An Acceptance and Mindfulness-Based Perspective on Social Anxiety Disorder

  • James D. Herbert
  • Lee Ann Cardaciotto
Part of the Series in Anxiety and Related Disorders book series (SARD)


Social anxiety disorder (SAD), also known as social phobia, is a common and often debilitating anxiety disorder. The cardinal features of SAD are anxiety in and avoidance of situations involving interpersonal behavior, social performance, or both. Pathological social anxiety is characterized by extreme concerns over humiliation, embarrassment, or similar emotional consequences resulting from fear of negative evaluation by others. The disorder is associated with serious impairment in multiple areas of functioning, including romantic and nonromantic relationships, academic functioning, and occupational functioning (e.g., Davidson, Hughes, George, & Blazer, 1993; Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). SAD is also associated with increased risk of comorbid psychopathology, especially depression other anxiety disorders and substance abuse (e.g., Magee, Eaton, Wittchen, McGonagle,& Kessler, 1996; Schneier et al., 1992).


Anxiety Disorder Social Anxiety Social Phobia Social Anxiety Disorder Physiological Arousal 
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  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
  3. Amir, N., Foa, E. B., & Coles, M. E. (1998). Negative interpretation bias in social phobia. Behavior Research & Therapy, 36, 945–957.CrossRefGoogle Scholar
  4. Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.Google Scholar
  5. Belloch, A., Morillo, C., & Gimenez, A. (2004). Effects of suppressing neutral and obsession-like thoughts in normal subjects: beyond frequency. Behavior Research and Therapy, 42, 841–857.CrossRefGoogle Scholar
  6. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.CrossRefGoogle Scholar
  7. Block, J. A. (2003). Acceptance or change of private experiences: A comparative analysis in college students with public speaking anxiety. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(9-B), 4361.Google Scholar
  8. Boegels, S. M., & Lamers, C. T. J. (2002). The causal role of self-awareness in blushing-anxious, socially-anxious, and social phobics individuals. Behaviour Research & Therapy, 40, 1367–1384.CrossRefGoogle Scholar
  9. Brown, E. J., Heimberg, R. G., & Juster, H. R. (1995). Social Phobia subtype and avoidant personality disorder: Effect on severity of social phobia, impairment, and outcome of cognitive behavioral treatment. Behavior Therapy, 26, 467–486.CrossRefGoogle Scholar
  10. Brown, K.W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.PubMedCrossRefGoogle Scholar
  11. Brown, K.W., & Ryan, R. M. (2004). Perils and promise in defining and measuring mindfulness: Observations from experience. Clinical Psychology: Science and Practice, 11, 242–248.CrossRefGoogle Scholar
  12. Bruch, M. A., & Heimberg, R. G. (1994). Differences in perceptions of parental and personal characteristics between generalised and nongeneralised social phobics. Journal of Anxiety Disorders, 8, 155–168.CrossRefGoogle Scholar
  13. Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65, 571–581.PubMedCrossRefGoogle Scholar
  14. Clark, D. M. (2001). A cognitive perspective on social phobia. In W. R. Crozier & L. E. Alden (Eds.), International handbook of social anxiety: Concepts, research, and interventions relating to the self and shyness (pp. 405–430). New York: Wiley.Google Scholar
  15. Clark, D. M., & Wells, A. (1995). Acognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guilford.Google Scholar
  16. Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper & Row.Google Scholar
  17. Dalrymple, K. L., Herbert, J. D., & Gaudiano, B. A. (2005). Onset of illness and developmental factors in social anxiety disorder: Findings from a retrospective interview. Manuscript under editorial review.Google Scholar
  18. Daly, J. A., Vangelisti, A. L., & Lawrence, S. G. (1989). Self-focused attention and public speaking anxiety. Personality & Individual Differences, 10, 903–913.CrossRefGoogle Scholar
  19. Davidson, J. R. T., Hughes, D. L., George, L. K., & Blazer, D. G. (1993). The epidemiology of social phobia: Findings from the Duke Epidemiological Catchment Areas Study. Psychological Medicine, 23, 709–718.PubMedCrossRefGoogle Scholar
  20. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditiation. Psychosomatic Medicine, 65, 564–570.PubMedCrossRefGoogle Scholar
  21. Deikman, A. J. (1996). “I”_awareness. Journal of Consciousness Studies, 3, 350–356.Google Scholar
  22. Ehlers, A.,& Breuer, P. (1992). Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology, 101, 371–382.PubMedCrossRefGoogle Scholar
  23. Ehlers, A., & Breuer, P. (1996). How good are patients with panic disorder at perceiving their heartbeats? Biological Psychology, 42, 165–182.PubMedCrossRefGoogle Scholar
  24. Fedoroff, I. C., & Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psychopharmacology, 21, 311–324.PubMedCrossRefGoogle Scholar
  25. Fehm, L., & Margraf, J. (2001). Thought suppression: Specificity in agoraphobia versus broad impairment in social phobia? Behaviour Research and Therapy, 40, 57–66.CrossRefGoogle Scholar
  26. Feske, U., & Chambless, D. L. (1995). Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis. Behavior Therapy, 26, 695–720.CrossRefGoogle Scholar
  27. Franklin, M. E., Feeny, N. C., Abramowitz, J. S., Zoellner, L. A., & Bux, D. A. (2001). Comprehensive cognitive behavior therapy: A multi-component treatment for generalized social phobia. Psicoterapia Cognitiva e Comportamentale, 7, 211–221.Google Scholar
  28. Fyer, A. J., Mannuzza, S., Chapman, T. F., Liebowitz, M. R., & Klein, D. F. (1993). A direct interview family study of social phobia. Archives of General Psychiatry, 50, 286–293.PubMedGoogle Scholar
  29. Gelernter, C. S., Uhde, T.W., Cimolic, P., Arnkoff, D. B., Vittone, B. J., Tancer, M. E., et al. (1991). Cognitive-behavioral and pharmacological treatments for social phobia: A controlled study. Archives of General Psychiatry, 48, 938–945.PubMedGoogle Scholar
  30. Gould, R. A., Buckminster, S., Pollack, H. M., Otto, M.W., & Yap, L. (1997). Cognitive behavioral and pharmacological treatment for social phobia: A meta-analysis. Clinical Psychology: Science and Practice, 4, 291–306.CrossRefGoogle Scholar
  31. Harvey, A. G. (2003). The attempted suppression of presleep cognitive activity in insomnia. Cognitive Therapy & Research, 27, 593–602.CrossRefGoogle Scholar
  32. Haug, T. T., Blomhoff, S., Hellstrom, K., Holme, I., Humble, M., Madsbu, H. P., et al. (2003). Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial. British Journal of Psychiatry, 182, 312–318.PubMedCrossRefGoogle Scholar
  33. Hayes, S. C. (1994). Content, context, and the types of psychological acceptance. In S. C. Hayes, N. S. Jacobsen, V. M. Follette, & M. J. Dougher (Eds.), Acceptance & change: Content and context in psychotherapy (pp. 13–32). Reno, NV: Context Press.Google Scholar
  34. Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. New York: Plenum.Google Scholar
  35. Hayes, S. C. Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford.Google Scholar
  36. Heimberg, R. G. (2002, November). The understanding and treatment of social anxiety: What a long strange trip it’s been (and will be). Paper presented at the Association for Advancement of Behavior Therapy, Reno, NV.Google Scholar
  37. Heimberg, R. G., & Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guilford.Google Scholar
  38. Heimberg, R. G., Dodge, C. S., Hope, D. A., Kennedy, C. R., Zollo, L., & Becker, R. E. (1990). Cognitive behavioral group treatment of social phobia: Comparison to a credible placebo control. Cognitive Therapy and Research, 14, 1–23.CrossRefGoogle Scholar
  39. Heimberg, R. G., Salzman, D., Holt, C. S., & Blendell, K. (1993). Cognitive behavioral group treatment of social phobia: Effectiveness at 5-year follow-up. Cognitive Therapy and Research, 17, 325–339.CrossRefGoogle Scholar
  40. Heinrichs, N., & Hofmann, S. G. (2001). Information processing in social phobia: A critical review. Clinical Psychology Review, 21, 751–770.PubMedCrossRefGoogle Scholar
  41. Herbert, J. D. (1995). An overview of the current status of social phobia. Applied and preventive Psychology, 4, 39–51.CrossRefGoogle Scholar
  42. Herbert, J. D., Crittenden, K., & Dalrymple, K. L. (2004). Knowledge of social anxiety disorder relative to attention deficit hyperactivity disorder among educational professionals. Journal of Clinical Child & Adolescent Psychology, 33, 366–372.CrossRefGoogle Scholar
  43. Herbert, J. D., & Dalrymple, K. L. (2004). Acceptance and commitment therapy for social anxiety disorder: A treatment manual. Unpublished manuscript, Drexel University, Philadelphia, PA.Google Scholar
  44. Herbert, J. D., Gaudiano, B. A., Rheingold, A., Harwell, V., Dalrymple, K., & Nolan, E. M. (2005). Social skills training augments the effectiveness of cognitive behavior group therapy for social anxiety disorder. Behavior Therapy, 36, 125–138.CrossRefGoogle Scholar
  45. Herbert, J. D., Rheingold, A. A., Gaudiano, B. A., & Myers, V. H. (2004). Standard versus extended cognitive behavior therapy for social anxiety disorder: A randomized controlled trial. Behavioural and Cognitive Psychotherapy, 32, 1–17.CrossRefGoogle Scholar
  46. Herbert, J. D., Rheingold, A. A., & Goldstein, S. G. (2002). Brief cognitive behavioral group therapy for social anxiety disorder. Cognitive and Behavioral Practice, 9, 1–8.CrossRefGoogle Scholar
  47. Hope, D. A., Herbert, J. D., & White, C. (1995). Social phobia subtype, avoidant personality disorder, and psychotherapy outcome. Cognitive Therapy and Research, 19, 339–417.CrossRefGoogle Scholar
  48. Huppert, J. D., Roth, D. A., Keefe, F. J., Davidson, J. R. T., & Foa, E. B. (2002, November). Comprehensive CBT, Fluoxetine, and their combination: A randomized, placebo-controlled trial. Paper presented at the Association for Advancement of Behavior Therapy, Reno, NV.Google Scholar
  49. Juster, H. R., & Heimberg, R. G. (1995). Social phobia: Longitudinal course and long-term outcome of cognitive-behavioral treatment. The Psychiatric Clinics of North America, 18, 821–842.PubMedGoogle Scholar
  50. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.Google Scholar
  51. Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disordes. American Journal of Psychiatry, 149, 936–943.PubMedGoogle Scholar
  52. Kashdan, T. B., & Herbert, J. D. (2001). Social anxiety disorder in childhood and adolescence: Current status and future directions. Clinical Child and Family Psychology Review, 4, 37–61.PubMedCrossRefGoogle Scholar
  53. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eschleman, S., et al. (1994). Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.PubMedGoogle Scholar
  54. Kimble, C. E., & Zehr, H. D. (1982). Self-consciousness, information load, selfpresentation, and memory in a social situation. Journal of Social Psychology, 118, 39–46.CrossRefGoogle Scholar
  55. Koster, E. H.W., Rassin, E., Crombez, G., & Naring, G.W. B. (2003). The paradoxical effects of suppressing anxious thoughts during imminent threat. Behaviour Research & Therapy, 41, 1113–1120.CrossRefGoogle Scholar
  56. Lang, A. J., & Stein, M. B. (2001). Social phobia: Prevalence and diagnostic threshold. Journal of Clinical Psychiatry, 62, 5–10.PubMedGoogle Scholar
  57. Liebowitz, M. R., Gorman, J. M., Fyer A. J., & Klein, D. F. (1985). Social phobia: Review of a neglected anxiety disorder. Archives of General Psychiatry, 42, 729–736.PubMedGoogle Scholar
  58. Magee, W. J., Eaton, W. W., Wittchen, H.-U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia, in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159–168.PubMedGoogle Scholar
  59. Mannuzza, S., Schneier, F. R., & Chapman, T. F., Liebowitz, M. R., & Klein, D. F. (1995). Generalized social phobia. Archives of General Psychiatry, 52, 230–237.PubMedGoogle Scholar
  60. Mansell, W., & Clark, D. M. (1999). How do I appear to others? Social anxiety and processing of the observable self. Behaviour Research & Therapy, 37, 419–434.CrossRefGoogle Scholar
  61. Mellings, T. M. B., & Alden, L. E. (2000). Cognitive processes in social anxiety: The effects of self-focus, rumination and anticipatory processing. Behaviour Research & Therapy, 38, 243–257.CrossRefGoogle Scholar
  62. Miller, J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192–200.PubMedCrossRefGoogle Scholar
  63. Norton, P. J., & Hope, D. A. (2001). Analogue observational methods in the assessment of social functioning in adults. Psychological Assessment, 13, 59–72.PubMedCrossRefGoogle Scholar
  64. Orsillo, S., Roemer, L., & Barlow, D. H. (2003). Integrating acceptance and mindfulness into existing cognitive-behavioral treatment for GAD: A case study. Cognitive and Behavioral Practice, 10, 222–230.CrossRefGoogle Scholar
  65. Orsillo, S. M., Roemer, L., Block-Lerner, J., LeJeune, C., & Herbert, J. D. (2004). ACT with anxiety disorders. In S. C. Hayes & K. Strosahl (Eds.) A clinician’s guide to acceptance and commitment therapy (pp. 103–132). New York: Springer.Google Scholar
  66. Otto, M. W., Pollack, M. H., Gould, R. A., Worthington, J. J., McArdle, E. T., Rosenbaum, J. F., et al. (2000). A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia. Journal of Anxiety Disorders, 14, 345–358.PubMedCrossRefGoogle Scholar
  67. Palfai, T. P., Monti, P. M., Colby, S. M., & Rohsenow, D. J. (1997). Effects of suppressing the urge to drink on the accessibility of alcohol outcome expectancies. Behaviour Research & Therapy, 35, 59–65.CrossRefGoogle Scholar
  68. Rapee, R. M., & Heimberg, R. (1997). A cognitive-behavioral model of anxiety in social phobia. Behavior Research & Therapy, 35, 741–756.CrossRefGoogle Scholar
  69. Reich, J., & Yates, W. (1988). Family history of psychiatric disorders in social phobia. Comprehensive Psychiatry, 29, 72–75.PubMedCrossRefGoogle Scholar
  70. Roemer, L., & Orsillo, S. M. (2003). Mindfulness: A promising intervention strategy in need of further study. Clinical Psychology: Science & Practice, 10, 172–178.CrossRefGoogle Scholar
  71. Saboonchi, F., Lundh, L. G., & Ost, L. G. (1999). Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia. Behaviour Research & Therapy, 37, 799–808.CrossRefGoogle Scholar
  72. Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia: Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282–288.PubMedGoogle Scholar
  73. Schwartz, C. E., Snidman, N., & Kagan, J. (1999). Adolescent social anxiety as an outcome of inhibited temperament in childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1008–1015.CrossRefGoogle Scholar
  74. Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W., & Clark, D. M. (2003). Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research & Therapy, 41, 991–1007.CrossRefGoogle Scholar
  75. Stein, M. B., Chavira, D. A., & Jang, K. L. (2001). Bringing up bashful baby: Developmental pathways to social phobia. Psychiatric Clinics of North America, 24, 661–676.PubMedCrossRefGoogle Scholar
  76. Stemberger, R. T., Turner, S. M., Beidel, D. C., & Calhoun, K. S. (1995). Social phobia: An analysis of possible developmental factors. Journal of Abnormal Psychology. 104, 526–531.PubMedCrossRefGoogle Scholar
  77. Stopa, L., & Clark, D. M. (1993). Cognitive processes in social phobia. Behaviour Research & Therapy, 31, 255–267.CrossRefGoogle Scholar
  78. Stopa, L., & Clark, D. M. (2000). Social phobia and interpretation of social events. Behavior Research & Therapy, 38, 273–283.CrossRefGoogle Scholar
  79. Strahan, E. Y. (2003). The effects of social anxiety and social skills on academic performance. Personality and Individual Differences, 34, 347–366.CrossRefGoogle Scholar
  80. Sullivan, M. J. L., Rouse, D., Bishop, S., & Johnston, S. (1997). Thought suppression, catastrophizing, and pain. Cognitive Therapy & Research, 21, 555–568.CrossRefGoogle Scholar
  81. Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 27, 1–9.PubMedCrossRefGoogle Scholar
  82. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting & Clinical Psychology, 70, 275–287.CrossRefGoogle Scholar
  83. Teasdale, J. D., Scott, J., Moore, R. G., Hayhurst, H., Pope, M., & Paykel, E. S. (2001). How does cognitive therapy prevent relapse in residual depression? Evidence from a controlled trial. Journal of Consulting and Clinical Psychology, 69, 347–357.PubMedCrossRefGoogle Scholar
  84. Thera, N. (1972). The power of mindfulness. San Francisco, CA: Unity Press.Google Scholar
  85. Turner, S. M., Beidel, D. C., Cooley, M. R., Woody, S. R., & Messer, S. C. (1994). A multicomponent behavioral treatment of social phobia: Social effectiveness therapy. Behaviour Research & Therapy, 32, 381–390.CrossRefGoogle Scholar
  86. Turner, S. M., Beidel, D. C., & Cooley-Quille, M. R. (1995). Two year follow-up of social phoics treated with social effectiveness therapy. Behaviour Research & Therapy, 33, 553–556.CrossRefGoogle Scholar
  87. Turner, S. M., Beidel, D. C., & Wolff, P. L. (1994). A composite measure to determine improvement following treatment for social phobia: The Index of Social Phobia Improvement. Behaviour Research and Therapy, 4, 471–476.CrossRefGoogle Scholar
  88. Veljaca, K., & Rapee, R. M. (1998). Detection of negative and positive audience behaviours by socially anxious subjects. Behaviour Research & Therapy, 36, 311–321.CrossRefGoogle Scholar
  89. Wells, A., & Papageorgiou, C. (1998). Social phobia: Effects of external attention on anxiety, negative beliefs, and perspective taking. Behavior Therapy, 29, 357–370.CrossRefGoogle Scholar
  90. Wells, A., & Papageorgiou, C. (2001). Social phobic interoception: Effects of bodily information on anxiety, beliefs and selfprocessing. Behaviour Research & Therapy, 39, 1–11.CrossRefGoogle Scholar
  91. Wittchen, H.-U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: Prevalence, risk factors, and co-morbidity. Psychological Medicine, 29, 309–323.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2005

Authors and Affiliations

  • James D. Herbert
    • 1
  • Lee Ann Cardaciotto
    • 1
  1. 1.Drexel UniversityPhiladelphiaUSA

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