This is another well-presented, compact volume in the series “Advances in psychotherapy – evidenced-based practice”. At 90 pages, it is aimed as a structured and practical guide to assist therapists working in the field of social anxiety. The authors are well-respected authorities in the field of anxiety disorders, and the writing feels authoritative and user-friendly.

Chapter one concisely outlines the condition of social anxiety disorder (or social phobia) together with epidemiological characteristics, comorbidity data, differential diagnoses, and commonly administered measures and interview schedules. Chapter two describes two influential cognitive models of social anxiety, those of Clark and Wells (Reference Clark, Wells, Heimberg, Liebowitz, Hope and Schneier1995) and of Rapee and Heimberg (Reference Rapee and Heimberg1997), noting the similarities and slight differences in these conceptualizations. Chapter three discusses some key variables to be assessed and which may indicate a particular direction of treatment. In addition it outlines possible pharmacological alternatives to treatment. Chapter four devotes 40 pages to treatment strategies, including use of psychoeducation, cognitive restructuring, analysis of core beliefs, exposure hierarchies, role plays, interoceptive exposure, social skills training, and relaxation strategies. Chapter five then describes two case vignettes, both centred upon an exposure hierarchy.

This book displays an excellent understanding of the troubles encountered by sufferers of social anxiety, and has a good account of two influential cognitive models. However, the treatment chapter presents rather as a composite list of available strategies, derived from traditional Beckian restructuring, traditional graded exposure, social skills training and relaxation approaches. Therefore, despite many valuable tips contained within, it perhaps lacks the coherence of a treatment approach derived from a comprehensive modern cognitive theory. Moreover, certain well-researched components of cognitive therapy for social anxiety are given cursory attention, or neglected altogether. Safety behaviours are rather underplayed, and it is not clear how certain classes of safety behaviour (for example, rehearsing what to say in advance, or trying hard to appear witty and interesting) fit neatly into an exposure hierarchy paradigm, as the authors advocate. Behavioural experiments are mentioned briefly but then not elaborated upon, and yet these may allow access to crucial cognitive information that the individual would not readily acquire by pursuing a hierarchy of social goals. The role of self-focused attention is also neglected, despite the evidence that this may be a fundamental impediment to individuals acquiring the information they need during exposure that their social environment or “audience” is not hostile or critical as they have feared. The role of negative self-imagery is not covered, and video feedback, possibly one of the most powerful corrective approaches emanating from the Clark and Wells (1995) model, is not described.

Overall, this volume delivers a mixture of hope and slight disappointment. It is great to see authors of this calibre devoting serious attention to the most prevalent and arguably the most under-recognized of the anxiety disorders. The house style of the series is adhered to faithfully, and the book presents as an informative, concise and attractive book for the practising clinician. However, despite many excellent suggestions for treatment, the theoretical underpinnings and coherence of the approach are limited, and the authors promote essentially an exposure-based approach peppered with some cognitive restructuring. Many would say this does not do complete justice to the state of the art (or indeed the science) with respect to modern cognitive formulations of social anxiety disorder. Nevertheless, this is undoubtedly a readable, attractive, clinically-grounded and useable book, and there exists the definite hope that it may inspire clinicians to attend more closely to and feel more confident with this rather neglected, often hidden, but severely troubled population.