Ariel Stravynski Ph.D., a longstanding contributor to the literature on the understanding and treatment of social phobia, provides a synthesis of his thinking on the subject in Fearing Others: The Nature and Treatment of Social Phobia. Dr Stravynski, a Professor in the Department of Psychology at the University of Montreal, argues that 40 years after the seminal description of the clinical syndrome by Marks & Gelder (1966), it is time for the field to take stock of our progress by scrutinizing the extent to which we understand the nature and treatment of social phobia.
The book, unlike many available multi-authored edited tomes, is uniquely reflective of Dr Stravynski's views about social anxiety. While one may not see eye to eye with him on each and every issue, it is inarguable that he knows the literature well, and that his synthesis of this literature leads the reader to consider new vantage points. For example, he posits that it is unreasonable to expect that therapies directed at anxiety reduction alone will lead to ‘adaptive social functioning. This seems unwarranted … Acting powerlessly and defensively is a long-standing habit, at this stage likely to be functionally independent and only loosely related to levels of anxiety (pp. 356–357).’ He argues persuasively for a more interpersonal approach to treatment – which, not surprisingly, he has championed in his own research. This suggestion, backed by a very credible review of the preclinical and clinical literatures pertaining to such topics as dominance behaviours and social roles, provides much-needed leverage for the development and testing of new interpersonally directed therapies. In other instances, the writing retreads familiar terrain in unsatisfying ways. In reflecting, for example, upon the oft-noted overlap between social phobia and avoidant personality disorder on Axes I and II, respectively, he states that, ‘Subversively, social phobia straddles both; it is simultaneously an anxiety and a personality disorder (p. 138).’ While superficially inarguable, this line of reasoning offers little in the way of new directions for research or practice.
Some parts of the book are much stronger (e.g. chapter 7: Social Phobia as a Consequence of Cognitive Biases) than others (e.g. chapter 6: Social Phobia as a Consequence of Brain Defects). Especially informative was chapter 9: Social Phobia as a Consequence of Individual History, where the author brings together a diverse literature on possible precursors of social phobia that range from temperament to parental loss. Especially disappointing was the mere 1½ pages devoted to the review of psychopharmacological treatments (pp. 331–332).
The book is encyclopedic, through mid-2006, in its amalgamation of the social phobia literature. This will make it an especially attractive reference resource for those individuals devoted to – or just becoming familiar with – this topic area. Overall, the writing is excellent, downright prosaic at times. I was taken, for example, by the author's description of the poverty of interpersonal life led by persons with social phobia, who ‘strive to lead a blameless life. For this, they adopt stringent standards of propriety and scruple; attempting, but not necessarily succeeding, to be beyond reproach (p. 9).’ These are the writings of a skilled clinician-scientist who understands not only the literature he reads (and writes) but also the inner lives of the patients he treats. The book is full of similarly insightful and engaging clinical pearls that make it mandatory reading for students, clinicians and researchers who share the author's passion for this subject.
