Imagery-enhanced versus verbally-based group cognitive behavioural therapy for social anxiety disorder.

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Social anxiety disorder (SAD) is a common and debilitating mental illness, with sufferers frequently experiencing chronic anxiety in anticipation of, and during and following exposure to, social situations. Currently, group cognitive therapy is efficiacious for SAD, but some 80% fail to achieve normative functioning. The current project will investigate the utility of a novel treatment approach for SAD, namely imagery-enhanced cognitive behavioural group therapy (IE-CBGT). In this approach, imagery-based techniques are used to enhance existing evidence-based techniques within a 12-session treatment package. In this trial participants will be randomised to one of two conditions: i) IE-CBGT, or ii) a ‘gold-standard’ treatment, verbally-based CBGT (VB-CBGT, which relies on identifying and challenging anxiety-provoking beliefs predominantly within the verbal cognitive mode). A minimum of ninety-six individuals with SAD will be recruited through established referral pathways to the Centre for Clinical Interventions (CCI) from general practitioners, psychiatrists and psychologists and randomised into one of the two treatment groups. Between 6-12 patients will be admitted per group. The objectives of the project are threefold: i) to compare outcomes of IE-CBGT and current gold-standard VB-CBGT for SAD, across cognitive, behavioural, psychophysiological and emotional measures (i.e., questionnaires, behavioural tasks and physiological monitoring), ii) to evaluate unique and common mechanisms of change across the two treatments to inform theory and future treatment innovations, and iii) to compare the cost-effectiveness of the treatments to ensure that IE-CBGT has broader cost benefits in a health sector with limited resources and increasing demand. A standard battery of self-report questionnaires will be administered at baseline, and prior to each treatment session in line with current practice at CCI. Additional self-report questionnaires will be administered following sessions 4 and 8 and after the final treatment session. A routine CCI (group) follow-up appointment will be made 1-month after treatment completion with the treating psychologist. An additional individual assessment appointment will be made 1-month after treatment completion so that a diagnostic interview and self-report questionnaires can be administered. Another follow-up appointment will be made 6 months after treatment, allowing for fine-grained assessment of mechanisms of change to be assessed. Psychophysiological responses will be recorded during a social stress task at baseline and upon completion of the treatment sessions (at the individual assessment 1-month follow-up).