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Social phobia is characterised by a tendency to interpret ambiguous social information in a negative of threatening manner. It is predicted that such biases play 'a causal role in the development and maintenance of social phobia. Research suggests that interpretive biases can be modified using a text-based paradigm called Cognitive Bias Modification for Interpretation (CB M-I), and that anxiety can reduce as a result. The efficacy and feasibility of this task as a clinical intervention has not been investigated using a social phobia clinical sample. The present study aimed to satisfy this. Nine participants, presenting to mental health services with social phobia were recruited from waiting lists. A non-concurrent multiple-baseline, single-case design was used to assess efficacy and feedback collected to assess feasibility of self-administered, one-week, daily sessions of CBM-I delivered at home. Measures of social phobia were completed daily during the baseline and intervention phases and change assessed. Secondary outcome measures were assessed for reliable and clinical change prior to CBM-I, post-CBM-I and at one-week follow-up. The results indicated that interpretive biases were reliably modified in eight of the participants and visual inspection of the daily scores showed that five of these participants responded to CBM-I in relation to reduced social phobia scores. Reliable and clinical change for secondary outcome measures of social phobia was mixed. For example, six participants demonstrated reliable improvements in Social Phobia Scale (SPS) scores post-CBM-I and five of these were considered to be clinically significant. Group effect sizes on the primary social phobia outcome measure were high. Results and feedback from participants suggest that CBM-I is a feasible clinical tool. The preliminary nature of these findings is discussed in relation to the literature and suggestions for clinical implications and future research are made.

The literature review examines theories and research concerning informative processing biases in social phobia, with a particular focus on selective attention for, and interpretation of, external social cues. After highlighting the clinical presentation and psychosocial impact of social phobia, theoretical conceptualizations are discussed, empirical findings are critically evaluated, and relevant therapeutic interventions are outlined. The subsequent empirical paper describes an investigation of biases in initial orienting, and maintenance, of attention towards social cues (faces), in individuals with generalized social phobia (GSP) and healthy volunteers. Eye-movements within a modified visual probe task were monitored. There were two trial types: (i) trails in which an emotional face (angry or happy) was paired with a socially-relevant control stimulus (neutral face), and (ii) trials in which face (angry, happy or neutral) was paired with a non-social control stimulus (household object). For each condition, the direction, speed and duration of initial gaze fixation were assessed. Results indicated that, in general, participants directed their gaze more often towards, and looked at, emotional (angry and happy) faces relative to neutral faces. In addition, participants (irrespective of group) initially oriented more often towards, and fixated for longer on, faces relative to objects. The magnitude of the latter bias (i.e. longer duration of initial fixation on faces) was significantly more pronounced in individuals with GSP, compared with controls. These findings are discussed in relation to the existing literature on attentional biases for external cues in GSP. Clinical implications and potential avenues for future research are considered.

Clark and Wells (1995) suggest that following a social situation, individuals with social phobia engage in PEP, a 'post-mortem' where they review the event in detail. The individual's negative self perception influences his or her review of the social encounter and consequently performance is viewed as worse than it actually was. This results in increased feelings of anxiety and shame. The literature review examines the developing evidence base on PEP and as such research is currently limited, the review also draws on relevant evidence from other areas. Theoretical perspectives to PEP include self-focussed attention and attentional bias, imagery and the observer-perspective, interpretation bias, memory bias, rumination in depression and emotional processing. The empirical study manipulated PEP by asking participants to focus on either the positive or the negative aspects of a social situation and examined the effect on imagery, thinking, performance, appraisals, and mood in high and low socially anxious individuals. Consistent with Clark and Wells' model, high socially anxious individuals rated their performance as worse, predicted worse performance, had more negatively valanced images, thought more about negative aspects of their performance in PEP and reported higher levels of anxiety and shame in a social situation compared to low socially anxious individuals. This study also provides a preliminary evidence to suggest that engaging in positive PEP may have beneficial effects on ratings of performance, future performance, image and impression valence and thoughts during PEP in high socially anxious participants.