Clark and Wells model of CBT

The following link describes the original Clark & Wells (1995) cognitive model of social phobia.

Subsequent research has led to the refinement of treatment techniques but the original interventions included:

  • Helping clients to develop specific and measurable goals for therapy.
  • Helping clients to understand how the different components of the “model” maintain their anxiety.
  • Changing safety behaviors and self-focused attention with behavioral experiments. Early approaches of the model might video-record the client taking part in two brief social interactions with a stranger: first while focusing attention on themselves, monitoring their performance, and using safety behaviors; and second, while focusing externally and dropping safety behaviors. Client ratings of attention, anxiety, and self-consciousness would be taken and compared.
  • Attention training to shift the focus of attention, prior to conducting behavioral experiments where the focus of attention is directed outwards during conversations.
  • Behavioral experiments to test negative predictions and assumptions, and negative self-images and self-impressions. Warnock-Parkes et al. (2020) recommend that while early experiments focus on dropping safety behaviors, experiments later in therapy focus on decatastrophising – intentionally testing what happens if the thing that the patient is afraid of were to happen (e.g. deliberately appearing sweaty in a conversation, deliberately saying something boring and monitoring other’s reactions).
  • Handling anticipatory worry and post-event rumination. This might include exploring the advantages and disadvantages of worry & rumination, rehearsing answers to common worries, and switching to actively testing out worries by using behavioral experiments.
  • Updating negative self-images and impressions. Warnock-Parkes et al (2020) suggest that attempts should be made to update self-images and impressions during the course of gathering new information from behavioral experients. Some patients benefit from interventions which directly process and update their self-image, especially where such images are linked to past experiences of social trauma.
  • Addressing dysfunctional negative beliefs and assumptions. The cognitive model suggests that dysfunctional assumptions predispose socially anxious individuals to appraise social situations in a negative light. These beliefs are addressed directly throughout the course of therapy to incorporate new information gathered from behavioral experiments and other interventions.