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Isr J Psychiatry Relat Sci. 2009 ; 46(1): 13–24.

Issues in the Assessment of Social Phobia: A Review

Andrea M. Letamendi, MS,

Department of Psychology, San Diego State University, Department of Psychiatry, University of
California San Diego
Denise A. Chavira, PhD, and
Department of Psychiatry, University of California, San Diego
Murray B. Stein, MD, MPH
Department of Psychiatry, University of California, San Diego

Abstract
Since the emergence of social phobia in DSM nomenclature, the mental health community has
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witnessed an expansion in standardized methods for the screening, diagnosis, and measurement of
the disorder. This article reviews formal assessment methods for social phobia, including
diagnostic interview, clinician-administered instruments, and self report questionnaires.
Frequently used tools for assessing constructs related to social phobia, such as disability and
quality of life, are also briefly presented. This review evaluates each method by highlighting the
assessment features recommended in social phobia literature, including method of administration,
item content, coverage, length of scale, type of scores generated, and time frame.

Introduction
Social phobia is an anxiety disorder characterized by excessive and persistent fear provoked
by exposure to social or performance situations (1). It is the potential criticism, humiliation,
or negative evaluation by others that is considered the source of anxiety among individuals
with social phobia. Excessive self-consciousness and self-criticism are features which often
lead to extreme phobic avoidance, the greatest cause of impairment among those with social
phobia (2). Significant distress or interference in functioning is, therefore, key to the
diagnosis of social phobia (3,1).
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Social phobia is considered a prevalent, chronic, and debilitating psychiatric disorder (4).
The U.S. National Comorbidity Survey Replication (NCS-R) found a lifetime and 1-year
prevalence rate of 12.1% and 7.1%, respectively (5). Non-U.S. international studies
demonstrate similarly high lifetime prevalence rates ranging from 7.1% to 16.1% (6,7).
Reports from the Israel National Health Survey (8), which did not examine social phobia,
suggest its inclusion would render anxiety disorders as more prevalent than mood disorders.

Rates of social phobia in primary care medical settings are slightly lower (7%) than in the
community (9), though these estimates may be a product of the patients’ social avoidance
and fewer care visits. Community rates are slightly higher among women than men with a
3:2 ratio (10), although these gender differences have not been found in clinical samples.
Prospective reports on the course of social phobia evidence an early onset (by age 19 in the

Correspondence and reprint requests to: Andrea M. Letamendi, MS, Anxiety and Traumatic Stress Disorders Research Program,
University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, Phone: 858-534-6438; fax:
858-534-6460, aletamen@ucsd.edu.
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majority of cases) with a flattening incidence rate after age 21 (11). Social phobia has a high
risk for persistence with rare natural remission; a chronic course is evidenced by individuals
in their 30’s and 40’s who endured either a progressive worsening or persistence of
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symptoms since onset (12). Social phobia is correlated with impairments spanning
relationship, family, employment, and educational domains (13). A review on the costs of
social phobia found associations between the disorder and lower educational attainment,
work impairment and lower wages (4). In regards to social impairment, individuals with
social phobia have few friendships, weak social support, and increased likelihood to be
unmarried or live alone (4).

Diagnostic heterogeneity and comorbidity

Social phobia first emerged as a diagnostic category in the third edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-III; 14). The central diagnostic feature
differentiating social phobia from other anxiety disorders was the excessive fear of
observation, evaluation, or scrutiny of others during a discrete performance situation (14).
Thus, the fear surrounding public speaking, stage acting, eating or drinking in front of
others, or any other performance-oriented situation constituted the core criterion for social
phobia. Subsequent DSM revisions, in response to empirical and clinical observation,
broadened the definition of social phobia to the marked fear of “one or more” social phobic
situations (15,16). Moreover, the DSM-III-R introduced the “generalized subtype” to denote
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fears related to “most social situations” (15). Individuals with generalized social phobia
experience excessive fear and preoccupation with most social interactions and settings, e.g.
initiating conversations, speaking to strangers, and attending parties. The specifier
“generalized” is used in the DSM-IV-TR to capture the psychopathology of individuals who
fear both public performance situations and social interaction situations (1).

Of the two subtypes identified, the generalized subtype is more persistent, more impairing,
and more likely associated with secondary psychiatric illnesses (17). Worth noting is the
recent literature establishing evidence for more than two subtypes (18,5) or a non-discrete
continuum of severity (19) among social phobia samples. Therefore, it is unlikely that either
the number or the content of feared situations single-handedly characterize the heterogeneity
of social phobia, an important issue considered throughout this assessment review.

Social phobia commonly co-occurs with other DSM disorders. The NCS-R found that nearly
two-thirds (62.9%) of respondents with social phobia met for at least one other DSM-IV
disorder, with higher comorbidity rates associated with higher numbers of social fears (5).
The most common secondary Axis I diagnoses include agoraphobia, substance use
disorders, major depression, and body dysmorphic disorder (20,5,21). Substantial
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phenomenological overlap between avoidant personality disorder and generalized social

phobia has raised questions about the DSM-IV classification of two distinct disorders on
separate axes (22). Indeed, evidence for a common genetic vulnerability suggests that co-
occurrence of the two disorders can be explained by shared etiological factors (23). Thus, it
may be clinically parsimonious to consider avoidant personality disorder a severe form of
generalized social phobia (24).

Formal Assessment
Methodized assessment plays a central role in describing a patient’s impairment, informing
an intervention method and guiding the ongoing treatment process. Distinct assessment
methods provide unique information—an assessor well-informed about measurement tools
will better approximate his or her aims. The recommended assessment of social phobia
includes diagnostic interviews, self report questionnaires, clinician-administered
instruments, and behavioral assessment (25,26). Guided by these recommendations, the

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following sections focus on commonly used formal techniques for symptomatic assessment
of generalized and nongeneralized social phobia in clinical and research settings. Frequently
used tools for assessing related constructs (e.g., quality of life) are also briefly presented.
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Behavioral assessment techniques and physiological measures of social phobia are not
described here due to space limitations, but are well reviewed in Hart et al. (26) and McNeil,
Ries, and Turk (27), respectively. Likewise, child and adolescent versions of assessments
mentioned in this review can be found in Hitchcock, Chavira, and Stein (28).

Important features of rating scales for social phobia have been proposed (29), and thus guide
our evaluation of each instrument’s utility; they include method of administration, item
content, coverage, length of scale, type of scores generated, and time frame.

Diagnostic Interview
Semi-structured clinical interviews are advantageous in that they utilize patient report,
behavioral observation, and clinician’s judgment to achieve a comprehensive diagnostic
impression. Semi-structured interviews assist with differential diagnosis and evaluation of
comorbid conditions, elements important to the assessment of social phobia because fears of
social evaluation often co-occur with features such as agoraphobic avoidance, panic attacks,
social withdrawal, rumination, and dysthymia.
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Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV)

The ADIS-IV (30) is a commonly used diagnostic interview that assesses major anxiety
disorders, mood disorders, substance use disorders, and disorders commonly overlapping
with anxiety disorders (e.g., hypochondriasis). A psychotic screening module is also
provided. A feature of the ADIS-IV is the Clinician Severity Rating (CSR), which allows
the clinician to assign a severity rating for each diagnosis using a 0(absent) to 8(very
severely disabling) scale. CSR’s reflect intensity of symptoms, behavioral avoidance
associated with the symptoms, and the interference in social and occupational functioning of
the symptoms endorsed (31). ADIS-IV reliability estimates for the diagnosis of social
phobia (Kappa =.64) are adequate (32). Data has also supported the validity of the CSR as a
global measure that reflects the fundamental aspects of social phobia (31).

Strengths of the ADIS-IV include its empirical support, broad coverage of anxiety disorders,
clinician severity ratings, and its modular format. Limitations of the ADIS-IV include the
cost and length of interview, required training to administer the interview, as well as the
omission of some psychiatric disorders. Familiarity of DSM Axis I psychiatric nomenclature
is a necessary criterion for proficient administration of the ADIS-IV.
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Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P)

The SCID-I/P (33) is a semi-structured clinical interview designed to be administered by a
clinician or trained mental health professional with substantial and comprehensive
knowledge of the DSM. The modular interview covers DSM-IV-TR Axis I major disorders,
subtypes, and course specifiers. Screening questions and skip-out items allow the skilled
clinician to navigate the sizable interview. Reliability studies from previous DSM-IV
versions of the SCID-I/P have demonstrated fair inter-rater agreement (Kappa =.63) and
test-retest agreement (Kappa =.59) for the diagnosis of social phobia (34).

Strengths of the SCID-I/P include flexibility of administration, modification for research

purposes, and an overview section for obtaining socio-occupational and other background
information. Limitations of the SCID-I/P include extensive training (35) as well as length of
interview in its entirety.

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Clinician-administered Scales
Clinician-rated psychometric instruments offer the brevity of an itemized scale as well as the
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flexibility of clinical judgment and qualitative behavioral observation. The two most
commonly used clinician-rated instruments are described here.

Liebowitz Social Anxiety Scale (LSAS)

The LSAS (36) is considered the most widely used clinician-administered scale for social
phobia assessment. The measure was designed to encompass the full range of the two
domains—performance situations and social interactions—persons with social phobia fear
and avoid. The scale consists of 24 items: 13 situations that are performance-related (e.g.
“participating in a small group,”) and 11 situations that are social interactions (e.g. “going to
a party”). Each situation is described by the clinician to the examinee, who rates the
intensity of anxiety experienced when in the situation (0= “none” to 3= “severe”) and the
frequency of their avoidance of the situation [0= “never” to 3= “usually (67–100%)”]. Four
subscores are obtained: Performance Fear, Performance Avoidance, Social Fear, and Social
Avoidance. A global score can be obtained by summing fear and avoidance ratings across all
situations. Heimberg and colleagues (37) provide support of the internal consistency of the
LSAS total score (Cronbach’s α =0.96) and six subscales (α ranging from 0.81 to 0.92).
Support was also found for the measure’s convergent validity; correlations between total
LSAS scores and self-report measures of social phobia were highly significant (37).
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Factor analytic evaluation of the LSAS has revealed a four-factor solution in one study: (1)
social interaction, (2) public speaking, (3) observation by others, and (4) eating and drinking
in public (38); and a five-factor solution in another: (1) interpersonal anxiety, (2) formal
speaking anxiety, (3) stranger-authority anxiety, (4) eating and drinking while being
observed, and (5) anxiety of doing something while being observed (39).

The LSAS was not intended as a diagnostic tool; however, it is often used for screening
social phobia in research settings. An LSAS score of 30 or above for nongeneralized social
phobia and 60 and above for generalized social phobia optimizes the balance between
sensitivity and specificity of the instrument (40). Treatment sensitivity has been
demonstrated in pharmacotherapy outcome research (41) as well as cognitive-behavioral
treatment of social phobia (42).

The LSAS has been translated into several languages and validated in international samples
(43–46). A Hebrew version of the LSAS demonstrated strong test-retest reliability, internal
consistency, and discriminant validity (47). The self-report version of the LSAS (LSAS-SR)
has demonstrated indistinguishable psychometric properties from the clinician version and
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thus may be validly employed in social phobia assessment (48).

In sum, the major strength of the LSAS is its broad coverage of both performance and
interaction-related anxiety. The total score on the LSAS is often used as an index of current
impairment due to social phobia. The LSAS-SR can be utilized efficiently in pharmaceutical
trials, which often rely on repeated assessment. A limitation of the measure is that it does
not capture cognitive schemas or physiological complaints characterized among persons
with social phobia. Furthermore, the two situational subscales—performance and interaction
—have not been supported empirically.

Brief Social Phobia Scale (BSPS)

The BSPS (49) is a symptom rating scale originally developed to assess social phobia
severity and symptom change over time with treatment (49). The scale includes 11 checklist
items, 7 which describe specific phobia situations that the examinee must rate on a severity

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scale of fear (0= “none” to 4= “extreme”) and a frequency scale of avoidance (0= “never” to
4= “always”). Four additional items comprise physiological symptoms associated with
experiencing or anticipating feared situations (e.g., blushing) that the examinee must also
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rate using the same severity scale above. Thus, three subscores are obtained (Fear,
Avoidance, and Physiology) as well as a total score. Any inconsistencies or ambiguities in
patient report are to be queried and reconciled by the assessor (49). Scores range from 0 to
72, with 20 or above the cutoff for generalized social phobia.

Inter-rater and test-retest reliability (49,50) as well as treatment sensitivity (51) of the BSPS
total scale have been well supported.

Strengths of the BSPS are its brevity and its inclusion of the observable physiological
markers often reported among persons with social phobia. Limitations include lack of
empirical support for its three subscales/factors (50) and poor reliability of the physiological
subscale (49).

Self-report Scales
Self-rating methods are the most time-efficient among assessment options. They are ideal
for repeated evaluation and minimize error variance due to multiple assessors. These
features are especially advantageous for treatment studies that use multiple sites and
frequent symptom monitoring (29). Over the last three decades, the quantity of self-report
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scales for social phobia has expanded considerably. Table 1 summarizes verbal self-report
questionnaires for social phobia, highlighting their key features.

Social Phobia and Anxiety Inventory (SPAI)

The SPAI (52,53) was designed to assess social anxiety distress across a broad range of
somatic symptoms, cognitions, and behavior across fear-producing situations (52). The scale
consists of an empirically derived set of 45 items covering social-situation anxiety, somatic
symptoms, and phobic cognitions. 13 items on the SPAI assess agoraphobia symptoms.
Each of the situational items includes separate ratings of distress for four specific groups: (a)
strangers; (b) authority figures; (c) the opposite sex; and (d) people in general. Among the 2
cognitive items, examinees are asked to self-rate 5 types of anticipatory thoughts (e.g. “I will
probably make a mistake and look foolish”) and 4 types of in-vivo thoughts (e.g. “I wish I
could leave and avoid the whole situation”). Likewise, each somatic item requires separate
ratings for physiological symptoms experienced in the situation: (a) Sweating; (b) Blushing;
(c) Shaking. Thus, the majority of “items” contain sub-components such that the scale
requires 109 individual self-ratings, using a seven-point distress scale (1= “never” to 7=
“always”). Social phobia subscale scores range from 0 to 192, with 60 an adequate screening
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cutoff for social phobia (52). The agoraphobia scale ranges from 0 to 78. The SPAI
difference score is calculated by subtracting the agoraphobia score from the social phobia
subscale score. Thus, the SPAI offers the option of factoring out avoidance due to
agoraphobia rather than social phobia.

Internal consistency and test-retest reliability for the SPAI are well supported (52,53).
Scores on the SPAI significantly differentiate patients with social phobia and those from
other clinic groups such as panic disorder and obsessive-compulsive disorder (52,60). The
SPAI difference score is considered less reliable than the SPAI social phobia subscale score
(61) and thus the latter is considered more parsimonious when evaluating groups of
individuals with social phobia. However, the SPAI difference score has demonstrated
superior discriminative power relative to the SPAI social phobia subscale (62). Furthermore,
both the SPAI difference score and the SPAI social phobia subscale score demonstrated
treatment sensitivity following cognitive-behavioral therapy with equivalent effect sizes

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(61). The SPAI social phobia subscale and the SPAI agoraphobia subscale have been
confirmed by factor-analysis using a nonclinical sample (63). Finally, an abbreviated SPAI
(SPAI-23) has recently been developed with statistical validation (64).
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Strengths of the SPAI include its thorough coverage of social situations, subcomponents to
assess the variety of observer contexts, superior discriminant validity over other self reports
(60), the optional exclusion of circumscribed agoraphobia symptoms, and inclusion of
physiological markers of social phobia. Limitations of the SPAI are its length of
administration and cumbersome scoring system relative to other self-report scales.
Furthermore, the use of the “opposite sex” term in many items overlooks potential subjects
with same-sex attraction, ostensibly attenuating their social phobia scores on the SPAI.

The Social Phobia Scale and the Social Interaction Anxiety Scale (SPS and SIAS)
The SPS and SIAS were developed as separate self-report measures of social anxiety by
Mattick and Clarke (54,55). Often administered together, the SPS pertains to fears of
scrutiny during observation by others, whereas the SIAS assesses anxiety experienced
during interaction with others. The SPS contains 20 statements that self-reporters must rate
the degree of how “characteristic or true” for them (0= “not at all” to 4= “extremely”). Items
include both worries pertaining to signs of nervousness (e.g., “I fear I may blush when I am
with others.”) as well as to scrutiny of performance (e.g., “I become anxious if I have to
write in front of others.”). The SIAS also contains 20 statements with the same rating system
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as the SPS. SIAS items pertain to discomfort in social settings (e.g., “I am tense mixing in a
group.”) including dyadic interactions (e.g. “I tense up if I meet an acquaintance on the
street.”). A total score from 0 to 80 is derived separately for each scale. Suggested cutoff
scores of 34 for the SIAS and 24 for the SPS denote generalized social phobia and
nongeneralized social phobia, respectively (65).

Internal consistency and test-retest reliability for the SPS and SIAS are well supported (55).
Both scales have demonstrated formal treatment sensitivity following cognitive behavioral
therapy with effect sizes for SIAS more robust (61) as well as following pharmacotherapy
(42). The SIAS and SPS reliably discriminate patients with social phobia from those with
other anxiety disorders (66). They appear to measure different but related constructs;
validity studies support the distinction between social interactional anxiety and scrutiny
fears (54,66). However, data reduction analysis of items from both scales revealed three
factors: (1) interaction anxiety, (2) anxiety about being observed by others, (3) fear that
others will notice anxiety symptoms (67). This finding suggests multifactoral phenomena in
nongeneralized anxiety and is consistent with research disconfirming the 2-subtype
heterogeneity of social phobia (18,5).
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Strengths of the SPS and SIAS include their combined coverage of social and performance
situations; usage of both scales is recommended for patients with generalized social phobia.
If only performance-related anxiety is of interest, the SPS is a facile, reliable self-report tool.
Coverage of social phobia phenomenology by the SPS and SIAS is limited to thoughts and
feelings (i.e. “worry about”; “tense”; “self conscious”). Thus, both scales lack any avoidance
ratings which we know to be pertinent to the patient’s impairment. Furthermore, the SPS
does not query all public speaking situations. Factor analytic findings suggest a conceptual
problem with treating the SPS as measuring a unidimensional construct.

Social Phobia Inventory (SPIN) and Mini-SPIN

The SPIN (56) is a recently created scale developed to assess the three important dimensions
(fear, avoidance, physiology) of social phobia in a brief format relative to previous self-
report scales. The SPIN’s 17 items, phrased similar to those on the BSPS, are rated on a

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scale (0= “not at all” to 4= “extremely”). The SPIN range of scores is 0 to 68; a cutoff score
of 19 distinguishes between social phobia and controls (56).
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Internal consistency, test-retest reliability, and construct validity of the SPIN has been
established by the developers of the measure (56) and confirmed with excellent estimates by
others (68). The SPIN has also evidenced treatment sensitivity following cognitive
behavioral therapy (68).

Advantages of the SPIN include its brevity, simplicity, social phobia sensitivity, and ease of
scoring (56); these facets make the measure popular among treatment outcome trials. A
limitation of the SPIN is the relatively modest empirical support for its physiological arousal
subscale (68).

The Mini-SPIN (57), a brief self-report scale created from 3 items of the SPIN, has recently
gained attention as an impressive screening tool with excellent sensitivity (89%) and
specificity (90%) in identifying generalized social phobia in managed care (57). Its three
items (“Fear of embarrassment causes me to avoid doing things and speaking to people.”; “I
avoid activities in which I am the center of attention.”; “Being embarrassed or looking
stupid are among my worst fears.”) evidenced strong internal consistency and support of
construct validity (69). The suggested cutoff score of 6 on the Mini-SPIN has been
empirically supported (57,69). Thus, the Mini-SPIN seems a promising assessment tool for
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social phobia presentations in time-limited settings.

Social Avoidance and Distress Scale (SAD)

The SAD (58), developed before the DSM-III introduction of social phobia, contains 28
items that measure social anxiety, avoidance, and distress associated with social interactions
(e.g., “Being introduced to people makes me tense and nervous.”). The SAD differs from
most self-report forms in that its items are rated on a true/false rather than a Likert-type
scale. The SAD, and Fear of Negative Evaluation Scale (described below) are two of the
most debated assessment measures for social phobia; the SAD has been questioned in its
usefulness in discriminating social phobia from other anxiety disorders (70,71) and in
evidencing treatment sensitivity (71). Subsequent research demonstrated that the SAD has
excellent internal consistency based on clinical samples of patients with anxiety disorders;
however, the measure did not significantly differentiate patients with social phobia from
those with other anxiety disorders (72).

The SAD is a reliable measure of general worry and avoidance of social interactions.
Limitations of the SAD include the absence of specific physiological responses to social
interactions and the lack of support for its use as a diagnostic aid for social phobia.
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Fear Questionnaire Social Phobia Subscale (FQ-Social)

The FQ-Social is a subscale of the Fear Questionnaire (59), a 15-item scale that assesses the
severity of phobias (i.e., agoraphobia, blood-injury phobia, and social phobia). The FQ-
Social comprises 5 items rated on a 0 to 8 scale of avoidance (0= would not avoid it; 8=
always avoid it). Each item briefly describes a situation involving being observed, being
criticized, or conversing (e.g., “Being watched or stared at”). The FQ subscale has been
empirically supported as a reliable, valid measure of social phobia (59,73,55).

Strengths of the FQ-Social include its brevity and simplicity; its five items effectively
differentiate between social phobia and other anxiety disorders (74,75). However, the FQ-
Social is limited to avoidance ratings and does not fully cover the breadth of social phobia
domains. Furthermore, mixed findings question the utility of the FQ-Social in differentiating
between generalized and nongeneralized social phobia (76,77).

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Cognitive Self-Report Measures

Because social phobia is characterized by fears of negative evaluation, cognitive products—
or simply, thoughts—are a core feature of the disorder (78). Individuals with social phobia
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judge themselves harshly and assume others judge them negatively; these are often the core
schema challenged in cognitive therapy (25). Social anxiety is hypothesized to be activated
and maintained by dysfunctional beliefs and biased information-processing; cognitive
change may be central to optimal outcomes among individuals with social phobia (79).
Table 2 provides an overview of cognitive measures of social phobia. They include the Fear
of Negative Evaluation Scale (FNE; 58), The Social Interaction Self-Statement Test (SISST;
80), The Social Thoughts and Beliefs Scale (STABS; 81), and the Appraisal of Social
Concerns (ASC; 82).

Related Variables of Interest

Features associated with social phobia, such as dysthymic mood, generalized anxiety, and
lowered life satisfaction often inform the scope, severity, and disability of patients with
social phobia. Antony (25) suggests the inclusion of self-report scales of depression, anxiety
and stress; Safren, Heimberg, and Brown (83) also highlight the importance of measuring
disability, functional impairment, and lowered life satisfaction as part of social phobia
assessment. Quality of life scales often used in psychiatric or medical settings, although
having little obvious relevance to social phobia, can elucidate impairment caused by
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excessive behavioral avoidance (i.e., social isolation) and cognitive rumination (83). Table 3
summarizes the recommended, psychometrically sound assessments for measuring
associated features of social phobia.

Conclusion
This review highlighted the broad array of instruments available for the assessment of social
phobia, as well as the key features and limitations associated with each. Consideration of
each assessment approach should be made with the acknowledgement that clinical
evaluation is in itself a phobic stimulus for many patients with social phobia (25).
Additionally, a skillful assessor maintains multicultural sensitivity when assessing
individuals with minority backgrounds, including sexual orientation, such that they are
aware of the potential bias(es) of a measurement tool. Therefore, the expertise, skill, and
professionalism of the clinician will influence the quality of social phobia assessment
beyond the abilities of the measure in question.

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Table 1
Self-rating scales for symptomatic assessment of social phobia
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Scale Description Features Limitations

Social Phobia and Anxiety 45 items cover somatic, cognitive, Agoraphobia subscale Cumbersome scoring
Inventory (52,53) and behavioral symptoms
Social Phobia Scale (54,55) 20 items assess fears of scrutiny by Full coverage of SP symptoms when No avoidance ratings
others used in conjunction with SIAS
Social Interaction Anxiety 20 items assess fears of interaction Full coverage of SP symptoms when No avoidance ratings
Scale (54,55) used in conjunction with SPS
Social Phobia Inventory (56) 17 items assess fear, avoidance, SP sensitivity and user-friendly Lacks strong support for
physiology of SP physiological subscale
Mini-SPIN(57) 3-items related to social Brief; excellent SP sensitivity/ Subsequent assessment usually
embarrassment specificity required
Social Avoidance and 28 items measure anxiety, Reliable among clinical SP samples Lack of empirical support as a
Distress Scale (58) avoidance, distress related to diagnostic aid
interactions
Fear Questionnaire Social 5 items rated on performance/ Brief, useful as diagnostic aid Limited to avoidance ratings
Phobia Subscale (59) social avoidance

SP = Social phobia
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Table 2
Self-rating scales for cognitive assessment of social phobia
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Scale Year Number of Items Description and Features

Fear of Negative Evaluation Scale (58) 1969 30 Assesses non-specific but critical cognitive features of SP
The Social Interaction Self-Statement 1982 21 Thought-endorsement measure relevant to 1-to-1 interactions
Test (80)
The Social Thoughts and Beliefs Scale 2003 21 Empirically validated to measure cognitions in situational parameters
(81)
Appraisal of Social Concerns (82) 2004 20 Measures SP-related threat appraisals; similar but more efficient than
thought-listing

SP = Social phobia
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Table 3
Assessments of associated features of social phobia
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Scale Description Scores Features

Sheehan Disability Scale 4-items assess current levels of Single dimension of global Change-over- time in scores
(84) impairment across work/school, functioning from 0 (unimpaired) to frequently used in treatment
social, and family domains 30 (highly impaired) outcome studies
Liebowitz Self-Rated Assesses current and lifetime Mean score of 39 = substantial Includes suicidal behavior
Disability Scale (13) impairment due to “emotional disability (85) domain
problems” across 11 domains
Beck Depression Inventory, Self-report of cognitive, behavioral, 0 to 10=Minimal depression 10– Efficient format with wide
2nd Edition (86) and somatic symptoms of 18=Mild depression 19– coverage of depression
depression 29=Moderate to severe depression symptomatology
30–63=Severe depression
Medical Outcomes Study Measures general quality of life 50 to 70 = Moderately reduced Validated in Hebrew (89) and
Health Status over a broad range of non- disease- quality of life Below 50 = Markedly other languages
Questionnaire-36 item Short specific health concepts reduced quality of life
Form (87,88)

SP = Social phobia
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