Effects of False Feedback on Affect, Cognition, Behavior, and Postevent Processing: The Mediating Role of Self-Focused Attention Steve R. Makkar Jessica R. Grisham University of New South Wales Current social phobia models (e.g., Clark & Wells, 1995; Leary & Kowalski, 1995) postulate that socially anxious individuals negatively appraise their anxiety sensations (e.g., sweating, heart racing, blushing) as evidence of poor social performance, and thus fear these anxiety symptoms will be noticed and judged negatively by others. Consequently, they become self-focused and hypervigilant of these sensations and use them to judge how they appear to others. To test this model, high (N =41) and low (N =38) socially anxious participants were shown false physiological feedback regard- ing an increase or decrease in heart rate prior to and during an impromptu speech task. Relative to participants who observed a false heart rate decrease, those in the increase condition reported higher levels of negative affect, more negative performance appraisals, and more frequent negative ruminative thoughts, and these effects were mediated by an increase in self-focused attention. The unhelpful effects of the physiological feedback were not specific to high socially anxious participants. The results have implications for current cognitive models as well as the treatment of social phobia. Keywords: social anxiety; social phobia; self-focused attention; post-event processing; false feedback CLARK AND WELLS (1995) PROPOSED that when social phobia patients enter social situations, attention shifts to a detailed monitoring of the self in order to manage self-presentation. This self-focused attention increases awareness of internal information such as anxiety symptoms (e.g., heart racing, blushing). Unfortunately, upon noticing this information, patients erroneously appraise their anxiety-related sensations as signs of impending or actual failure to meet their desired social impressions and incorrectly utilize this somatic information to infer how they appear to others. Thus, feeling anxious becomes equated to looking anxious. In sum, patients’ nega- tive interpretation of their anxiety symptoms is a key mechanism that contributes to the maintenance of social phobia. In support, multiple studies indicate that socially anxious individuals rely on their own internal arousal to judge the visibility of their anxiety (e.g., Dodd, Hudson, Lyneham, Wuthrich, & Monier, 2011; Mansell & Clark, 1999; McEwan & Devins, 1983). Moreover, high socially anxious individuals who are falsely led to believe they are experiencing physiological symptoms such as in- creased pulse or heart rate (HR) during social situations report elevated anxiety and greater nega- tive beliefs (Papageorgiou & Wells, 2002; Wells & Papageorgiou, 2001). Recent studies, however, suggest that both high and low socially anxious individuals negatively inter- pret anxiety symptoms as evidence of poor social performance. First, Roth, Antony, and Swinson (2001) found that both social phobia patients and nonanxious controls negatively interpreted anxi- ety symptoms in others as being due to “intense anxiety”; “use of drugs, alcohol, or medication”; or “a medical [or] some other psychiatric condition.” Second, Dodd et al. (2011) found that among a sample of high and low anxious children, there was a Available online at www.sciencedirect.com Behavior Therapy 44 (2013) 111 – 124 www.elsevier.com/locate/bt Address correspondence to Steve R. Makkar, School of Psychology, University of New South Wales, Sydney NSW 2052, Australia; e-mail: srm@unsw.edu.au. 0005-7894/40/111-124/$1.00/0 © 2012 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.