Social anxiety disorder

Persistent fear of social scrutiny or negative evaluation with relevant distress or impairment. Self-focused attention and safety behaviors can maintain threatening self-impressions while reducing access to corrective information.

An unfavorable mental representation of oneself that can be treated as if it were accurate evidence of how others perceive the person. Comparing an explicit prediction with external feedback can test that inference.

An internally generated representation of how one appears, often experienced as an observer's view. Its vividness or emotional force does not establish that it matches an independent observer's impression.

Thinking ahead about a feared encounter. It can become anxiety-maintaining when selective predictions and rehearsal preserve threat expectations instead of preparing flexible engagement.

Repetitive review of a social encounter, potentially privileging threatening interpretations and internal impressions over external evidence. Its occurrence and its causal contribution should be assessed separately.

A cognitive account in which feared evaluation promotes self-focused attention and an internally generated threatening impression of the self. Safety behaviors can distort an interaction and prevent disconfirmation; anticipatory and post-event processing can maintain the threat. Developed by David M. Clark and Adrian Wells, the account generates separate experimental questions about attention, behaviour and interpretation. Adolescent applicability requires developmentally valid measures, rather than assuming an adult self-report vocabulary.^[ref]

Leigh and colleagues compared counterbalanced conversations under combined internal-focus/safety behavior instructions versus external-focus/safety-reduction instructions. Self, partner and independent ratings in a symptom-selected sample provided experimental evidence for the combined manipulation. Because two processes changed together, this experiment does not by itself identify their separate causal effects or establish treatment efficacy in diagnosed patients.^[ref]