A metacognitive model of social anxiety: Implications for treatment

Clinical Psychology Review, Vol. 3, pp. 435-456, Printed in the USA. All rights reserved.

1983 Copyright

0272-7358/83 $3.00 + .O 0 1983 Pergamon Press Ltd.

A METACOGNITIVE MODEL OF SOCIAL ANXIETY: IMPLICATIONS FOR TREATMENT Lorne M. Hartman Addiction

Research

Foundation,

University

of Toron to

ABSTRACT. This article represents an attempt to clarify questions posed by evidence of varying pathways to change in social anxiety. A new perspective is developed which addresses these questions and, importantly, lays the foundation for an innovative treatment approach. Essentially, social anxiety is construed here as the product of a disorganization in which feelings and cognitions (both conscious and preconscious) about the self, about other people, and about the relations between self and others are organized. Specrfically, the socially anxious client experiences others autocentrically: that is, in terms of how the other person perceives, evaluates, and affects one’s own self. The result is a narrowed capacity for experiencing others. The goal of treatment in the new approach advocated here is to allow the individual to understand, appreciate, and share the feelings, thoughts, and experience of other people. Therapy is directed toward getting clients out of themselves and into other people.

The understanding and treatment of social anxiety has attracted much attention in recent years. This is due to the prevalence of such problems and the importance of social competence for present and future adjustment (Hartman, 1979; Poser & Hartman, 1979; Zigler & Philips, 1961). Social anxiety is a frequent complaint among individuals seeking psychotherapy. It has recently been estimated that 40% of North Americans experience extreme discomfort in social interactions, many with excessive avoidance of interpersonal situations (Zimbardo, 1977). A large number of these individuals regard their social anxiety as a problem which interferes with the ability to develop meaningful relationships or to pursue occupational goals. Social anxiety and interpersonal skill deficits have been implicated in a number of disorders including depression (Libet & Lewinsohn, 1973), delusions (Hartman & Cashman, 1983), schizophrenia (Bellack, Hersen, & Turner, 1976), sexual deviation (Abel, 1976), and alcoholism (Higgins & Marlatt, 1975). DSM-III (APA, 1980) defines social phobia as an anxiety disorder in which the main ingredient is a “persistent, irrational fear of, and compelling desire to avoid, situations in which the individual may be exposed to scrutiny by others” (p. 227). An important element is the individual’s fear that others will detect their anxiety Requests for reprints should be addressed to Dr. L. M. Hartman, Addiction Research Foundation, 33 Russell Street, Toronto,

Ontario, Canada M5S 2Sl 435

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through perception of visible cues, such as perspiration, blushing, or tremor. Various forms of social anxiety frequently mentioned in the literature include shyness, heterosocial anxiety, speech anxiety, stage fright, and so forth. Schlenker and Leary (1982) have drawn a useful distinction between two broad classes of social anxiety. Interaction anxiety occurs in contingent social transactions that involve continuous input and feedback from others (e.g., shyness, dating anxiety). In contrast, audience anxiety occurs in noncontingent interaction (e.g., stagefright, speech anxiety). Albeit not identical, these two forms of social anxiety are positively correlated (r = .48), so that people who tend to experience one will often manifest the other (Buss, 1980). Social anxiety here is defined as an affective, cognitive, and behavioral response characterized by feelings of arousal, tendencies toward avoidance/distress, and apprehension resulting from the prospect or presence of personal self-evaluation in real or imagined interpersonal situations. Behaviors associated with high social anxiety (Cheek & Buss, 1982) include nervous responses (e.g., fidget, perspire, stutter), disaffiliation (e.g., reticence, decreased eye contact, avoidance of situations), and self-protective discourse (e.g., not interrupting, attentive listening, nodding). Cognitive components of social anxiety (Hartman, in press) include thoughts of general social inadequacy (e.g., “I feel defenseless”), concern with others’ awareness of distress (e.g., “Does my anxiety show?” ), fear of negative evaluation (e.g., “What do they think of me?“), and preoccupation with arousal or performance “I feel tense in my stomach”). Affective considerations involve active and (e.g., unpleasant dimensions, concurrent with high intensity (Daly, Lancee, & Polivy, 1983; Leary, 1983). Behavioral research on the nature and treatment of social anxiety has relied on three theoretical formulations: conditioned autonomic anxiety, social skills deficit, and faulty cognitive-evaluative appraisal. Each of these hypotheses will be briefly examined prior to presenting an integrative model which sets the stage for an innovative approach to the treatment of social anxiety. The new model outlined here attempts to integrate a broad subset of phenomena related to social anxiety in terms of a metacognitive excess corresponding to an increased level of selfawareness. The ability of such an analysis to integrate a number of diverse research findings will be illustrated along with speculation as to the most profitable avenues for future research. CURRENT THEORIES OF SOCIAL ANXIETY

The first approach occupying attention in the behavioral literature is the conditioned anxiety hypothesis. This view states that social phobia is due to the inhibition of interpersonal responses by anxiety (Wolpe & Lazarus, 1966). It is suggested that adequate skills are available to the individual, but that autonomic arousal conditioned to social interactions interferes with or prevents satisfactory interpersonal functioning. Based on this premise, then, interventions focusing on anxiety reduction would be the treatment of choice. Indirect evidence in support of this hypothesis is available from studies demonstrating alleviation of social anxiety and enhancement of interpersonal skill through treatment based on relaxation and systematic desensitization (Curran & Gilbert, 1975; Hartman, 1982; Marshall, Keltner, & Marshall, 1981; Trower, Yardley, Bryant, & Shaw, 1978). The second model is based on a skills deficit hypothesis which states that the

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cause of subjective distress in social situations is an inadequate or inappropriate repertoire of interpersonal behavior. Differences in social competence between low and high socially anxious subjects as rated by judges have been observed (Arkowitz, Lichtenstein, McGovern, & Hines, 1975; Borkovec, Stone, O’Brien, & Kaloupek, 1974). Social anxiety due to skill insufficiency suggests response acquisition methods as an appropriate treatment tactic. Skills training has been shown to increase interpersonal competence and, at the same time, reduce social anxiety (Cut-ran & Gilbert, 1975; Hersen & Eisler, 1976; Twentyman & McFall, 1975). Finally, cognitive factors in the development, maintenance, and treatment of social anxiety have recently attracted considerable attention (Hartman, in press). Setting unrealistic performance criteria, underestimating one’s own skill, overly negative self-evaluation, and insufficient self-reinforcement may be implicated in the origin and maintenance of social anxiety. Thus, high socially anxious individuals recall more negative feedback than positive feedback (O’Banion & Arkowitz, 1977) and interpret the same feedback as more negative than do low socially anxious subjects (Smith & Sarason, 1975). Compared with low anxious subjects, high anxious subjects also underestimate their own social performance and expect greater negative evaluation from others, although external judgments of social skill by observers fail to differentiate between the two groups (Clarke & Arkowitz, 1975). Socially anxious individuals report more irrational beliefs and become more emotionally aroused when imagining themselves in situations of possible social rejection (Goldfried & Sobocinski, 1975). Finally, high anxious males emit more negative self-statements than low anxious males when anticipating discussion with an unfamiliar female (Cacioppo, Glass, & Merluzzi, 1979). Cognitive therapy approaches based on self-statement modification and rational restructuring have produced promising results in the treatment of social anxiety (Glass, Gottman, & Shurak, 1976; Kanter & Goldfried, 1979; Malkiewich & Merluzzi, 1980). In summary, social anxiety has been conceptualized as involving at least three distinct variables, each of which suggests a different treatment emphasis. Interventions based on these hypotheses have all been somewhat successful in the alleviation of social avoidance and interpersonal distress. In fact, other psychotherapeutic approaches aligned with so-called “nonbehavioral” schools have similarly claimed successful results in the treatment of social anxiety (Luborsky & Spence, 1978). Several explanations need to be addressed in order to explain apparent similarities in treatment outcome with different forms of therapy. How is it that anxiety management, skills training, and cognitive therapy (not to mention psychoanalytic, client-centred or gestalt approaches) all seem to be effective in assisting socially anxious persons? ISSUES BROUGHT TO FOCUS BY EXTANT MODELS Individual

Differences

The fact that different treatment approaches are capable of producing comparable successes can be accounted for by several alternative explanations. The first possibility is that social phobia is not a uniform condition manifest in the same manner by all anxious individuals. Following Lang (1977) and many other contemporary theorists and researchers, anxiety may be seen as consisting of at least three components. These have been described as the verbal-cognitive, physiological-auto-

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nomic, and behavioral-motoric. Each system of .esponding corresponds with one of the treatment approaches noted above: that is, cognitive therapy, anxiety management and interpersonal skills training, respectively. Thus, it could be that the failure to obtain treatment findings which document superiority of a given method is due to the camouflaging of average group outcomes. That is, individual differences in the relative importance of response systems are hidden by the analysis of group comparisons. For example, certain individuals may experience interpersonal discomfort in and avoidance of social situations because of autonomic anxiety without social skill deficits or faulty cognitive-evaluative appraisal. This group of socially distressed persons would be candidates for some type of anxiety managment training. A second sub-type consists of those with primary inadequacy in social performance skills, which mediates anxiety, avoidance, and subsequent self-evaluative impairment. Response acquisition and rehearsal methods would probably be the treatment of choice here. Finally, there may be a class of social phobics who primarily engage in faulty perception and irrational thinking. Such persons with a first order deficit in cognitive processes would benefit most from a treatment approach designed to modify thinking patterns, restructure self-evaluations, and change inaccurate belief systems. This analysis is not meant to imply that a therapeutic strategy is associated only with a single, unidimensional effect. Rather, in all likelihood, psychological interventions have multiple effects, in the sense of response generalization, that impact other behavioral modalities. Thus, for example, cognitive therapy may have effects on self-statements that, in turn, yield changes in overt behavior and physiological arousal. Common Therapeutic Variables Accordingly, a second possible explanation for the absence of robust differences in the efficacy of varying treatment strategies may reside in the convergent processes which characterize therapeutic change. Many writers in the psychotherapy field today are calling for an integrative understanding of various approaches to psychotherapy (Garfield, 1980; Goldfried & Padawer, 1982). Each form of psychotherapy emphasizes a particular channel of change or aspect of human experience. Most of the variance in therapeutic change, however, may be accounted for by psychological forces which are shared in common by different treatment approaches. Goldfried and Padawer (1982) have suggested that the search for commonality among therapeutic orientations is most likely to be profitable in the domain of basic principles or strategies. A lower level of abstraction, that of techniques, only allows for trivial similarities to emerge. Points of meaningful comparison at a higher theoretical level are not probable, especially given the lack of consensus within any particular form of psychotherapy. A review of the three behavioral therapies employed in treating social anxiety reveals a number of similarities in principles or strategies. These include the culturally induced expectation that treatment holds some promise of alleviating personal distress (Frank, 1961). In addition, the participation in a therapeutic relationship provides an important context within which change may occur (Strupp, 1973), especially in light of the interpersonal nature of social anxiety. More important, however, is the observation that all forms of therapy provide

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some manner of feedback which is designed to correct individuals’ subjective views of themselves and their environment. Providing an alternative way of looking at oneself sets the stage for subsequent therapeutic change. The individual who learns progressive muscular relaxation and later engages in previously avoided social transactions is thus exposed to corrective feedback in perceptual-cognitive processes. Meichenbaum (1980), for example, has referred to an evidential theory of change. The person who refused to eat lunch in the cafeteria at work because of social anxiety may, through treatment, be able to have a snack one afternoon in the coffee shop. Whether the ability to enter a feared situation occurs as a result of newly developed coping skills (relaxation), changed internal dialogue (cognitive therapy), or an enhanced behavioral repertoire (social skills training) may be secondary. The important therapeutic mechanism resides in facing or confronting the problem situation, and, as a result of this exposure, effecting a change in one’s self-appraised abilities, competencies, or self-efficacy (Bandura, 1977). Each form of therapy for social anxiety is designed to expand the client’s range of social experience. This task results in the disconfirmation of expectancies (e.g., “I really believed I would faint if the office manager asked me a direct question at the staff meeting”). Such corrective experiences are often mediated by performance-based operations and result in a modification of socially anxious clients’ views of themselves and others. Clients can then continue to add further data consistent with this new and more adaptive understanding of social experience through continued reality testing. There are many other common therapeutic elements which cut across different orientations and techniques. These include the placebo response, the mere passage of time, modeling, reassurance, and support. Further exploration of these factors, however, is not likely to provide answers to the present question. How does behavior change come about through so many different ways? Specifically, why is it that training in anxiety management and coping responses, developing new social behaviors, changing self-talk, and modifying self-evaluative beliefs all lead to some alleviation of social anxiety and interpersonal distress? Several explanations were explored in attempting to account for the result that apparently diverse forms of therapy prove successful in similar cases. First, we examined the possibility that the population of social phobics may be composed of different sub-classifications, each of which is better suited to a particular therapeutic approach. The second explanation emerges from a search for factors common to diverse methods of psychotherapy. Each form of psychotherapy may promote change by affecting a shared set of psychological mechanisms. A third possibility arises from an integrative understanding of the above considerations and, more importantly, lays the groundwork for developing a new approach to the treatment of social anxiety. A METACOGNITIVEMODEL Using clinical practice as a starting point, some very definite possibilities exist for a far better understanding of social anxiety and, hopefully, more effective treatment. To begin with, we all accept the notion that it is circular to infer etiology from treatment effectiveness. Restructuring negative self-statements, for example, results in cognitive, affective, and behavioral change. The reasons for change, however, may be at a different level than the mere substitution of positive thoughts

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for negative ones. The central mechanism of ‘!ange is not necessarily embedded within the therapeutic strategy. Certainly, as adumbrated above, different forms of therapy do mobilize common forces which result in change. The analysis proposed here, however, suggests that social anxiety may be best understood in terms of a characteristic feature in higher order cognitive processing. Despite the evidence for individual differences in response systems, there is a level of psychological functioning at which all socially anxious persons are alike. A common ingredient in social anxiety occurs in the form of an over-abundance of self-centered cognitive and perceptual operations. This information-processing mechanism may be similarly influenced by different treatment approaches indirectly through a distraction or disengagement process. The socially anxious individual’s manner of self-appraisal or metacognitive (cf. Flavell 8c Wellman, 1977) executions (that is, cognitions about thinking and perceputal events) is impaired and, in turn, mediates arousal, avoidance, and faulty appraisal. It is not that a deficit exists in the metacognitive domain of this clinical population, but an excess. Metacognition, here, refers to self-knowledge about cognitive processes, “knowing about knowing,” or the person’s awareness of his or her own cognitive machinery (Brown, 1978). The components of social performance include cognitive, perceptual, physiological and motor processes. Control processes or executive functions occur at the level of metacognitions. Social anxiety due to a metacognitive excess occurs when the normally automatic functions of social discourse are impaired as a result of the individual’s attention to them. Self-directed attention engages the “comparator” (in control theory terms: cf. Carver & Scheier, 1982) at a superordinate level, here referred to as metacognitive. Metacognitive activity involves higher order organizational properties, or second level awarenesses in the monitoring and control of cognitive operations. In normal social interaction, attention shifts from moment-to-moment and at times the perception of one’s own thoughts, feelings, and behavior may be temporarily focal. This awareness of one’s present state or behavior defines our use of the term metacognition. Metacognitive strategies involve self-regulatory mechanisms during ongoing activity as in, for example, the internal monitoring of behavioral intentions and instructions to the motor system (Shatz, 1978). As a result of this monitoring, the person becomes conscious of his or her thoughts, images or feelings (Neisser, 1976). Metacognitive activity involves the direct awareness of one’s behavioral intentions and inputs to motor systems and thus allows the person to edit the production of his or her behavior. When self-awareness or “editing” (that is, metacognitive activity) becomes recursive in an interpersonal context, the individual is removed from the interactive process, resulting in anxiety and impaired social performance.

Social Anxiety and Metacognition The individual who is fearful of interpersonal situations and anticipates negative evaluation from others engages in too much self-focused metacognition. There is a profound attentional bias characteristic of this group of distressed persons that interferes with satisfactory social functioning. Clients are constantly attempting to monitor their arousal, assess performance, appraise others’ perceptions of them and anticipate external evaluations. They are so caught up with themselves-what they say, how they look, who they’re interacting with, whether they’re performing

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well-that they have lost the ability to participate comfortably, enjoyable and efand ficiently in social transactions. For one thing, the excessive self-monitoring self-appraisal actually interfere with attentional processes. In the psychoanalytic framework, “experiencing versus observing ego” is a phrase employed to describe the self-examination of executive functions. Thought processes are thus directed by a higher order operation of self-reflection. The detour takes the person along a new route which monitors, evaluates and reflects upon experience. In the case of social anxiety, this metacognitive process results in repeated efforts to appraise self-worth and self-efficacy in response to even remotely relevant evaluative situations. Perception, execution, and thought processes become disorganized in a closed-loop of self-reflection rather than an adaptive integration of internal and external processes. This phenomenon is well illustrated by the fable of the centipede. Upon deciding that walking is a desirable skill to acquire, the centipede only manages to stumble all over himself because he focuses on walking behavior rather than on where he is going. Similarly, the socially anxious person is excessively self-reflective. The object of attention shifts from the environment to the self (especially in terms of performance, arousal and appraisal). The result is a dramatic change in the ambience of social transactions. Consistent with the present analysis, Meichenbaum and Butler (1980) characterized the thinking processes of high socially anxious individuals as: (a) self-oriented rather than taskoriented, which serves to deflect attention from the task at hand; (b) basically negative rather than positive or coping; and (c) automatic and stereotyped. Internal dialogues tending towards evaluative self-reference and all of the adverse concomitants associated with such ideation may contribute to affect disturbance and performance impairment.

Self-Concept

and Metacognition

Socially anxious clients frequently complain that they are unable to follow a conversation long enough to engage meaningfully in the dialogue. “It’s as if my own thoughts are so loud that I can’t listen to what other people are saying”. This is not a paranoid, delusional process with auditory hallucinations. These people are not psychotic; nor do they show evidence of formal thought disorder. They simply and completely have too little confidence in their own merits as a person. It is partly “ego anxiety” in the form of anxiety about one’s self, one’s being, one’s essence. The sense of self or personal worth is too tentative, too easily threatened. In fact, a negative self-attitude, in many cases, may be the basic developmental construct about the self. In support of this hypothesis, Zimbardo (1977) reported a significant negative correlation between self-esteem and shyness (r = - .48). Regardless of how one attempts to explain the genesis of such a deficit in selfesteem, clinical and research evidence of its existence in this group of patients is compelling. Whether due to faulty modeling, social isolation, or environmental impoverishment, the interpersonally timid, avoidant, anxious individual continues to question his or her fundamental worth as a valuable and acceptable person. Excessive metacognitive self-focusing in combination with low self-esteem is the standard recipe for social anxiety (Brockner, 1979a, 1979 b; Brockner & Hulton, 1978; Buss & Scheier, 1976; Ickes, Wicklund, & Ferris, 1973; Turner, Scheier, Carver, & Ickes, 1978).

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The low self-esteem in social anxiety may be due to faulty interpretation of feedback from others (Mead, 1934). According to this view, we learn about ourselves through a process of reflective appraisal. During social interaction, the social feedback provided from others guides self-perception. Effective use of such feedback, however, depends on the person’s ability to adopt the other’s viewpoint. Selffocusing tendencies may thus interfere with the formation of a favorable selfconcept through inhibition of reflective appraisal (Gergen, 197 1). This hypothesis has received empirical support from recent research examining the effects of selfdirected and other-directed attentional states on self-evaluation in social interaction (Diener & Srull, 1979; Fenigstein, 1979). Self-directed attention in social anxiety may cause an individual to feel psychologically removed from the interaction and to concentrate on his private agendas and thoughts, to engage in metacognitive self-focusing at the possible expense of a similar awareness of external events. Egocentric metacognitive processes are likely to interfere with reflective appraisal resulting in low self-esteem and social anxiety. Social situations thus become severely stressful and debilitating experiences. As a result, the socially anxious individual begins to feel more personal responsibiIity for failure than for success (Ellis & Holmes, 1982). Arkin, Appelman, and Burger (1980), for example, found that high social anxiety subjects approached social situations with a modest presentation of self, reflecting an attempt to avoid embarrassment and rejection (“cost-orientation”). Low social anxiety subjects, by comparison, were “reward-oriented”; that is, they entered social situations with a favorable presentation of self in the attempt to win approval. A study of fear based behavior conducted by Carver, Blaney, and Scheier (1979a) found that confident subjects were not deterred by self-awareness during an approach task (the feared stimulus being a snake) whereas doubtful subjects withdrew earlier in the approach sequence when self-focus was high than when it was low. This result was conceptually replicated in a different behavioral domain, persistence in response to failure (Carver, Blaney, & Scheier, 1979b). Inducing unfavorable expectancies resulted in less persistence when self-focus was high than when it was low. Favorable expectancies, on the other hand, resulted in more persistence when self-focus was high than low. Hull and Levy (1979) presented a model of self-awareness consistent with the above findings. Specifically, self-awareness purportedly implicates a particular form of encoding that has its effects independent of focal attention and comparison processes. In accord with the results of Geller and Shaver (1976), self-awareness serves to increase the individual’s understanding of the immediate situation in terms of contingencies that are potentially self-relevant. High self-conscious individuals possess a more uniform and well-structured cognitive organization corresponding to the self that is more easily activated by environmental cues to self-reference. Metacognitions are postulated as the superordinate framework governing the encoding process that heightens an individual’s sensitivity to self-relevant aspects of the immediate situation. Carver’s (1979) cybernetic model of self-attention processes is consistent with and extends the information-processing view of self-directed attention. Briefly summarized, self-focus heightens awareness of salient self-elements when behavioral standards are absent. Automatic matching-to-standard occurs in response to self-focus when behavioral standards are present. A negative feedback system is

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thus established and allows for both positive affect (in response to favorable outcome assessments) and negative affect perhaps with behavioral withdrawal (in response to unfavorable outcome assessments). A large body of research evidence is presented in support of the model and comparisons made with self-awareness theory (Duval & Wicklund, 1972), Bandura’s (1977) analysis of cognitive processes underlying fear-related behavior, helplessness theory (e.g., Abramson, Seligman, & Teasdale, 1978), and social comparison theory (Festinger, 1959). Of particular relevance to the present argument is the notion that the aspect of self that is examined during self-attention is usually suggested by environmental cues. Thus, if interpersonal stimuli are categorized as typically emotion-inducing, then such stimuli may cue a search for bodily arousal as a salient self-dimension when attention is self-directed. Clearly, a reciprocal process is also possible. That is, examination of a salient self-aspect may determine the environmental stimuli attended to when attention is directed outwards. Thus, awareness of an existing state of bodily arousal in the absence of a recognized antecedent may result in environmental search oriented towards stimuli categorized by the person as potentially emotion-inducing. In a similar manner, anxiety expectancies involve learning to anticipate becoming anxious when social occasions are encountered. Moreover, such anticipation of anxiety becomes fear-eliciting when the individual is afraid of becoming anxious (Reiss, 1980). The Carver et al. (1979a, 1979b) research on outcome expectancy discussed earlier in this section suggests that individuals with unfavorable expectancies are more likely to experience negative affect in response to self-directed attention. Socially anxious individuals have doubts about their ability to function in social contexts. They are not certain that they possess the specific skills, abilities, or characteristics required for executing effective interpersonal behavior. The perception that behavior is impeded by such a self-deficit (low efficacy expectancy) will result in affect that is associated with the self. The consequences are reflected in self-esteem (Brockner, 1979b). Social anxiety, in the present analysis, is a function of chronic low self-esteem in combination with metacognitive self-awareness. It involves a deficit in the individual’s ability to exit from the closed loop of metacognitive self-awareness to an external focus which, parenthetically, may also be metacognitively mediated. Excessive self-awareness interferes with attention (Vallacher, 1978) and prosocial behavior (Gibbons 8c Wicklund, 1982). Metacognitive self-awareness thus inhibits sensitivity to others. Moreover, the metacognitive surfeit may be the common element which is similarly affected by each of the treatment strategies outlined at the beginning of this article. Teaching anxiety self-management skills, acquiring new social behaviors, and changing cognitive-evaluative processes all serve to indirectly distract the individual from the metacognitive fixation. Clients are taught to focus attention on developing relaxation, emit specific overt responses, or engage in an adaptive covert dialogue. All of these activities are, to some degree, incompatible with metacognitive self-concern viewed here as the primary preoccupation of the socially anxious client. Albeit not intended, herein may lie the answer to our question. Improved social functioning and interpersonal comfort may occur as a result of operations which disengage the individual from self-monitoring, self-appraisal and self-centeredness. The impairment in social function due to a self-centered metacognitive overload can be seen as a “selective attention deficit.” From the perspective of information-

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processing theory, Schneider and Shiffrin (1977) have suggested that limited capacity to process and act upon information interferes with performance because of a “divided-attention deficit.” Two conversations cannot be followed as easily as one, and the socially anxious person has at least three conversations to attend to. One external, and two internal: that is, (1) the subject’s dialogue with the other person; (2) the subject’s conscious thought or internal dialogue, and (3) the subject’s metacognitions, the organizing aspect of thinking that monitors and directs the strategies, route and content of conscious thought. Metacognition represents the executive that controls the workings of subordinate functions. The state of this executive system at any given moment helps determine the level and type of activity in basic components of social performance. Thus, selfawareness is not only affected by physiological arousal; for example, it affects the system as well. The metacognitive system can only process a limited amount of information at any given time. In a difficult task (and interpersonal functioning definitely can be seen as such) the amount of information being fed back to the metacognitive system may exceed its capacity. Metacognitions become overloaded and valuable information about the social transaction that cannot be processed gets lost, distorted or ignored. In the case of social anxiety, the capacity of the metacognitive function is overtaxed, with resulting loss of efficiency and impairment of interpersonal performance. As I will argue in the final section of this paper, the ability to allocate attentional resources so as to minimize the probability of bottlenecks will serve to improve the effective capacity of the system. Relateci Perspectives

on the Self

Self-awareness as a dispositional mediator of attentional deficit, anxiety, and interpersonal effectiveness is not a new concept to the psychological literature. Despite much previous interest in self-consciousness, however, behavioral writers have paid scant attent.ion to it. Early in the history of psychology, William James (19 10) noted the dichotomous nature of awareness (external-environmental versus internal-self). Increased awareness of the self plays an important role in psychoanalysis as a treatment technique, therapeutic goal, and patient variable predicting outcome. Argyle (1969) discussed the impact of self-awareness on social interaction, while Duval and Wicklund (1972; Wicklund, 1975) have elaborated a theory of selfawareness that has generated investigations of the behavioral consequences of selfawareness (e.g., Duval, 1976). Fenigstein, Scheier, and Buss (1975) developed a scale for assessing self-consciousness, which revealed, through factor analysis, three components: private selfconsciousness, public self-consciousness, and social anxiety.* Relationships among these scales indicate that the Private and Social Anxiety scales are essentially unrelated, while the Public scale shows a moderate correlation, about .30, with the Private scale and the Social Anxiety scale (Buss, 1980). A focus of attention on oneself as a social object (public self-consciousness) is important for the experience of social anxiety (Hartman, in press). Fenigstein (1979) found that subjects high in public self-consciousness showed a more negative reaction when confronted with ‘Public self-awareness is what is commonly thought of as “self-consciousness”; that is, an awareness of the self as a social object. Private self-awareness involves a focus of attention on the covert, internal aspects of oneself (such as beiiefs 2nd feelings).

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the rejection of a group than did those who were low on this dimension. Scheier and Carver (1977) as well as Borkovec and O’Brien (1977) have shown that selffocused attention serves to intensify an individual’s affective or emotional experience. Self-monitoring processes emphasize mechanisms underlying variations among individuals in the extent to which they are aware of and regulate social affects and behaviors (Snyder, 1979). Individuals high in self-monitoring are particularly sensitive to the expression and presentation of others in social situations. These cues are employed by the person to monitor, regulate, and control his or her own verbal and non-verbal presentation of self. A self-report scale developed to assess selfmonitoring has resulted in a good deal of research suggesting that high self-monitors attend more to social cues, read these cues better, are better at acting out roles, are seen by others as having better control of emotional expression, seem to be more aware of themselves and others as social objects, try to present themselves in ways they deem appropriate, and assume that others are likely to do the same (Snyder, 1979). Although there are problems in interpreting the results of research with the Self-Monitoring scale (Buss, 1980), there is some overlap with the present analysis of social anxiety. The concept of self-monitoring may represent the positive side of public self-consciousness and be inverseiy related to social anxiety. High seif-monitors engage in an abundance of externally-focused metacognitive activity that emphasizes awareness of oneself as a social object and uses that information for adaptive self-presentation. Low self-monitors may also be high in public selfconsciousness but with deleterious effects on social performance and anxiety. Thus, socially anxious individuals are also likely to be high in public self-consciousness. Whether or not the individual high in public self-consciousness will experience social anxiety depends on whether they use metacognitive self-awareness for the purpose of efficient self-presentation (high self-monitoring in Synder’s scheme) or deficient self-denigration (low self-monitoring). In the latter case, individuals focus attention on how they think others see them rather than on their perception of others. This process results in pernicious metacognitive self-focusing with subjective distress in social situations and impaired interpersonal performance. Markus (1977) reported on the influence of se~sc~emutu defined as “cognitive generalizations about the self, derived from past experience, that organize and guide the processing of self-related information contained in the individual’s social experiences” (p.64). These cognitive generalizations about the self are subject to individual differences which can be linked to a number of empirical referents. Performance on a variety of cognitive tasks indicated that self-schemata facilitate the processing of information about the self, contain easily retrievable behavioral evidence, allow confident predictions of future behavior, and resist counter-schematic information. In accord with these results, metacognitive activity corresponding to an increased level of self-awareness may involve the individual’s propensity to encode information in terms of its self-relevance by the invocation of elaborated self-schemata. It is suggested that socially anxious persons tend to have many selfschemata simply because they think about themselves so often. Such an analysis is consistent with the cybernetic model of Carver (I 979) and the results of Hull and Levy (1979) discussed earlier. Schlenker and Leary (1982) advocated a self-presentation approach to the study of social anxiety. They propose that social anxiety arises when people are motivated to make a preferred impression on real or imagined audiences but doubt that they

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will do so. The resultant perceived or imagined unsatisfactory evaluative reactions from subjectively important audiences mediate both affective arousal and behavior. In terms of the present approach, self-presentational problems may be viewed as a correlate of self-attention. The experience of social anxiety is heightened by the individual’s increased awareness of internal states, including thoughts and affect. Self-presentation is a motivational process in social anxiety. People are motivated to make a preferred impression on others. According to the present analysis, however, the arousal and affect that accompany social anxiety and the behaviors associated with social anxiety are mediated by metacognitive self-awareness. The socially anxious person is trapped in a state of self-examination, concentrating on their thoughts, feelings, and behaviors in a way that debilitates performance. The combination of self-preoccupation, negative affect/arousal, and impairment of social performance may originate in doubts about self-presentation producing desired reactions from others. Such a view is not inconsistent with the model advocated here. Doubts about creating preferred impressions on others may be an important consideration in the early developmental stages of social anxiety. By the time someone presents for treatment, however, they have come to conceptualize themselves as socially anxious. Their impression-relevant outcome expectancies are abysmally low. In fact, they assume adverse impressions, selectively attend to negative feedback, and are more disturbed by unfavorable reactions (O’Banion 8c Arkowitz, 1977; Smith 8c Sarason, 1975). Consistent with the present approach, Christensen (1982) reported two studies demonstrating maladaptive social effects of excessive self-consciousness. First, persons high in maladaptive self-consciousness were seen as more socially inadequate by their peers. Secondly, maladaptive self-consciousness was associated with ineffective social behavior, reduced sensitivity to other persons, and heightened self-perception of inadequacy in a contrived social interaction. Thus, it seems that obsessive self-concern prevents awareness of external events. Self-awareness is cognitively demanding and, as a result, the self-conscious person is less sensitive to subtle behaviors and emotions in others. Interpersonal performance is impaired as a consequence of the metacognitive excess. Accordingly, social inadequacy may be the result of a difference in the attentional focus of high and low socially anxious individuals during interpersonal transactions. In a related area, Wine (1971) reviewed the literature suggesting an attentional interpretation of the adverse effects which test anxiety has on task performance. Like the highly test-anxious individual, persons experiencing social anxiety suffer from an internal focus on self-evaluative, self-deprecatory thinking, and perception of autonomic arousal. The additional component of attention to others’ perceptions and evaluation establishes the interpersonal variable distinguishing social anxiety from test anxiety. Since effective social function requires full attention for adequate performance, the socially anxious subject is impaired by the effort to divide attention between internal cues, external cues, and task cues. As in the case of test anxiety, the activation of self-oriented interfering tendencies in social anxiety is greatest in situations perceived to be highly evaluative. In a similar vein, Sarason (1975a, 1975b) pointed out that anxiety is related to self-evaluation. The highly anxious person is self-centered and focuses on self-evaluation and self-worry, rather than on the situation task. These descriptions all refer to attentionally demanding cognitive activity during social interaction. Christensen’s (1982) self-consciousness comes closest to the pres-

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ent proposition. The socially anxious person responds to evaluative interpersonal situations with ruminative self-awareness and thus cannot direct attention to the ongoing flow of an interaction. The current analysis views this attentional impairment as a self-focused metacognitive excess and, furthermore, suggests that treatment designed to direct attention to “other-person variables” and away from the self will result in improvement. The formulation of social anxiety advocated here suggests treatment in which clients are given intensive practice in interpersonal exercises, accompanied by instructions to focus fully on the other person and thus inhibit self-directed metacognition (i.e., awareness of self-relevant cognitive processes). The present analysis may have implications for other psychological disorders, especially conditions thought to be mediated, in part, by social anxiety. For example, Hull (1981) has proposed that many of the causes and effects of alcohol consumptidn can be understood given the premise that alcohol functions to decrease the individual’s level of selfawareness. According to this perspective, alcohol effectively interferes with the higher order mental processes (that is, metacognition) involved in self-aware states and thereby reduces the individual’s sensitivity to information regarding the self. Preliminary experimental findings on alcohol’s cognitive, behavioral and physiological effects are consistent with the self-awareness hypothesis (Hull & Young, 1982; Hull, Levenson, Young, 8c Sher, 1983). In a related vein, Jones and Berglas (1978) have suggested that drinking may be one of several self-handicapping behaviors used by individuals to avoid being viewed by others as lacking in competence. When the individual is unsure of his/ her ability to perform successfully, (e.g., perceived constraints on self-presentation in a social situation; Schlenker & Leary, 1982), drinking provides one convenient justification for interpersonal incompetence. This self-handicapping model received some support in a study by Tucker, Vuchinich, and Sobell (1981), who found that college students confronted with a very difficult task drank in a selfhandicapping manner if a performance-enhancing option (e.g., study of test materials) was not available to them. In fact, simply suffering anxiety provides an esteem-protective function when used as a self-handicapping tactic (Smith, Snyder, & Handelsman, 1982).

In proposing yet another approach to the treatment of social anxiety, it is important to move away from the traditional concern with equilibration which characterizes all forms of psychotherapy. The evocative therapies promote discharge in order to relieve tension from pent-up anxieties. Insight therapies encourage understanding through interpretation and feedback. Finally, the behavioral therapies (including cognitive orientations) focus on control and regulation in order to produce adaptation. The treatment model advocated here directly adresses the central resistant “mechanism” in social anxiety. What is it that prevents change? Where is the resistance to change in social anxiety? In answering this question we have moved from a problem-centered focus to an examination of underlying patterns in the metacognitive domain. The major obstacle in overcoming social anxiety is resistance in the form of self-centeredness. The socially anxious person must be helped to break out of the self-preoccupation which is the source of resistive paralysis. Thus, the therapeutic strategy described

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~~~I

PRoCESSES -

F’IGURE 1. Antecedents, components, and processes of social anxiety.

below works with the resistance through inversion. By attending differently to the social world, clients are helped to surrender themselves to disequilibrium so that reorganization and accomodation can eventually occur. Specifically, the client is encouraged, taught, and given opportunities to practise being an other-centered interactionist in a group therapy format. The goal is to provide structured opportunities to practise insistent, willed, and even exaggerated attention toward others so that a decreased need for the exercise of external awareness will be possible. Once established, the vigilant exercise of other-centered awareness, also metacognitively mediated, is less important and the individual is readily able to integrate attentional needs. In the proposed system, the antecedents of social anxiety (within subject factors and environmental stimuli) directly activate and receive feedback from attentional processes directed toward the self. Psychological vulnerability (e.g., self-esteem or efficacy expectations) and challenging situational variables (e.g., perceived threat or cues to self-reference) both precipitate self-focus and are heightened by enhanced self-awareness. Only the process variables, self-focus and metacognition, can directly activate and receive feedback from each of the components within the system (thoughts, feelings and behavior). Thus, control passes directly from self-

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EXTERNAL FOCUS PROCESSES I

FIGURE 2. Metacognitive mediation of external focus and the component system.

focus to the metacognitive function or indirectly through the component system to metacognition. Each of the components can activate each other indirectly, and receive information from each other indirectly; in both cases, mediation occurs via the metacognitive to self-focus route. For example, given low self-esteem and perceived evaluative threat, self-focusing may result in autonomic arousal (e.g., sweating) which affects other components of the system (i.e., performance and cognition) but only via the metacognitive link. Information about autonomic activity is filtered to thinking and behaving in the situation through metacognitive channels. Treatment strategies designed to develop coping behaviors (anxiety reduction, interpersonal skills or positive self-talk) intervene at the level of components and alleviate the self-centered metacognitive overload by creating a distracting task orientation. The overall system, however, remains operative, and the effects of such treatment are likely to be neither lasting nor clinically significant. This is because intervention at the component level involves a focus on minimizing the intensity of disruption in a particular channel of the system resulting in some amelioration of the negative metacognitive to self-focus feedback loop. Alternatively, treatment strategies designed to disengage the metacognitive self-focus loop through decentering operations serve to systematically short-circuit the maladaptive escalation of anxiety processes and encourages, in fact mandates, effective other-centered interaction and social performance.

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Accordingly, the proposed treatment employs metacognitive processes for the adaptive regulation of cognitive, physiological and performance components. Therapy involves instructions and training designed to promote thinking and perceptual operations that are externally-focused. Thoughts, feelings, and behaviors during the course of social transaction are geared towards the other person. The external focus of awareness is mediated at the level of metacognition. The individual instructs him or herself to think, feel, and behave differently and, importantly, attends differently to feedback from the component system. An interpretation of social interaction in terms of Piaget’s (1950) concept of decentering lends support to such a therapeutic strategy in treating social anxiety. Effective social interaction requires the ability to consider one’s behavior in light of different perspectives simultaneously (Feffer, 1970). Each participant in a social interaction modifies behavior in accordance with anticipation of the other’s response. Accurate anticipation of the other’s reaction requires the ability to take the other’s perspective. Feffer and Suchotliff (1966) found that the simultaneous consideration of different viewpoints as measured in a role-taking task indicated a level of cognitive organization which facilitated effective social interaction. Conversely, individuals who were only able to focus upon their behavior from a single viewpoint (self-focused metacognition) were found to have difficulty in appropriately modifying their responses in a communication task. Clearly, future research needs to assess the causal (temporal) sequence between the cognitive, behavioral, affective, and physiological dimensions of social anxiety. For example, research reviewed in the previous section suggests a primary role for self-focusing and attentional properties of metacognition with respect to arousal, self-concept, performance and anxiety. On the other hand, arousal per se has been shown to lead to self-focused attention (Wegner & Giuliano, 1980). An attempt to replicate this finding proved unsuccessful, however, (McDonald, Harris, & Maher, 1983) and, to further complicate matters, Brodt and Zimbardo (1981) were able to alter social behavior in specifiable ways by misattributing arousal to an external source. When specific arousal symptoms, presumably associated with social anxiety, were misattributed to a nonpsychological source, subjects were more verbally fluent and assertive, less aroused, and reported strong preference for further affiliation. It is therefore clear that a final mapping of the causal relationship among the major variables that constitute thinking, feeling, and behaving is not yet available. Nevertheless, a review of the current state of knowledge in this respect has directed the present analysis towards a speculative intervention centering on the effects of other versus self-focused attending on arousal and performance in social anxiety. Two predominant sets of skills constitute basic ingredients in decentering: responding skills and initiating skills. In the area of responsiveness, therapy focuses on developing empathy. Socially anxious clients are trained to see the world through another’s eyes. To stand in another’s place and experience the world the way they do involves perceputal and processing operations which are incompatible with the self-centered metacognitive fixation of social anxiety. Regardless of the benefits inherent in developing empathic responsiveness, helping clients to “get outside of their own skins” is itself a viable treatment goal. It directly works with the resistant features of social anxiety, produces disequilibrium, and eventually allows for accommodation or a dynamic integration of self versus other-centeredness. Socially anxious clients are well-equipped to acquire these skills given their proclivity for monitoring others in order to detect subtle cues of critical evaluation, denigration

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and rejection. Now, however, they are taught to employ similar perceptual operations but without any self-referent judgments. The goai is to attend only to the other person, to experience their ph~uomenoiogy, to “walk in another’s moccasins.” In part, this effort serves to enhance interpersonal sensitivity. But the major objective of the therapeutic task is to short-circuit the self-centered attentional style. Interpersonal skills dealt with in the training program include attending, observing, accurate understanding and empathic responding. Instructions, role-play, feedback, group exercises, and assigned homework (self-monitoring and behavioral practice) are employed as training vehicles. A more detaiied description of the therapy program is available upon request. Treatment emphasizing other-centered attentional strategies in general and responding skills in particular is supported by interpersonal attraction research (Kupke, Calhoun, & Hobbs, 1979; Kupke, Hobbs, 8r Cheney, 1979). A related psychological state, loneliness, involves deficits in social functioning that further support therapeutic interventions designed to foster other-centered interactional abilities. In interpersonal situations, high-lonely, as contrasted with low-lonely subjects were less accurate in describing the personality of a dyadic partner relative to the partner’s self-description (Jones, Freemon, & Goswick, 198 1). Consistent with the results of the assessment of social skills, high-loneiy subjects were found to interact with fess awareness of or concern for others, with less responsiveness, and in a more self-focused or self-absorbed manner (Jones, Hobbs, & Hockenbury, 1982). These investigators also demonstrated that the increased use of partner attention following brief instruction resulted in significant reductions in self-reported laneliness and related self-perceptions.

I have attempted a brief analysis of three main hypotheses put forward to account for social anxiety by behavioral writers in recent years: (1) autonomic-physiological arousal; (2) interpersonal skill deficits; and (3) cognitive-evafuative impairment. These three perspectives were reviewed in order to highlight the major issue confronting clinical theory and practice in this area. ft seems that many diverse methods of treatment for social anxiety claim favarable success rates. In an effort to resolve questions posed by this issue, several alternative explanations were explored. A metacognitive model of social anxiety was advocated in which sufferers of interpersonal distress are proposed to be overly invested in cognitive and perceptual operations at a second-order level that have to do with themselves. That is, they are preoccupied with metacognition: thoughts about their physio1~gi~a1 arousal, ongoing performance and others’ perceptions of them as socially incompetent, inappropriately nervous, or psychologically inadequate. This metacognitive mechanism involves a higher level of abstraction about the causes, nature, and consequences of social anxiety. It operates simultaneously and continuous1y in interaction, mediating social avoidance and distress. Furthermore, this perceptual and processing mechanism involves a feedback system which results in an escalating anxiety cycle. A new treatment method was developed in order to specifically deal with selfcentered metacognitions postulated as the central maladaptive feature in social anxiety. According to the therapy approach e1aborated here, socially anxious clients are trained to attend differently to interpersonal transactions. By channeling per-

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ceptions and cognitions externally and focusing on the other person, these individuals can develop the means for improved control of their affective experience in social discourse. Clients are helped to be more attentive, expressive and observant; to practice emotional responding. The salubrious results of such training occur through the effective blocking of self-centered metacognitions in the effort to conduct oneself as an other-centered interactionist. This is a performance-based treatment method derived from a cognitive analysis of social anxiety. The adequacy of the treatment approach and theoretical model upon which it rests must await empirical efforts hopefully inspired by this article. The theory proposed here allows us to anticipate and account for certain outcomes and has the added advantage of connecting with a practical treatment method which can be evaluated in controlled clinical trials. In closing, a comment is warranted on the development of theory in behavior therapy. associate

Until terms

very

recently,

and

still in many

quarters,

there

is a tendency

to

such as resistance, ego, and insight with psychoanalysis, and just as immediately to dismiss them as mentalistic, untestable, and invalid. The ascendance of countless, repeated technical outcome studies in the behavioral literature has only resulted in minimal returns. Studies based on single hypotheses that don’t address psychological issues within the person lack the power needed for a thorough and meaningful analysis of the problem. As a colleague of mine once stated, “You can take psychology out of the treatment (as in behavioral techniques) but you can’t take psychology out of the person.” What is essential is a theoretical approach to the underlying mechanisms of emotion, cognition and behavior. Only by putting the person (behavioral tendencies, temperament, characteristic modes of responding, cognitive style, emotional structure, etc.) back into behavioral research and treatment, will we be able to gain deeper insights into emotional function, dysfunction, and therapy.

Acknowledgement-The author is grateful to Eleanor Daly, Kingsley Ferguson, Allison Fleming and Don ~e~chenbaum, who offered valuable feedback and comments on an earlier version of this article.

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