The University of Southampton’s Stopa (2009) puts forward three constructs about the self in managing social phobia. This is an essay that responds to inadequate explanations in cognitive psychology about the role of the self in the dynamics of social phobia. It may seem paradoxical to focus on the construction of the self for a condition characterized by fear of social situations. Nonetheless, the existing literature – including one speculation that social phobia is not so much fear of social interaction as oversensitivity about exposing the self — does impel this meta-analysis of Stopa’s.
The author would have us understand the various theories of the self by categorizing them into those that emphasize content, structure/process and imagery. These are the three main concepts we learn from her work. The first synthesizing construct she offers, content, refers to all the knowledge the socially phobic individual has about himself. This is the most clearly cognitive and rational in nature. Conceptually, the phobic individual has an exaggerated or distorted body of knowledge about his traits, abilities and capabilities. Whether the phobic patient’s anxiety-provoking knowledge concerns social skills, inability to suppress the outward signs of anxiety, physical defects or character shortcomings, “content” is all about whatever the afflicted one can recognize and verbalize.
If content is data about self, so to speak, the second construct of structure and process concern how an individual organizes all the information, knowledge and cognitive understanding the socially phobic have about themselves. Conceptually, structure should also cover matters of attending to and regulating the human self. To illustrate this idea, the author cites the example of the “retrieval competition” hypothesis. This refers to the notion that cognitive therapy is not really about changing the ideas one has about one’s self; rather, therapy helps the patient limit retrieval of negative information and gain preferential access to more constructive, accomplishment-inducing concepts of self.
“Imagery” is the third organizing idea the author uses to address the balance of extant literature concerning self and social phobia. This is distinct from cognitive content. Rather, “imagery” refers to affect-tinged concepts of self, memories of past situations and inadequacies. To the extent that these gravely diminish self-worth, imagery of failure both causes and maintains the condition of social phobia. In most cases, the author maintains, crippling imagery springs from early-life experiences. In any case, therapy runs parallel to that for cognitive deficiencies: help the patient neutralize negative imagery with, e.g. video feedback or “rescripting” to interpret early memories in a more positive light.
At the end of the day, Stopa has given those of us headed for charge nurse or coordinator positions three benefits. By deepening our insights into the centrality of self in the make-up of the socially phobic, we expand our horizons in the neuro-psychiatric service. This means having a better appreciation of the conflicts that tear unstable personalities apart. After all, social phobia is an early sign of trouble, as it were, for those who finally lapse into frank and self-destructive psychoses and become inpatients. Secondly, greater insights into the structure of human personality cannot but increase the comfort level of nursing professionals when career growth paths takes them to the level of interdisciplinary care teams. And thirdly, the dichotomy between the human self and externally-based phobias strengthens the ability to discriminate mental health and relationship issues from real somatic problems when screening incoming patients.
Stopa, L. (2009). Why is the self important in understanding and treating social phobia? Cognitive Behaviour Therapy, 38(S1) 48–54.