Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient

Conventional cognitive-behavioral therapy for social anxiety disorder, which is closely based on the treatment for depression, has been shown to be effective in numerous randomized placebo-controlled trials. Although this intervention is more effective than waitlist control group and placebo conditions, a considerable number of clients do not respond to this approach. Newer approaches include techniques specifically tailored to this particular population. One of these techniques, social mishap exposure practice, is associated with significant improvement in treatment gains. We will describe here the theoretical framework for social mishap exposures that addresses the client's exaggerated estimation of social cost. We will then present clinical observations and outcome data of a client who underwent treatment that included such social mishap exposures. Findings are discussed in the context of treatment implications and directions for future research.

► Social mishap exposures target patients’ exaggerated social cost by confronting them with the consequences of such mishaps. ► Data suggest that protocols that include social mishap exposures show greater efficacy than traditional CBT protocols. ► The current study provides a case example outlining how social mishap exposures can be incorporated into treatment. ► Social mishap exposures should be specifically tailored to the core fear of the patient.