Imagery-enhanced cognitive behavioural group therapy for social anxiety disorder: A pilot study

Abstract

Cognitive behavioural group therapy (CBGT) for social anxiety disorder (SAD) is efficacious and effective, however a substantial proportion of patients remain in the clinical range so treatment innovations are required. Research suggests that working within the imagery mode may be more emotionally potent than traditional verbal-linguistic strategies.This study piloted an imagery-enhanced CBGT (IE-CBGT) protocol for SAD. It was hypothesised that IE-CBGT would be acceptable to patients, demonstrate large effect sizes, and compare favourably to historical controls who completed CBGT without the imageryenhancements. Patients (N = 19) were consecutive referrals to a community clinic specialising in anxiety and mood disorders. Primary outcomes were self-reported performance and social interaction anxiety. IE-CBGT was highly acceptable to patients with high attendance and completion rates. Effect sizes were large by mid-treatment and very large at post-treatment and follow-up. A high proportion of patients achieved reliable change. Outcomes compared favourably to published group and individual treatments for SAD but larger randomised controlled trials are now required.

The essential role of mental imagery in cognitive behaviour therapy: What is old is new again

“…There are a number of ways that imagery can be emphasised within the thought record process to enhance emotional engagement and impact, which have been implemented by McEvoy, Saulsman, et al (2018) (see also McEvoy et al, 2015;McEvoy & Saulsman, 2014) in their Imagery-Enhanced CBT for Social Anxiety Disorder protocol, and also outlined by Josefowitz (2017). First, mental imagery can be applied in the eliciting phase of thought record work.…”

Combined Audience and Video Feedback With Cognitive Review Improves State Anxiety and Self-Perceptions During Speech Tasks in Socially Anxious Individuals

“…The distorted self-images involve an observer's perspective (Hackmann et al, 1998) and are discrepant from what is truly visible to others (Rapee & Lim, 1992), leading to underestimations of performance, overestimations of anxiety symptom visibility, and large discrepancies between self and objectiveobserver perceptions of performance (Hirsch, Clark, Mathews, & Williams, 2003;Hirsch, Meynen, & Clark, 2004;Makkar & Grisham, 2011). To target distorted self-imagery, video feedback can usefully provide a more objective source of information about one's social performance, and has been incorporated into cognitive therapy for SAD (Clark et al, 2006;McEvoy & Saulsman, 2014).…”

Attenuated Psychophysiological Reactivity following Single-Session Group Imagery Rescripting versus Verbal Restructuring in Social Anxiety Disorder: Results from a Randomized Controlled Trial

“…A subsequent controlled trial [46] also demonstrated that either individual single-session IR or cognitive restructuring yielded reductions in self-reported social anxiety symptoms compared to waitlist. Our own previous work with group interventions has demonstrated that social anxiety symptoms often appreciably decrease around week 3 of treatment, and continue to decrease through to session 12 and 1-month follow-up [20, 21]. Such effects may well reflect the fact that changes in self-concept tend to evolve over a more protracted timescale, at least in group treatment [47].…”

“…Facilitators were trained in both protocols and supervised throughout the study. The group IR intervention was adapted from an existing 12-week imagery-enhanced group cognitive-behavioral therapy protocol [21], identified as effective for treating SAD [20], and which incorporates established imagery methods [11]. The VR intervention was adapted from Rapee et al [39].…”

“…Individually delivered single-session IR protocols [16, 17] reduce SAD-related symptomatology, whether used in isolation [18] or following cognitive restructuring [19]. Integration of imagery-based techniques into cognitive-behavioral treatment protocols is also beneficial for SAD in a group setting [20, 21]. However, no studies have examined the effectiveness of group-based IR compared to verbal-linguistic interventions (e.g., thought challenging) in treating SAD.…”