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

Peter M. McEvoy, 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, Emily A. Holmes, David A. Moscovitch, Ottmar V. Lipp, Bruce N. C. Campbell, Ronald M. Rapee

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13 Citations (Scopus)
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BackgroundCognitive 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.MethodsA 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.ResultsIntention 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noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).ConclusionsGroup IE-CBT and VB-CBT were safe and there were no significant differences in outcomes.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.

Original languageEnglish
Pages (from-to)1277-1286
Number of pages10
JournalPsychological Medicine
Issue number7
Early online date11 Sept 2020
Publication statusPublished - May 2022


  • cognitive behavior therapy
  • fear of negative evaluation
  • group therapy
  • imagery
  • randomized controlled trial
  • social anxiety disorder
  • social interaction anxiety


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