Attentional focus in social anxiety disorder: Potential for interactive processes

The two preeminent cognitive behavioral models of social anxiety [Clark, D.M., & Wells, A., (1995). A cognitive model of social phobia. In Heimberg, R.G., Liebowitz, M., Hope, D.A., and Schneier, F.R. (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guilford Press.; Rapee, R.M., & Heimberg, R.G., (1997). A cognitive behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756.] suggest that attention to threat stimuli is critical in the maintenance of social fear. However, Clark and Wells assert that socially anxious persons attend almost exclusively to negative thoughts and self-imagery during social situations, whereas Rapee and Heimberg contend that socially anxious persons simultaneously attend to these internal cues and external stimuli potentially indicative of negative evaluation, such as an audience member's facial expressions. Rapee and Heimberg further suggest that attention to external and internal cues during social situations should be interdependent, such that focus on one has causal implications for the experience of the other. The current review examines the nature of the literature as it supports the assertions of each of these models of social anxiety, with particular attention to differing predictions regarding attentional focus. We conclude that socially anxious persons engage in both internal and external focus throughout the course of a social situation; however, there are a number of significant limitations to the literature. Accordingly, directions for future research are considered.