy ofpersonality disorders. New York: Guilford.
5.
Beck, A. T. , Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.
6.
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.
7.
Beidel, D. C. , Turner, S. M., & Jacob, R. G. (1989). Assessment of social phobia: Reliability of an impromptu speech task. Journal of Anxiety Disorders, 3, 149-158.
8.
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.
9.
Butler, G. (1984). Treatment protocolfor associative therapy.Unpublished manuscript, Department of Psychiatry, University of Oxford.
10.
Butler, G. , Cullington, A., Munby, M., Amies, P., & Gelder, M. (1984). Exposure and anxiety management training of social phobia. Journal of Consulting and Clinical Psychology, 52, 642-650.
11.
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: Guilford.
12.
Cohen, J. (1988). Statistical poweranalysisfor the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
13.
Davidson, J.R.T. , Hughes, D. L., George, L. K., & Blazer, D. G. (1993). The epidemiology of social phobia: Findings from the Duke epidemiological catchment area study. Psychological Medicine, 23, 709-718.
14.
DiNardo, P. A. , & Barlow, D. H. (1988). Anxiety Disorders Interview Schedule-Revised. New York: Graywind.
15.
Foa, E. B. , & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.
16.
Glass, C. R. , Merluzzi, T. V., Biever, J. O., & Larsen, K. H. (1982). Cognitive assessment of social anxiety: Development and validation of a self-statement questionnaire. Cognitive Therapy and Research, 6, 37-55.
17.
Heimberg, R. G. (1991). Cognitive behavioral treatment of social phobia in a group setting: A treatment manual.Unpublished manuscript, State University of New York at Albany.
18.
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: Guilford.
19.
Herbert, J. D. , Bellack, A. S., & Hope, D. A. (1991). Concurrent validity of the Social Phobia and Anxiety Inventory. Journal of Psychopathology and Behavioral Assessment, 13, 357-368.
20.
Herbert, J. D. , Bellack, A. S., Hope, D. A., & Mueser, K. T. (1991). Scoring the Social Phobia and Anxiety Inventory: Reply to Beidel and Turner. Journal of Psychopathology and Behavioral Assessment, 14, 381-383.
21.
Hope, D. A. , Gansler, D. A., & Heimberg, R. G. (1989). Attentional focus and causal attributions in social phobia: Implications from social psychology. Clinical Psychology Review, 9,49-60.
22.
Hope, D. A. , Heimberg, R. G., & Bruch, M. A. (1995). Dismantling cognitive-behavioral group therapy for social phobia. Behaviour Research and Therapy, 33, 637-350.
23.
Hope, D. , Herbert, J., & White, C. (1995). Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive behavioral group therapy for social phobia. Cognitive Therapy and Research, 19, 285-303.
24.
Holt, C. S. , & Heimberg, R. G. (1990). The reaction to treatment questionnaire: Measuring treatment credibility and outcome expectancies. Behavior Therapist, 13, 213-222.
25.
Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375.
26.
Ley, R. (1979). F curves have two tails but the F test is a one-tailed two-tailed test. Journal of Behavior Therapy and Experimental Psychiatry, 10, 207-212.
27.
Lucock, M. P. , & Salkovskis, P. M. (1988). Cognitive factors in social anxiety and its treatment. Behaviour Research and Therapy, 26, 297-302.
28.
Marks, I. , & Mathews, A. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17, 263-267.
29.
Mattick,P. , & Peters, L. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cognitive restructuring. Journal of Consulting and Clinical Psychology, 56, 251-260.
30.
Mattick, R. P. , Peters, L., & Clarke, J. C. (1989). Exposure and cognitive restructuring for social phobia: A controlled study. Behavior Therapy, 20, 3-23.
31.
Peterson, C. , Semmel, A., von Baeyer, C., Abramson, L. Y., Metalsky, G. I., & Seligman, M.EP. (1982). The attributional style questionnaire. Cognitive Therapy and Research, 6, 287-300.
32.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
33.
Scheier, M. F. , & Carver, C. S. (1985). The Self-Consciousness Scale: A revised version for use with general populations. Journal of Applied Social Psychology, 15, 687-699.
34.
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.
35.
Scholing, A. , & Emmelkamp, P.M.G. (1993). Exposure with and without cognitive therapy for generalized social phobia: Effects of individual and group treatment. Behaviour Research and Therapy, 31, 667-681.
36.
Spitzer,B. , Williams, J.B.W., Gibbon, M., & First, M. B. (1990a). Structured clinical interview for DSM-III-R-patient edition (with psychotic screen). Washington, DC: American Psychiatric Press.
37.
Spitzer, R. B. , Williams, J.B.W., Gibbon, M., & First, M. B. (1990b). Structured clinical interview for DSM-III-R-personality disorders. Washington, DC: American Psychiatric Press.
38.
Stravynski, A. , Marks, I., & Yule, W. (1982). Social skills problems inneurotic outpatients: Social skills training with and without cognitive modification. Archives of General Psychiatry, 39, 1378-1385.
39.
Turner, S. , Beidel, D., Cooley, M., Woody, S., &Messer, S. (1994). Amulticomponent behavioral treatment for social phobia: Social effectiveness therapy. Behaviour Research and Therapy, 32, 381-390.
40.
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.
41.
Turner, S. M. , Beidel, D. C., & Jacob, R. (1994). Social phobia: A comparison of behavioral therapy and atenolol. Journal of Consulting and Clinical Psychology, 62, 350-358.
42.
Wolf, F M. (1986). Meta-analysis: Quantitative methods for research synthesis. Newbury Park, CA: Sage.
