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Clark Wells Model Central Factor — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersClark Wells Model Central FactorMRCPsych Paper B

A woman with social anxiety disorder gives a presentation while closely monitoring the warmth in her face and slight tremor in her voice. Although the audience responds neutrally, she becomes convinced that she appeared markedly anxious and incompetent and does not register evidence to the contrary. In the Clark and Wells cognitive model, which process most directly accounts for this interpretation?

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Correct answer: DSelf-focused attention constructing a distorted self-image from internal cues

The correct answer is D. In the Clark and Wells model, perceived social threat prompts a shift towards self-focused attention. The person monitors thoughts, bodily sensations and self-imagery, then uses these internal cues to infer how they appear to others. This produces a distorted, often observer-perspective negative self-image and diverts attention from external information that could disconfirm feared evaluation. Avoidance and safety behaviours can also maintain social anxiety, but avoidance alone does not explain the conversion of internal sensations into apparent evidence of others’ judgement. Option E describes an agoraphobic concern, while option B is characteristic of the cognitive model of panic disorder. Substance use may become a maladaptive coping or safety behaviour but is not the central cognitive process described here.

Reference: National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment. NICE guideline CG159, recommendation 1.3.13, 2013. https://www.nice.org.uk/guidance/cg159/chapter/recommendations