Social phobia: Effects of external attention on anxiety, negative beliefs, and perspective taking

When entering anxiety-provoking social situations, individuals with social phobia tend to shift attention inward, toward the self. This tendency is likely to diminish the potential for exposure to correct negative beliefs and associated anxiety. The present study tested the hypothesis that by shifting to an external attention focus on disconfirmatory information, the effectiveness of brief exposure is increased. This hypothesis was tested in a single-case series of 8 socially phobic patients. Following an initial behavior test, half of the patients received one session of exposure alone followed by one session of exposure plus external attention focus, while the other half of the patients received these sessions in reversed order. Both conditions were rated as equally credible. Exposure plus external attention focus was significantly more effective than exposure alone in reducing within-situation anxiety and belief in feared catastrophes. Moreover, the attention condition produced a shift from an observer to a field perspective in patients' images of the feared social situation. A manipulation-check measure of degree of self-focused attention confirmed that the attention manipulation had influenced self-focus as intended. The role of attention manipulations in the treatment of social phobia is discussed.