Re:ocular contact avoidance

There are many good references on the treatment of social phobia but I don't remember if any of them specifically address avoidance of eye contact. The treatment approach you have in mind, relaxation and gradual exposure, should work well.

One thing which may be useful to do in addition is to identify the client's cognitions regarding eye contact and address them. This could include pinpointing his automatic thoughts regarding eye contact and asking about his expectations regarding what will happen if he makes eye contact and how others will respond if he makes eye contact. In my experience, the cognitions can range from ordinary ones such as "I won't know what to say." to more uncommon ones such as "They'll start talking to me and I'll be stuck, I won't be able to end the conversation." Many social phobics are afraid that the other person will notice that they are anxious and think that they are strange. I even had a Korean client who feared that, if he made eye contact, the other person would be able to tell that he was depressed and that this would entail an intollerable loss of face.

Cognitive interventions which address these cognitions will not make the anxiety and avoidance go away, in-vivo exposure is essential. However, if the therapist addresses these cognitions, it often makes it easier to get the client to follow through on the in-vivo exposure.

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