Table 4.

Illustration of clinical utility of SPIN subscale scores: Tailoring cognitive-behavioral therapy

Subscale Score	Further assessment/Case conceptualization	Treatment Indications
Fear of Negative Evaluation is HIGH	Focus on elaborating the specific feared consequences of negative evaluation (e.g., experiencing embarrassment or humiliation, being socially isolated, losing one's job, forgetting the rest of one's speech)	Work toward identifying core beliefs that make negative evaluation seem highly likely or consequential Fear and Avoidance Hierarchy should include situations that strongly activate these concerns As situational exposure progresses, incorporate criticism and other negative feedback into exposure scenarios Foster acceptance of the inevitability of occasional negative evaluation and problem-solve coping with negative feedback
Fear of Physical Symptoms is HIGH Note: If combined with LOW Fear of Negative Evaluation, consider additional diagnostic assessment focused on the differential between Panic Disorder and SAD	Assess full range of physical symptoms associated with anxiety to determine whether patient is concerned about symptoms other than those assessed by the SPIN (blushing, heart palpitations, sweating, trembling/shaking) Determine feared outcomes of symptoms (e.g., they will be noticed by others, they will prevent normal speech or other social behavior)	Consider conducting interoceptive exposure if patient fears the symptoms themselves Incorporate symptom provocation during situational exposure (e.g., induce sweating before interacting with a stranger) and also expose the patient to feared outcomes (e.g., conversation partner remarks that the patient is blushing). Video-record exposures to provide realistic information about the degree to which physical symptoms are noticeable
Fear of Uncertainty in Social Situations is HIGH	Conduct detailed inquiry about feared scenarios that could arise in situations that involve unfamiliar people or settings (e.g., having to “break into” an ongoing conversation at a party; encountering a highly critical observer when the center of attention)	Psychoeducational component of treatment could include discussion of anxiety being a response to unpredictability; and when this can be helpful vs. counterproductive Fear and Avoidance Hierarchy should include graded variations of situations where the person may interact with groups, strangers, and/or be the focus of attention Exposures should include confederates who model a wide variety of response styles (e.g., quiet conversation partner) and include unpredictable or novel events (e.g., audience member interrupts or walks out during speech)