This chapter may seem like a bit of an oddity; it is a chapter about challenges in the treatment of generalized social phobia (GSP) that appears in a book about shyness. In comparison with the literature on shyness and its treatment, the literature on the assessment and treatment of social phobia is very new. However, when people present for treatment because of extreme social anxiety, they receive a diagnosis of social phobia (DSM-IV) rather than a diagnosis of ‘shyness’. Although there has been an unfortunate lack of communication between researchers interested in the study of shyness and those interested in the study of social phobia, excellent summaries of both the treatment of shyness and the treatment of GSP are available elsewhere (e.g. Jones, Cheek and Briggs, 1986; Heimberg, Leibowitz, Hope and Schneier, 1995). It is not our purpose to provide another review of these literatures. Rather, we would like to describe our current attempt to integrate the shyness and social phobia literature that we hope will improve our understanding and treatment of patients with social phobia.