Focus-of-attention behavioral experiment: an examination of a therapeutic procedure to reduce social anxiety

Abstract

A clinical protocol based on contemporary cognitive behavioral treatment for social anxiety was developed and examined. Previously published instructions for conducting a focus-of-attention behavioral experiment targeting self-focused attention and safety behaviors during exposure were used to create a structured protocol. Individuals (n = 45) with high levels of social anxiety and public-speaking anxiety were randomly assigned to either a focus-of-attention behavioral experiment (FABE) or an Exposure-Only Control (EOC) condition. During four exposure trials, those in the FABE condition (n = 24) were alternately instructed to engage in self-focused attention vs. externally focused attention and to eliminate safety behaviors. Those in the EOC condition (n = 21) were not so instructed. At post-intervention, individuals in the FABE condition showed significantly less self-focused attention and anxiety, and better observed performance as rated by audience members. Focus-of-attention statistically mediated the effect of condition on anxiety. For those in the FABE condition, the degree of association between focus-of-attention and anxiety during the intervention predicted less self-focused attention post-intervention. The FABE appears to be a useful procedure for implementing part of the contemporary cognitive behavioral treatment model.

Keywords:

• Social anxiety
• self-focused attention
• behavioral experiment
• cognitive-behavioral therapy

Acknowledgments

We are grateful to the participants for their contribution, to Holly Orcutt and John Skowronski for feedback on the project, and to the following individuals for their help with various aspects of the data collection and project management: Sarah Smith, Nicole Patterson, Emily Lefew, Karen Wiemeyer, Nicole Stockberger, Jennifer Ursini, Jill Connelly, Kimberly Robinson, Adreean Bobo, Amy Cusimano, Martha Magana, Megan Armstrong, and Jamie Gardner-Haycox.