commentary
Reconceptualizing the Self

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Abstract

This article is an invited commentary on Moscovitch’s (2009) paper “What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment.” The crux of Moscovitch’s argument is that current models of social phobia fail to conceptualize the nature of social fears correctly. Moscovitch proposes that the self is the phobic stimulus and should be the target of exposure treatment, rather than social situations. This commentary evaluates Moscovitch’s claim and agrees that distorted views of self are at the heart of the disorder, but contests the idea that the self can be conceptualized as a phobic stimulus. Instead, we need to recognize that all individuals have multiple self-representations and that access to a current working self depends on a set of retrieval mechanisms that involve both the contents of self-knowledge and the way that this information is stored. The application of these ideas to social phobia is discussed. In the final section of the commentary, I discuss Moscovitch’s contributions to treatment derived from his new model and outline some additional methods of working with the self, including imagery rescripting.

Section snippets

The Self as a Feared Stimulus

Moscovitch (2009) uses Foa and Kozak’s (1986) fear network theory as the conceptual framework for his arguments. According to this theory, “the extinction of learned fear during exposure-based CBT depends integrally on ensuring that patients process new emotional information that is incompatible with their existing mental representations of fear” (p. 124; this issue). In this formulation, exposure only works if you expose the patient to the correct stimulus, and of course in order to do this,

Reconceptualizing the Self

If the basic premise that the self can be conceptualized as a phobic stimulus is inaccurate or unhelpful, then what is the alternative and how might this be useful clinically? Or, to put it another way, how should we conceptualize the self in models of social phobia? The first point is that the self is not a single unitary entity. Rather, the self comprises multiple different representations, and at any given time, the individual has “on-line” a particular subset of self-representations or a

Clinical Applications of Moscovitch’s Model

Moscovitch argues that his new model of case conceptualization can be tailored to “the specific features of individual patients with social phobia” (p. 128; this issue) and contrasts this with Clark et al., 2003, Hofmann, 2007 CBT frameworks, which he says are designed to describe specific features of social phobia rather than specific features of the individual. I am not convinced by this argument, as my own clinical experience of working with Clark and Wells’ (1995) model, and indeed the

Therapeutic Interventions That Target the Self

In cases where emotions other than anxiety are triggered by revealing the self, the therapist will have to consider different strategies. One promising strategy is to use imagery rescripting, particularly where shame is associated with early memories. Hackmann et al. (2000) showed that many of the negative and distorted images of self reported by patients with social phobia were linked to early memories of aversive social experiences such as being bullied. Imagery rescripting is a technique

Conclusions

To conclude, then, I have tried to outline the ways that I think Moscovitch’s new model is helpful, but also to highlight the points at which the full extent of its potential contribution is limited by remaining both conceptually and therapeutically within a learning theory framework. I am not suggesting that learning theory no longer has a valuable contribution to make to both the understanding and treatment of social phobia: this would clearly be throwing the baby out with the bathwater.

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