Updating the self: a mechanistic roadmap for effective treatment of adults with social anxiety disorder

What drives effective psychological treatment of social anxiety disorder (SAD)? The emerging consensus among clinical researchers based on over 40 years of data from relevant studies is that treatment success for people with SAD requires new affective learning about the self, a process we refer to throughout this chapter as self-updating. In the pages below we provide an integrative, evidence-based framework for treating adults with SAD that is grounded in mechanistic principles of self-updating derived from clinical and neurocognitive models of learning and memory. First, we elucidate the nature of negative self-perception in SAD. Next, we clarify what clients with SAD must learn about themselves during treatment and how specific interventions can be optimally designed and administered to guide clients' new learning in service of achieving successful self-updating to reduce functional impairment and produce enduring symptom change. Finally, we identify key directions for future research, emphasizing the need for rigorous intervention studies that distinguish more deliberately and clearly between therapeutic procedures, mechanisms, and outcomes to advance our understanding and successful application of effective psychological treatment for people with SAD.