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BACKGROUND: Cognitive therapy is an effective treatment for social anxiety disorder but little is known about the mechanisms by which the treatment achieves its effects. AIMS: This study investigated the potential role of self-focused attention and social phobia related negative automatic thoughts as mediators of clinical improvement. METHOD: Twenty-nine patients with social phobia received individual cognitive therapy (ICT) in a randomized controlled trial. Weekly process and outcome measures were analysed using multilevel mediation models. RESULTS: Change from self-focused to externally focused attention mediated improvements in social anxiety one week later. In contrast, change in frequency of, or belief in, negative social phobia related negative automatic thoughts did not predict social anxiety one week later. CONCLUSIONS: Change in self-focused attention mediate therapeutic improvement in ICT. Therapists should therefore target self-focused attention.

Original publication




Journal article


Behav Cogn Psychother

Publication Date





63 - 73


Social phobia, attention, beliefs, cognitive therapy, individual CBT, Adult, Attention, Cognitive Therapy, Female, Humans, Male, Phobic Disorders, Self Concept