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Social Anxiety and Social Anxiety Disorder
Abstract
Research on social anxiety and social anxiety disorder has proliferated over the years since the explication of the disorder through cognitive-behavioral models. This review highlights a recently updated model from our group and details recent research stemming from the (a) information processing perspective, including attention bias, interpretation bias, implicit associations, imagery and visual memories, and (b) emotion regulation perspective, including positive emotionality and anger. In addition, we review recent studies exploring the roles of self-focused attention, safety behaviors, and post-event processing in the maintenance of social anxiety. Within each area, we detail the ways in which these topics have implications for the treatment of social anxiety and for future research. Finally, we conclude with a discussion of how several of the areas reviewed contribute to our model of social anxiety disorder.
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“SA symptoms are particularly contextually bound, and thus, it is of utmost relevance to consider the sensitivity of the context [2].”
From Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review (2024) · cites this paper as [2]
In the citing paper
“SAD is a heterogeneous clinical condition that usually entails high levels of dysfunction in the lives of people who experience it. This heterogeneous nature of SAD is marked by the dynamic deployment of cognitions, emotions, and behaviors in the interaction with others and in different contexts [2].”
From Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review (2024) · cites this paper as [2]
In the citing paper
“The most cited models of emergence of social anxiety experience and etiology of SAD are connoted as ‘cognitive’ and present social anxiety as a product of a specific type of attention, stimuli interpretation, or both [9,10,11].”
From Shame or What Makes Irrational Social Anxiety Rational. (2025) · cites this paper as [11]
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“This unwillingness may in turn lead to maladaptive efforts to resist, escape, and avoid such experiences (Morrison & Heimberg, 2013).”
Self esteem, dependency, self-efficacy and self-criticism in social anxiety disorder
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“According to the cognitive models of SAD [3,37], dysfunctional self-views play an important role in the maintenance of the disorder.”
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“Unfortunately, the prevention mode inherent to SAD disrupts the ability to pay attention to situational and proprioceptive cues when emotionally aroused (see Morrison & Heimberg, 2013).”
The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review
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“fear of having perceived flaws exposed in social situations, leading to negative evaluations and ultimately, rejection (Morrison and Heimberg 2013; Moscovitch 2009).”
BackgroundSocial anxiety is characterized by biased learning about performance and the self.
Koban, L., Schneider, R., Ashar, Y. K., Andrews‐Hanna, J. R., Landy, L. N., Moscovitch, D. A., Wager, T. D., & Arch, J. J. (2017) · Emotion · doi:10.1037/emo0000296 · Cited by 109
“…showed negatively biased, but not overall reduced social learning about themselves and their performance, suggests that learning biases may occur independently of or synergistically with known attentional biases (Morrison & Heimberg, 2013)—a possibility that future studies could test directly.”
Heeren, A., Billieux, J., Philippot, P., Raedt, R. D., Baeken, C., de Timary, P., Maurage, P., & Vanderhasselt, M. (2016) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsw119 · Cited by 111
“Indeed, as argued by cognitive theorists of SAD (Heimberg et al., 2010; Morrison and Heimberg, 2013; Wong and Rapee, 2016), AB for threat may interfere with the ability to process external nonthreat cues that disconfirm the negative beliefs of people with SAD when they encounter socially challenging situations.”
BackgroundAudience effects: what can they tell us about social neuroscience, theory of mind and autism?
Hamilton, A. F. D. C., & Lind, F. (2016) · Culture and Brain · doi:10.1007/s40167-016-0044-5 · Cited by 118
Detection, processing and reinforcement of social cues: regulation by the oxytocin system
Menon, R., & Neumann, I. D. (2023) · Nature Reviews Neuroscience · doi:10.1038/s41583-023-00759-w · Cited by 100
“Fear and avoidance of social situations is a characteristic feature of SAD 124 , which has been modelled in an operant social fear conditioning paradigm in mice 30,125 .”
BackgroundInfluentialFactor Analysis of the Five Facet Mindfulness Questionnaire in a Heterogeneous Clinical Sample
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Neural pathways of embarrassment and their modulation by social anxiety
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“Our correlational data with subclinical social anxiety support the notion that in public contexts, persons with greater social anxiety pay increased attention to others which might be related to the clinically well-described negative bias in terms of what the audience might think of them (Morrison and Heimberg, 2013).”
BackgroundResultInfluentialTheory of mind and peer relationships: The role of social anxiety
Ronchi, L., Banerjee, R. A., & Lecce, S. (2019) · Social Development · doi:10.1111/sode.12417 · Cited by 81
“…to which excessive self-focus during arousing social interactions precludes anxious children from attending important external social information (Morrison & Heimberg, 2013), such as others’ mental states (Colonnesi et al., 2016); thus negatively affecting social outcomes (Hughes & Devine, 2015).”
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“Severe social anxiety can also cause social anxiety disorders in individuals [13, 14].”
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“For instance, one body of research confirms that people differ in social anxiety – those higher in social anxiety expect more negative evaluations from others, give more attention to potential threats in an interaction, and aremore socially avoidant [17].”
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Harrewijn, A., Schmidt, L. A., Westenberg, P. M., Tang, A., & van der Molen, M. J. W. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.09.013 · Cited by 70
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“There is indeed evidence that descriptions of ambiguous social scenarios are interpreted by socially anxious individuals in a more negative, or a less positive, manner than by non-anxious ones (see Mobini, Reynolds, & Mackintosh, 2013; Morrison & Heimberg, 2013).”
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Behavioural and neural correlates of self-focused emotion regulation in social anxiety disorder
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“There is evidence that the attention bias in patients with SAD also manifests as diminished processing of positive (social) information.(7) Future studies should extend the investigation of voluntary emotion regulation through selffocused reappraisal to positively valenced stimuli.”
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“Social anxiety (SA) has been defined as a common human experience characterized by intense fear of evaluation by others in social situations (Morrison & Heimberg, 2013).”
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“Theoretical models posit that difficulties in interpersonal relationships in individuals with SAD may arise from a misunderstanding of others’ thoughts and intentions for both negative and positive content (Morrison & Heimberg, 2013).”
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“According to the cognitive model of social phobia [1,74], negative self-views play important roles in the maintenance of the disorder.”
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“In addition, the internal consistency of the measures in this ASD sample closely mirrored those reported from typically developing samples. processing, such as. deficits in emotion recognition, although findings are not wholly consistent (Morrison and Heimberg, 2013).”
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“…analysis corroborates these studies by showing that people with social anxiety traits, who have increased concerns to gain social approval (Cremers & Roelofs, 2016; Morrison & Heimberg, 2013), are more likely to change their behaviour (to signal good reputation) when other people are observing.”
BackgroundResultPersonalized networks of social anxiety disorder and depression and implications for treatment
Piccirillo, M. L., & Rodebaugh, T. L. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.034 · Cited by 53
Too bad: Bias for angry faces in social anxiety interferes with identity processing
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Behavioral and EEG responses to social evaluation: A two-generation family study on social anxiety
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Neural circuit basis of pathological anxiety
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“Individuals with SAD experience exaggerated fear and avoidance of social situations owing to concerns about negative evaluation or rejection 112 .”
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Treatment of social approach processes in adults with social anxiety disorder
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“Multiple outcome studies support the effectiveness of cognitive–behavioral regimens in reducing SAD symptoms and maintaining treatment gains for up to 4 years (e.g., Clark et al., 2003, 2006; Heimberg et al., 1998; see Morrison & Heimberg, 2013).”
Anxiety and speaking in people who stutter: An investigation using the emotional Stroop task
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“Models of anxiety, including those specific to social anxiety (e.g., Morrison & Heimberg, 2013), emphasise interactions between behavioural, physiological and cognitive components (Balsamo et al., 2013; Elwood et al., 2012).”
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“…of SAD might be due to automatic cognitive biases in the processing of social information (Beck et al., 1985; Clark and Wells, 1995; Bögels and Mansell, 2004; Morrison and Heimberg, 2013), such as increased automatic processing of angry faces (GilboaSchechtman et al., 1999; Mogg et al., 2004).”
BackgroundMethodAttention bias dynamics and symptom severity during and following CBT for social anxiety disorder.
Davis, M. L., Rosenfield, D., Bernstein, A., Zvielli, A., Reinecke, A., Beevers, C. G., Koster, E. H. W., & Smits, J. A. J. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000125 · Cited by 47
“Attention bias is thereby thought to drive a variety of maladaptive processes implicated in social anxiety disorder (e.g., misinterpretation of threat; Clark & Wells, 1995; Heinrichs & Hofmann, 2001; Morrison & Heimberg, 2013).”
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“Cognitive theorists have argued that AB may be causally implicated in the maintenance, and perhaps in the etiology, of SAD (Clark and Wells, 1995; Rapee and Heimberg, 1997; for a review, see Morrison and Heimberg (2013)).”
Large-scale brain functional network abnormalities in social anxiety disorder
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“More seriously, social anxiety will develop into social anxiety disorder (SAD) when it impairs social functioning (Morrison & Heimberg, 2013).”
BackgroundWhat does it take to be rigid? Reflections on the notion of rigidity in autism
Petrolini, V., Jorba, M., & Vicente, A. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1072362 · Cited by 56
“skills are related to experiencing social anxiety [see (44)].”
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“…across a wide range of mental disorders (for reviews and meta-analyses, see Brooks, Prince, Stahl, Campbell, & Treasure, 2011; Eysenck, Derakshan, Santos, & Calvo, 2007; Field, Munafò, & Franken, 2009; Lazarov et al., 2019; Mitte, 2008; Morrison & Heimberg, 2013; Savulich, Shergill, & Yiend, 2012).”
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A Review of Scales to Measure Social Anxiety Disorder in Clinical and Epidemiological Studies
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“According to cognitive models of SAD (Clark and Wells, 1995), the development of the disorder is not just related to emotional hyperactivity, but also to biased information, leading to abnormal and excessive responses (Morrison and Heimberg, 2013).”
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Association of factor V Leiden with Behçet's disease.
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“Cognitive and emotional components are known to be involved in the development of SAD [42].”
BackgroundSocial anxiety disorder exhibit impaired networks involved in self and theory of mind processing
Cui, Q., Vanman, E. J., Long, Z., Pang, Y., Chen, Y., Wang, Y., Duan, X., Chen, H., Gong, Q., Zhang, W., et al. (2017) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsx050 · Cited by 40
“Although many studies have emphasised the role of emotional dysfunction in the pathophysiology of SAD (Phan et al., 2006; Etkin and Wager, 2007), the contribution of impairments in self- and theory-of-mind (ToM)-processing remain relatively unexamined (Moscovitch, 2009; Morrison and Heimberg, 2013).”
BackgroundInfluentialEffects of post-exposure naps on exposure therapy for social anxiety
Pace-Schott, E. F., Bottary, R. M., Kim, S.-Y., Rosencrans, P. L., Vijayakumar, S., Orr, S. P., Lasko, N. B., Goetter, E. M., Baker, A. W., Bianchi, M. T., et al. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.10.015 · Cited by 40
“Social Anxiety Disorder (SAD) (APA, 2013) can occur with a range of severities varying from a circumscribed fear of public speaking to a debilitating generalized condition that severely limits social interactions (Morrison and Heimberg, 2013).”
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Goodyear, B. G., Heidari, F., Ingram, R. J. M., Cortese, F., Sharifi, N., Kaplan, G. G., Ma, C., Panaccione, R., Sharkey, K. A., & Swain, M. G. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izac089 · Cited by 42
Effects of stress on sleep quality: multiple mediating effects of rumination and social anxiety
Zhang, J., Li, X., Tang, Z., Xiang, S., Tang, Y., Hu, W., Tan, C., & Wang, X. (2024) · Psicologia Reflexão e Crítica · doi:10.1186/s41155-024-00294-2 · Cited by 63
“This thinking pattern leads individuals to excessively focus on their performance in social situations and potential negative evaluations, thereby increasing the degree of social anxiety (Morrison & Heimberg, 2013).”
BackgroundKivity, Y., & Huppert, J. D. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.029 · Cited by 41
Fears and fear-related cognitions in children with selective mutism
Vogel, F., Gensthaler, A., Stahl, J., & Schwenck, C. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01281-0 · Cited by 39
Kivity, Y., & Huppert, J. D. (2018) · Cognition & Emotion · doi:10.1080/02699931.2018.1446414 · Cited by 42
“For example, in Heimberg’s updated model of social anxiety (Morrison & Heimberg, 2013), emotion dysregulation in social anxiety disorder (SAD) includes behavioural attempts to avoid feeling anxious (such as avoidance or escape from stressful situations) and expressive suppression due to believing…”
BackgroundCognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review
Spain, D., Sin, J., Harwood, L., Mendez, M. A., & Happé, F. (2017) · Advances in Autism · doi:10.1108/aia-07-2016-0020 · Cited by 37
“This raises a question about whether SA in ASD is underpinned by impairments in social skills, unlike SA in other populations (Morrison and Heimberg, 2013; Rapee and Heimberg, 1997).”
BackgroundJordan, D. G., Winer, E. S., Salem, T., & Kilgore, J. (2017) · Cognition & Emotion · doi:10.1080/02699931.2017.1289895 · Cited by 38
“These results are somewhat unsurprising, however, when considering differences in heterogeneity between the constructs of depression and social anxiety (Fried & Nesse, 2015; Morrison & Heimberg, 2013).”
ResultKimmig, A.-C. S., Dresler, T., Hudak, J., Haeussinger, F. B., Wildgruber, D., Fallgatter, A. J., Ehlis, A., & Kreifelts, B. (2018) · Journal of Neural Transmission · doi:10.1007/s00702-018-1954-5 · Cited by 37
Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives
Ginat-Frolich, R., Gilboa-Schechtman, E., Huppert, J. D., Aderka, I. M., Alden, L. E., Bar-Haim, Y., Becker, E. S., Bernstein, A., Geva, R., Heimberg, R. G., et al. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102415 · Cited by 36
Self-citationKivity, Y., Cohen, L., Weiss, M., Elizur, J., & Huppert, J. D. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.021 · Cited by 44
Zhao, X., Dang, C., & Maes, J. H. R. (2020) · Biological Psychology · doi:10.1016/j.biopsycho.2019.107840 · Cited by 34
Heitmann, C. Y., Feldker, K., Neumeister, P., Brinkmann, L., Schrammen, E., Zwitserlood, P., & Straube, T. (2017) · NeuroImage Clinical · doi:10.1016/j.nicl.2017.01.020 · Cited by 34
“Automatic threat processing, that is, the attentional capture by, and the detection and processing of, threat stimuli that are outside the current attentional focus and/or task-irrelevant (Carretié, 2014; Moors and De Houwer, 2006), is considered a critical factor for the development and maintenance of SAD and other a…”
BackgroundTargeted Memory Reactivation During REM Sleep in Patients With Social Anxiety Disorder
Borghese, F., Henckaerts, P., Guy, F., Mayo, C., Delplanque, S., Schwartz, S., & Perogamvros, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.904704 · Cited by 33
“It is a chronic disorder with a lifetime prevalence rate of 13% and an early onset in adolescence (3, 4).”
BackgroundThe Relationship between Perfectionism and Social Anxiety: A Moderated Mediation Model
Wang, Y., Chen, J., Zhang, X., Lin, X., Sun, Y., Wang, N., Wang, J., & Luo, F. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912934 · Cited by 41
“When it reaches a certain degree of severity such that functioning is impaired, it is referred to as social anxiety disorder [2].”
BackgroundMairet, K. S., Boag, S., & Warburton, W. (2014) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 33
The role of shame and self-criticism in social anxiety: a daily diary study in a nonclinical sample
Lazarus, G., & Shahar, B. (2018) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2018.37.2.107 · Cited by 32
Parental phubbing and academic burnout in adolescents: the role of social anxiety and self-control
Jiang, Y., Lin, L., & Hu, R. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1157209 · Cited by 33
“Social anxiety is one of the most prevalent anxiety symptoms in adolescents and is characterized by a strong and irrational feeling of embarrassment in social situations (Morrison and Heimberg, 2013; Alkozei et al., 2014).”
BackgroundEmotion Regulation in Social Anxiety Disorder
Goldin, P. R., Jazaieri, H., & Gross, J. J. (2014) · Social Anxiety · doi:10.1016/b978-0-12-394427-6.00017-0 · Cited by 31
Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress
Siegel, D. M., Burke, T. A., Hamilton, J. L., Piccirillo, M. L., Scharff, A., & Alloy, L. B. (2018) · Anxiety Stress & Coping · doi:10.1080/10615806.2018.1482723 · Cited by 31
Deng, X., Chen, X., Zhang, L., Gao, Q., Li, X., & An, S. (2022) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2022.100329 · Cited by 31
Daniel, K. E., Baee, S., Boukhechba, M., Barnes, L. E., & Teachman, B. A. (2019) · Depression and Anxiety · doi:10.1002/da.22970 · Cited by 30
“…self (Hope, Rapee, Heimberg, & Dombeck, 1990), this study examines whether social anxiety, a form of psychopathology that is intimately tied to emotion dysregulation (see Morrison & Heimberg, 2013, for review), moderates different ways of measuring the effectiveness of ER attempts in daily life.”
BackgroundPerfectionism and Perfectionistic Self-Presentation in Social Anxiety
Flett, G. L., & Hewitt, P. L. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-394427-6.00007-8 · Cited by 30
Duijndam, S., Karreman, A., Denollet, J., & Kupper, N. H. M. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.09.013 · Cited by 37
Busch, C. A., Wiesenthal, N. J., Mohammed, T. F., Anderson, S., Barstow, M., Custalow, C., Gajewski, J., Garcia, K., Gilabert, C. K., Hughes, J., et al. (2023) · CBE—Life Sciences Education · doi:10.1187/cbe.22-10-0195 · Cited by 37
“FNE is also distinct from social anxiety, which pertains to affective reactions in social situations regardless of whether evaluation from others occurs (Weeks et al. , 2005; Morrison and Heimberg, 2013).”
Social anxiety and perception of (un)trustworthiness in smiling faces
Gutiérrez-García, A., & Calvo, M. G. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.07.004 · Cited by 28
Social anxiety and trustworthiness judgments of dynamic facial expressions of emotion
Gutiérrez-García, A., & Calvo, M. G. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2016.04.003 · Cited by 28
Huppert, J. D., Kivity, Y., Cohen, L., Strauss, A. Y., Elizur, Y., & Weiss, M. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.08.002 · Cited by 30
du Rocher, A. R., & Pickering, A. D. (2023) · Current Psychology · doi:10.1007/s12144-023-04624-y · Cited by 27
“Moreover, self-report studies show that both trait social interaction anxiety and trait social phobia are negatively correlated with dispo-sitional attentional control (Morrison & Heimberg, 2013b).”
Metadata
- Authors
- Morrison, A. S., & Heimberg, R. G.
- Affiliations
- Temple University (US)
- Venue
- Annual Review of Clinical Psychology
- Publisher
- Annual Reviews
- Published
- 2013-03-28
- Volume
- 9
- Issue
- 1
- Pages
- 249-274
- ISSN
- 1548-5943 (ISSN-L)
- 1548-5951
- OpenAlex
- W2147509803
- Cited by
- 480
- References
- 127
- Citations by year
- 2026: 54 · 2025: 71 · 2024: 80 · 2023: 61 · 2022: 39 · 2021: 20 · 2020: 26 · 2019: 22 · 2018: 23 · 2017: 19 · 2016: 24 · 2015: 21 · 2014: 16 · 2013: 3
- FWCI
- 3.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annual Review of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- social anxiety, social anxiety disorder, cognitive-behavioral model, attentional bias, interpretation bias, implicit associations, imagery, visual memory, positive affectivity, anger, self-focus, safety behavior, post-event processing, social anxiety treatment
- MeSH terms
- Attention, Emotions, Humans, Models, Psychological, Phobic Disorders, Self Concept
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