Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder

study protocol for a randomized controlled trial

Peter M. McEvoy*, Michelle L. Moulds, Jessica R. Grisham, Emily A. Holmes, David A. Moscovitch, Delia Hendrie, Lisa M. Saulsman, Ottmar V. Lipp, Robert T. Kane, Ronald M. Rapee, Matthew P. Hyett, David M. Erceg-Hurn

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)


Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for facilitating affective change. This study will compare two group CBGT interventions, one that predominantly uses verbally-based strategies (VB-CBGT) and another that predominantly uses imagery-enhanced strategies (IE-CBGT), in terms of (a) efficacy, (b) mechanisms of change, and (c) cost-effectiveness. This study is a parallel groups (two-arm) single-blind randomized controlled trial. A minimum of 96 patients with SAD will be recruited within a public outpatient community mental health clinic in Perth, Australia. The primary outcomes will be self-reported symptom severity, caseness (SAD present: yes/no) based on a structured diagnostic interview, and clinician-rated severity and life impact. Secondary outcomes and mechanism measures include blind observer-rated use of safety behaviors, physiological activity (heart rate variability and skin conductance level) during a standardized speech task, negative self-beliefs, imagery suppression, fear of negative and positive evaluation, repetitive negative thinking, anxiety, depression, self-consciousness, use of safety behaviors, and the EQ-5D-5L and TiC-P for the health economic analysis. Homework completion, group cohesion, and working alliance will also be monitored. The outcomes of this trial will inform clinicians as to whether integrating imagery-based strategies in cognitive behavior therapy for SAD is likely to improve outcomes. Common and distinct mechanisms of change might be identified, along with relative cost-effectiveness of each intervention.

Original languageEnglish
Pages (from-to)34-41
Number of pages8
JournalContemporary Clinical Trials
Publication statusPublished - Sep 2017


  • social anxiety disorder
  • cognitive behavior therapy
  • imagery
  • cognitive therapy
  • randomized controlled trial
  • mechanisms
  • cost-effectiveness

Fingerprint Dive into the research topics of 'Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: study protocol for a randomized controlled trial'. Together they form a unique fingerprint.

  • Cite this