Patterns of anxious arousal during exposure to feared situations in individuals with social phobia.

Behavioral assessment tests (BATs) are commonly used in studies of social phobia (SP). While previous studies have examined subjective anxiety during BATs, they have usually reported only mean or peak ratings. The current study examined whether there are different patterns of anxious arousal in anticipation of, and during exposure to, feared situations among individuals seeking treatment for SP (N = 153). A four cluster solution was judged to best describe the data, and the four clusters were labeled 'high anxiety,' 'increasing/high anxiety', 'moderate anxiety' and 'mild anxiety'. Before treatment, the cluster groups did not differ on person characteristics, subtype of social phobia, or levels of depressive symptoms. However, they did differ in terms of the severity of social phobia symptoms and the emotional valence of thoughts reported at the conclusion of the BAT. While members of all clusters benefited from cognitive-behavioral group therapy for social phobia, the clusters showed some differential response in amount of symptom reduction and likelihood of continuing to meet diagnostic criteria following treatment. The different emotional experiences of clients in the various clusters are explored and implications for cognitive-behavioral therapy are proposed. Finally, limitations of this study and future directions are discussed.