Table 2.

Description of the SA steps, therapeutic target, and its theoretical, empirical, and clinical basis.

Step	Therapeutic target	Theoretical, empirical and clinical basis
1	Identifying situational triggers	CBT model of SAD
2	Identifying and challenging automatic thoughts	Integrated CBT model of SAD
3	Unhelpful self-focused attention	Integrated CBT model of SAD
4	Acceptance of physical sensations	Integrated CBT model of SAD
5	Overt avoidance behaviors	Integrated CBT model of SAD
6	Covert safety behaviors	Integrated CBT model of SAD
7	Fostering intimate relationships (i.e., targeting safety behavior of concealment)	Focus group feedback
8	Self-acceptance (i.e., targeting maladaptive perfectionistic cognitions)	Focus group feedback
9	Managing negative events in everyday life (i.e., targeting personalizing bias)	Focus group feedback
10	Shame (cognitions) and associated safety behaviors	Empirical findings relevant to psychosis and comorbid SAD1
11	Paranoia (cognitions) and associated safety behaviors	Empirical findings relevant to psychosis and comorbid SAD2
12	Social rank (cognitions) and associated safety behaviors	Empirical findings relevant to psychosis and comorbid SAD3

¹Substantial empirical evidence shows that a psychotic disorder diagnosis carries severe social stigma, and many of those diagnosed internalize this stigma and suffer shame and diminished self-esteem (12–13, 14, 17). ²Empirical findings suggest that paranoid thinking and social anxiety can overlap significantly, and issues of social power/rank may underpin both forms of anxiety (13–14, 15, 57). ³Study findings show that individuals with SAD tend to assess their worth based upon how they rank in comparison with others (i.e., social rank) (15, 17), resulting in a view of the self that is highly linked to the views of others. For individuals with psychosis and SAD, this relationship is further complicated by feelings of shame, social rejection, and entrapment associated with the stigma of schizophrenia.