Elsevier

Behaviour Research and Therapy

Volume 65, February 2015, Pages 42-51
Behaviour Research and Therapy

Imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: A benchmarking study

https://doi.org/10.1016/j.brat.2014.12.011Get rights and content

Highlights

  • Evaluated imagery-enhanced cognitive behavioural group therapy (IE-CBGT).

  • Compared outcomes to historical controls without imagery enhancements.

  • Attrition from IE-CBGT was very low suggesting high acceptability.

  • Effect sizes were very large in IE-CBGT.

  • Acceptability and outcomes were superior to controls.

Abstract

Emerging evidence suggests that imagery-based techniques may enhance the effectiveness of traditional verbal-linguistic cognitive interventions for emotional disorders. This study extends an earlier pilot study by reporting outcomes from a naturalistic trial of an imagery-enhanced cognitive behavioural group therapy (IE-CBGT, n = 53) protocol for social anxiety disorder (SAD), and comparing outcomes to historical controls who completed a predominantly verbally-based group protocol (n = 129). Patients were consecutive referrals from health professionals to a community clinic specialising in anxiety and mood disorders. Both treatments involved 12, two-hour group sessions plus a one-month follow-up. Analyses evaluated treatment adherence, predictors of dropout, treatment effect sizes, reliable and clinically significant change, and whether self-reported tendencies to use imagery in everyday life and imagery ability predicted symptom change. IE-CBGT patients were substantially more likely to complete treatment than controls (91% vs. 65%). Effect sizes were very large for both treatments, but were significantly larger for IE-CBGT. A higher proportion of the IE-CBGT patients achieved reliable change, and better imagery ability was associated with larger symptom change. Outcomes compared very favourably to published group and individual treatments for SAD, suggesting that IE-CBGT may be a particularly effective and efficient mode of treatment delivery.

Section snippets

Participants

Inclusion criteria were (a) a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) SAD diagnosis, (b) no current suicidal intent, (c) no psychotic illness, and (d) a level of substance use judged by the assessing clinician as unlikely to significantly interfere with engagement in treatment. The Mini International Neuropsychiatric Interview (MINI PLUS 5.0; Sheehan et al., 2001) was administered by masters- or doctorate-level clinical psychologists to establish Axis I

Baseline characteristics

Pre-treatment demographic and clinical characteristics for the imagery-enhanced and historical control groups are compared in Table 1. The majority of differences were small and not statistically significant, including age, educational achievement, employment status, and clinical features such as the proportion of patients with a comorbid diagnosis. There were no pre-treatment differences on the SIAS, SPS, or BFNE-S (see Table 2). There was a small but statistically significant difference on

Discussion

Social anxiety disorder (SAD) is an early onset and debilitating disorder that tends to be unremitting without treatment (DeWit, Ogborne, Offord, & MacDonald, 1999). CBT is efficacious and effective for SAD but a substantial minority of sufferers do not respond to treatment in community clinics (McEvoy, 2007, McEvoy et al., 2012). In an attempt to improve outcomes, the first aim of this study was to compare the acceptability and effectiveness of an imagery-enhanced CBGT protocol to a large

Conflict of interest

The authors have no conflict of interest to declare.

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