Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention.

Four domains of evidence regarding the relationship between attention and social phobia are reviewed: (1) possible maintaining factor, (2) causal relationship, (3) specific relationship and (4) mediator of change during treatment. Two areas of research are covered and integrated: vigilance-avoidance of social threat stimuli and self-focused attention. There is empirical support for these processes as possible maintaining factors that are specific to patients and non-clinical samples with high levels of social anxiety. There is reasonable evidence to promote the use of attentional strategies in the treatment of social phobia, although better controlled studies are required. We propose six overlapping mechanisms that could be responsible for change: reduced vigilance; reduced avoidance; reduced self-focused attention; mindfulness; increased attentional control; increased self-esteem.