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Clark and Wells Model — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersClark and Wells ModelMRCPsych Paper B

A 28-year-old man with social anxiety disorder describes what happens during work meetings. He monitors facial warmth, the sound of his voice and any momentary mental blankness. He then experiences an observer-perspective image of himself appearing visibly anxious and incompetent, and treats this image as evidence of his colleagues' view despite paying little attention to their actual responses. In the Clark and Wells cognitive model, which maintaining process is most specifically illustrated?

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Correct answer: E — Self-focused attention that uses internal information to construct a negative impression of the self

The correct answer is E. In the Clark and Wells model, entering a feared social situation produces increased self-focused attention. Bodily sensations, thoughts and mental images are then used to construct an often observer-perspective, negatively distorted impression of how the person appears to others. Attention is consequently diverted from external responses that might disconfirm the feared evaluation. Negative assumptions in A contribute to perceived social danger but do not describe the specific internal self-monitoring mechanism. Safety behaviours in C are another important maintaining factor, but none is described here. Anticipatory processing in D occurs before the encounter, whereas post-event processing in E occurs afterwards; the vignette describes processing during the meeting.

Reference: Spurr JM, Stopa L. Self-focused attention in social phobia and social anxiety. Clinical Psychology Review. 2002;22(7):947–975. https://pubmed.ncbi.nlm.nih.gov/12238248/