The Clark and Wells cognitive model (1995) is the dominant theoretical framework for understanding social anxiety. It proposes that people with social anxiety construct a negative image of themselves in social situations (distorted self-image) and use it as a prediction of how others see them. The model describes 5 maintaining mechanisms: (1) negative beliefs, (2) self-referential processing, (3) safety behaviors, (4) self-directed attention, (5) post-event processing strategies. The CBT derived from this model (Clark 2001) is the treatment with the most evidence.
Concept origin
Clark DM, Wells A. (1995). A cognitive model of social phobia. In Heimberg RG, Liebowitz MR, Hope DA, Schneier FR (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). Guilford Press. (founding model described in Wells 1997 (no verifiable DOI for the original chapter))
How it manifests
- ▸ Applicable as theoretical model (not an individual symptom)
- ▸ Used to map the 5 maintainers in each patient
Therapeutic approach
CBT derived from Clark (2001) works the 5 mechanisms: (1) restructuring of negative beliefs (video feedback to correct self-image), (2) reduce self-referential attention with external focus, (3) withdraw safety behaviors (behavioral experiment), (4) gradual exposure with response prevention (no safety), (5) post-event re-evaluation (re-attribution). Robust efficacy in 14-16 sessions.
Related concepts
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