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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
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
Corresponding

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.

Type
Original Articles
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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