Modifying Negative Self-Imagery Increases the Effectiveness of Cognitive Behavior Therapy for Social Anxiety Disorder: A Benchmarking Study

Cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has been proven to be efficacious and yet the rate of non-responders is high. In this study, we developed an enhanced CBT (ECBT) which focused on changing negative self-imagery through imagery rescripting, repeated video feedback, and increased trials of exposure training and compared it with a historical control that received the conventional group CBT (CCBT). Among 90 patients with SAD, 45 received ECBT and the other 45 received CCBT. Results showed that ECBT were significantly better and faster in reducing social interaction anxiety, fear of negative evaluation, judgment bias, and dysfunctional self-belief than CCBT. ECBT showed a significantly higher rate of clinically significant change than CCBT at the 3-month follow-up. The pre-to-post effect sizes of ECBT were 1.39–1.66, and the pre-to-follow-up effect sizes were 1.62–2.05, which were comparable to those of the most efficacious treatments for SAD.