Treatment of social phobia

David Veale is an honorary senior lecturer at the Royal Free and University College Medical School and a consultant psychiatrist at the Priory Hospital (The Bourne, Southgate, London N14 6RA, UK). He has a special interest in cognitive–behavioural therapy and its application to anxiety disorders and body dysmorphic disorder.

Social phobia (or social anxiety disorder) manifests as a marked and persistent fear of negative evaluation in social or performance situations. The epidemiology, diagnosis and psychopathology are reviewed, including clinical presentation, cultural aspects and the differences between agoraphobia and social phobia. Behavioural treatments, including graded self-exposure and cognitive restructuring, are considered. A cognitive model of the maintenance of social phobia is discussed. It is hypothesised that attentional shifting towards imagery, safety behaviours and ‘post-mortem’ analyses play a key role in symptom maintenance. The implications of this for treatment are described, and guidelines for pharmacological treatment are summarised.