Clark Wells Model Central Factor — MRCPsych Paper B MCQ
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Correct answer: D — Self-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