The enhancement of beneficial effects following audio feedback by cognitive preparation in the treatment of social anxiety: A single-session experiment Jan-Erik Nilsson a, * , Lars-Gunnar Lundh b , Shahriar Faghihi c , Gun Roth-Andersson d a Kognio, Centre for CBT, Annedalsvägen 9, 227 64 Lund, Sweden b Department of Psychology, Lund University, Sweden c Department of Psychiatry, Lund University Hospital, Sweden d Department of Social Work, Ängelholm Hospital, Sweden article info Article history: Received 22 October 2010 Received in revised form 3 May 2011 Accepted 17 May 2011 Keywords: Social anxiety Audio feedback Cognitive preparation Implicit association test abstract Background and objectives: : According to cognitive models, negatively biased processing of the publicly observable self is an important aspect of social phobia; if this is true, effective methods for producing corrective feedback concerning the public self should be strived for. Video feedback is proven effective, but since one’s voice represents another aspect of the self, audio feedback should produce equivalent results. This is the first study to assess the enhancement of audio feedback by cognitive preparation in a single-session randomized controlled experiment. Method: Forty socially anxious participants were asked to give a speech, then to listen to and evaluate a taped recording of their performance. Half of the sample was given cognitive preparation prior to the audio feedback and the remainder received audio feedback only. Cognitive preparation involved asking participants to (1) predict in detail what they would hear on the audiotape, (2) form an image of themselves giving the speech and (3) listen to the audio recording as though they were listening to a stranger. To assess generalization effects all participants were asked to give a second speech. Results: Audio feedback with cognitive preparation was shown to produce less negative ratings after the first speech, and effects generalized to the evaluation of the second speech. More positive speech evaluations were associated with corresponding reductions of state anxiety. Social anxiety as indexed by the Implicit Association Test was reduced in participants given cognitive preparation. Limitations: Small sample size; analogue study. Conclusion: Audio feedback with cognitive preparation may be utilized as a treatment intervention for social phobia. Ó 2011 Elsevier Ltd. All rights reserved. 1. Introduction Cognitive models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997) predict that, during social interactions, socially anxious individuals focus their attention towards their own bodily sensations, feelings, and behaviour. They also posit that social phobia is associated with negatively biased processing of the public self (i.e., one’s appearance). Moreover, Clark and Wells (1995) suggest that much of this self-processing is done from an observer perspective (i.e., seeing oneself as from the viewpoint of others), as opposed to a field perspective (i.e., seeing through one’s own eyes), and often in the form of an image. Consistent with these models, research has shown that socially anxious individuals are characterized by increased negative thinking in social interactions (Beidel, Turner, & Dancu, 1985; Stopa & Clark, 1993), in particular related to social performance (Hope, Burns, Hayes, Herbert, & Warner, 2010). Furthermore, these indi- viduals typically underestimate their performance relative to ratings by neutral observers (Alden & Wallace, 1995; Rapee & Lim, 1992; Stopa & Clark, 1993; Voncken & Bögels, 2008), reflecting heightened levels of negative self-evaluation (Ashbaugh, Antony, McCabe, Schmidt, & Swinson, 2005; Garner, Mogg, & Bradley, 2006; Moscovitch & Hofmann, 2007). Interestingly, people with high social anxiety seem to lack the positive bias consistently found in individuals with low social anxiety (Garner et al., 2006; Hirsch & Mathews, 2000; Huppert, Pasupuleti, Foa, & Mathews, 2007). The perception of their performance by these individuals has recently been found to serve as a mediating function between dispositional * Corresponding author. Tel.: þ46702074352. E-mail address: jan-erik.nilsson@kueab.se (J.-E. Nilsson). Contents lists available at ScienceDirect Journal of Behavior Therapy and Experimental Psychiatry journal homepage: www.elsevier.com/locate/jbtep 0005-7916/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.jbtep.2011.05.004 J. Behav. Ther. & Exp. Psychiat. 42 (2011) 497e503