Skip to main content Accessibility help

The Impact of Self-Imagery on Affective, Cognitive, and Attentional Processes in Social Phobia: A Comprehensive Literature Review of the Theoretical and Empirical Literature

  • Ashlen S. Ng (a1) and Maree J. Abbott (a1)


Social Phobia (SP) is a psychological disorder characterised by an excessive and persistent fear of negative evaluation in social or performance situations that interferes with daily functioning. Cognitive models of SP (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the role of negative images of the self as an important factor in the maintenance of SP. While empirical research has demonstrated the link between negative self-imagery and social anxiety, many aspects of this cognitive factor are yet to be understood. Currently, there is limited research investigating the impact of different types of self-imagery and their effects on social anxiety and performance. Further research assessing the relationships between self-imagery and other maintaining processes proposed in cognitive models is also warranted. This review assesses the literature focusing on self-imagery in social anxiety, including qualitative, empirical, and preliminary treatment studies to date. Recommendations for future research and the use of imagery-based rescripting methods in the treatment of SP are also discussed.


Corresponding author

Address for correspondence: Maree J. Abbott, Clinical Psychology Unit (K01), School of Psychology, University of Sydney NSW 2006, Australia. Email:


Hide All
Alden, L.E., Taylor, C.T., Mellings, T.M., & Laposa, J.M. (2008). Social anxiety and the interpretation of positive social events. Journal of Anxiety Disorders, 22 (4), 577590.
Alden, L.E., & Wallace, S.T. (1995). Social phobia and social appraisal in successful and unsuccessful social interactions. Behaviour Research and Therapy, 33 (5), 497505.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behavior Research and Therapy, 37, 715740.
Australian Bureau of Statistics. (2007). National survey of mental health and wellbeing: Summary of results. Canberra, Australia: Author. Retrieved from:
Beck, A.T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
Brown, T.A., & Barlow, D.H. (2014). Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5L). Oxford University Press: Oxford.
Clark, D. (2001). A cognitive perspective on social phobia. In Crozier, W.R. & Alden, L.E. (Eds.), International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness (pp. 405430). New York: John Wiley & Sons.
Clark, D.M., Elhers, A., Hackmann, A., McManus, F., Fennell, M. & Grey, N., . . . Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568578.
Clark, D., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R., Liebowitz, M., Hope, D., & Schneier, R., (Eds.), (Social phobia: Diagnosis, assessment and treatment (pp. 6993). New York: Guilford Press.
Crum, R., & Pratt, L. (2001). Risk of heavy drinking and alcohol use disorders in social phobia: A prospective analysis. American Journal of Psychiatry, 158, 16931700.
Coles, M.E., Turk, C.L., Heimberg, R.G., & Fresco, D.M (2001). Effects of varying levels of anxiety within social situations: Relationship to memory perspective and attributions in social phobia. Behaviour Research and Therapy 39 (6), 651665.
Fehm, L., Pelissolo, A., Furmark, T., & Wittchen, H.-U. (2005). Size and burden of social phobia in Europe. European Neuropsychopharmacology, 15 (4), 453462.
Furmark, T. (2002). Social phobia: Overview of community surveys. Acta Psychiatrica Scandinavica, 105 (2), 8493.
Grant, B.F., Hasin, D.S., Blanco, C., Stinson, F.S., Chou, S.P., Goldstein, R.B., . . . Huang, B. (2005). The epidemiology of social anxiety disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66 (11), 13511361.
Hackmann, A., Clark, D.M., & McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38 (6), 601610.
Hackmann, A., Surawy, C., & Clark, D.M. (1998). Seeing yourself through others’ eyes: A study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26 (1), 312.
Heimberg, R.G., & Becker, R.E. (2002). Cognitive behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York, NY: Guilford Press.
Heimberg, R.G., Liebowitz, M.R., Hope, D.A., Schneier, F.R., Holt, C.S., Welkowitz, L.A., . . . Klein, D.F. (1998). Cognitive behavioral group therapy vs. phenelzine therapy for social phobia. Archives of General Psychiatry, 55, 11331141.
Hirsch, C.R., Mathews, A., Clark, D.M., Williams, R., & Morrison, J. (2003). Negative self-imagery blocks inferences. Behaviour Research and Therapy 41 (12), 13831396.
Hirsch, C., Meynen, T., & Clark, D. (2004). Negative self‐imagery in social anxiety contaminates social interactions. Memory 12 (4), 496506.
Hofmann, S. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36 (4), 193209.
Hulme, N., Hirsch, C., & Stopa, L. (2012). Images of the self and self-esteem: Do positive self-images improve self-esteem in social anxiety? Cognitive Behaviour Therapy, 41 (2), 163173.
Kessler, R.C., Chiu, W.T., Demler, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62 (6), 617627.
Kessler, R.C., Petukhova, M., Sampson, N.A., Zaslavsky, A.M., & Wittchen, H.U. (2012). Twelve month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21 (3), 169184.
Lampe, L., Slade, T., Issakidis, C., & Andrews, G. (2003). Social phobia in the Australian National Survey of Mental Health and Well-Being (NSMHWB). Psychological Medicine, 33, 637646.
Lee, S.R., & Kwon, J. (2013). The efficacy of Imagery Rescripting (IR) for social phobia: A randomized controlled trial. Journal of Behavioural Therapy and Experimental Psychiatry, 44 (4)351360.
McEvoy, P.M., & Saulsman, L.M. (2014). Imagery-enhanced cognitive behavioural group therapy for social anxiety disorder: A pilot study. Behaviour Research and Therapy. Advance online publication.
Makkar, S.R., & Grisham, J.R. (2011). Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing. Behaviour Research and Therapy, 49 (10), 654664.
Ng, A., Abbott, M., & Hunt, C. (2013). The effect of imagery on symptoms and processes in social anxiety: A systematic review. Manuscript submitted for publication.
Nilsson, J., Lundh, L., & Viborg, G. (2012). Imagery rescripting of early memories in social anxiety disorder: An experimental study. Behaviour Research and Therapy, 50, 387392.
Patel, A., Knapp, M., Henderson, J., & Baldwin, D. (2002). The economic consequences of social phobia. Journal of Affective Disorders 68 (2–3), 221233.
Rapee, R.M. (1995). Descriptive psychopathology of social phobia. In Heimerg, R., Liebowitz, M., Hope, D., & Schneier, F. (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 4166). New York: Guilford Press.
Rapee, R.M., Gaston, J.E., & Abbott, M.J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317327.
Rapee, R.M., & Heimberg, R.G. (1997). A cognitive–behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741756.
Rapee, R.M., & Spence, S.H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review, 24, 737767.
Ruscio, A.M., Brown, T.A., Chiu, W.T., Sareen, J., Stein, M.B., & Kessler, R.C. (2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological medicine, 38 (01), 1528.
Spurr, J.M., & Stopa, L. (2003). The observer perspective: Effects on social anxiety and performance. Behaviour Research and Therapy, 41 (9), 10091028.
Stopa, L., Brown, M.A., & Hirsch, C.R. (2012). The effects of repeated imagery practice on self-concept, anxiety and performance in socially anxious participants. Journal of Experimental Psychopathology, 3 (2), 223242.
Stopa, L., & Jenkins, A. (2007). Images of the self in social anxiety: Effects on the retrieval of autobiographical memories. Journal of Behavioural Therapy and Experimental Psychiatry, 38 (4), 459473.
Turner, S.M., Beidel, D.C., Dancu, C.V., & Stanley, M.A. (1989). An empirically derived inventory to measure social fears and anxiety: The social phobia and anxiety inventory. Psychological Assessment, 1, 3540.
Vassilopoulos, S. (2005). Social anxiety and the effects of engaging in mental imagery. Cognitive Therapy and Research 29 (3), 261277.
Wallace, S.T., & Alden, L.E. (1995). Social anxiety and standard setting following social success or failure. Cognitive Therapy and Research, 19 (6), 613631.
Wallace, S.T., & Alden, L.E. (1997). Social phobia and positive social events: The price of success. Journal of Abnormal Psychology, 106 (3), 416424.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33 (4), 448.
Wells, A., Clark, D.M., & Ahmad, S. (1998). How do I look with my mind's eye: Perspective taking in social phobic imagery. Behaviour Research and Therapy, 36 (6), 631634.
Wells, A., & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37 (7), 653.
Wild, J., & Clark, D.M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioural Practice, 18, 433443.
Wild, J., Hackmann, A., & Clark, D.M. (2007). When the present visits the past: Updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38 (4), 386401.
Wild, J., Hackmann, A., & Clark, D.M. (2008). Rescripting early memories linked to negative images in social phobia: A pilot study. Behavior Therapy, 39 (1), 47.
Wittchen, H.U., Feutsch, M., Sonntag, H., Muller, N., & Liebowitz, M. (2000). Disability and quality of life in pure and comorbid social phobia: Findings from a controlled study. European Psychiatry, 15, 4658.
Wittchen, H.U., & Jacobi, F. (2005). Size and burden of mental disorders in Europe — A critical review and appraisal of 27 studies. European Neuropsychopharmacology, 15 (4), 357376.


Related content

Powered by UNSILO

The Impact of Self-Imagery on Affective, Cognitive, and Attentional Processes in Social Phobia: A Comprehensive Literature Review of the Theoretical and Empirical Literature

  • Ashlen S. Ng (a1) and Maree J. Abbott (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.