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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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
Volume60
DOIs
Publication statusPublished - Sep 2017
Externally publishedYes

Fingerprint

Imagery (Psychotherapy)
Cognitive Therapy
Group Psychotherapy
Randomized Controlled Trials
Cost-Benefit Analysis
Safety
Consciousness
Fear
Mental Health
Outpatients
Anxiety
Heart Rate
Economics
Outcome Assessment (Health Care)
Social Phobia
Interviews
Depression
Skin
Health

Cite this

McEvoy, Peter M ; Moulds, Michelle L ; Grisham, Jessica R ; Holmes, Emily A ; Moscovitch, David A ; Hendrie, Delia ; Saulsman, Lisa M ; Lipp, Ottmar V ; Kane, Robert T ; Rapee, Ronald M ; Hyett, Matthew P ; Erceg-Hurn, David M. / Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder : Study protocol for a randomized controlled trial. In: Contemporary Clinical Trials. 2017 ; Vol. 60. pp. 34-41.
@article{58aaa7f0af5b43a08877e649c184b0b2,
title = "Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: Study protocol for a randomized controlled trial",
abstract = "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.",
keywords = "Australia, Behavior, Cognitive Therapy/methods, Cost-Benefit Analysis, Female, Group Processes, Heart Rate, Humans, Imagery (Psychotherapy)/methods, Male, Phobia, Social/therapy, Psychotherapy/economics, Psychotherapy, Group/methods, Research Design, Severity of Illness Index, Single-Blind Method",
author = "McEvoy, {Peter M} and Moulds, {Michelle L} and Grisham, {Jessica R} and Holmes, {Emily A} and Moscovitch, {David A} and Delia Hendrie and Saulsman, {Lisa M} and Lipp, {Ottmar V} and Kane, {Robert T} and Rapee, {Ronald M} and Hyett, {Matthew P} and Erceg-Hurn, {David M}",
note = "Copyright {\circledC} 2017 Elsevier Inc. All rights reserved.",
year = "2017",
month = "9",
doi = "10.1016/j.cct.2017.06.010",
language = "English",
volume = "60",
pages = "34--41",
journal = "Controlled Clinical Trials",
issn = "0197-2456",
publisher = "Elsevier",

}

McEvoy, PM, Moulds, ML, Grisham, JR, Holmes, EA, Moscovitch, DA, Hendrie, D, Saulsman, LM, Lipp, OV, Kane, RT, Rapee, RM, Hyett, MP & Erceg-Hurn, DM 2017, 'Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: Study protocol for a randomized controlled trial' Contemporary Clinical Trials, vol. 60, pp. 34-41. https://doi.org/10.1016/j.cct.2017.06.010

Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder : Study protocol for a randomized controlled trial. / McEvoy, Peter M; Moulds, Michelle L; Grisham, Jessica R; Holmes, Emily A; Moscovitch, David A; Hendrie, Delia; Saulsman, Lisa M; Lipp, Ottmar V; Kane, Robert T; Rapee, Ronald M; Hyett, Matthew P; Erceg-Hurn, David M.

In: Contemporary Clinical Trials, Vol. 60, 09.2017, p. 34-41.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder

T2 - Study protocol for a randomized controlled trial

AU - McEvoy, Peter M

AU - Moulds, Michelle L

AU - Grisham, Jessica R

AU - Holmes, Emily A

AU - Moscovitch, David A

AU - Hendrie, Delia

AU - Saulsman, Lisa M

AU - Lipp, Ottmar V

AU - Kane, Robert T

AU - Rapee, Ronald M

AU - Hyett, Matthew P

AU - Erceg-Hurn, David M

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/9

Y1 - 2017/9

N2 - 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.

AB - 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.

KW - Australia

KW - Behavior

KW - Cognitive Therapy/methods

KW - Cost-Benefit Analysis

KW - Female

KW - Group Processes

KW - Heart Rate

KW - Humans

KW - Imagery (Psychotherapy)/methods

KW - Male

KW - Phobia, Social/therapy

KW - Psychotherapy/economics

KW - Psychotherapy, Group/methods

KW - Research Design

KW - Severity of Illness Index

KW - Single-Blind Method

U2 - 10.1016/j.cct.2017.06.010

DO - 10.1016/j.cct.2017.06.010

M3 - Article

VL - 60

SP - 34

EP - 41

JO - Controlled Clinical Trials

JF - Controlled Clinical Trials

SN - 0197-2456

ER -