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Imagery-enhanced v. verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial

Published online by Cambridge University Press:  11 September 2020

Peter M. McEvoy Open the ORCID record for Peter M. McEvoy [Opens in a new window] ,
Matthew P. Hyett ,
Samantha R. Bank ,
David M. Erceg-Hurn ,
Andrew R. Johnson ,
Michael J. Kyron ,
Lisa M. Saulsman ,
Michelle L. Moulds ,
Jessica R. Grisham  and
Emily A. Holmes
...Show all authors
Peter M. McEvoy*
Affiliation:
School of Psychology, Curtin University, Perth, Australia Centre for Clinical Interventions, Perth, Australia
Matthew P. Hyett
Affiliation:
School of Psychology, Curtin University, Perth, Australia
Samantha R. Bank
Affiliation:
School of Psychology, Curtin University, Perth, Australia Centre for Clinical Interventions, Perth, Australia
David M. Erceg-Hurn
Affiliation:
School of Psychology, Curtin University, Perth, Australia Centre for Clinical Interventions, Perth, Australia
Andrew R. Johnson
Affiliation:
School of Psychology, Curtin University, Perth, Australia
Michael J. Kyron
Affiliation:
School of Psychology, Curtin University, Perth, Australia
Lisa M. Saulsman
Affiliation:
School of Psychological Science, University of Western Australia, Perth, Australia
Michelle L. Moulds
Affiliation:
School of Psychology, University of New South Wales, Sydney, Australia
Jessica R. Grisham
Affiliation:
School of Psychology, University of New South Wales, Sydney, Australia
Emily A. Holmes
Affiliation:
Department of Psychology, Uppsala University, Uppsala, Sweden
David A. Moscovitch
Affiliation:
Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
Ottmar V. Lipp
Affiliation:
School of Psychology, Curtin University, Perth, Australia
Bruce N. C. Campbell
Affiliation:
Centre for Clinical Interventions, Perth, Australia
Ronald M. Rapee
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
*
Author for correspondence: Peter M. McEvoy, E-mail: peter.mcevoy@curtin.edu.au
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Abstract

Background

Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.

Methods

A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.

Results

Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).

Conclusions

Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.

Keywords

Cognitive behavior therapyfear of negative evaluationgroup therapyimageryrandomized controlled trialsocial anxiety disordersocial interaction anxiety
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 7 , May 2022 , pp. 1277 - 1286
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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