Imagery-based CBT for Social Anxiety Disorder: Piloting a Treatment Augmentation Protocol

Social Anxiety Disorder Clinical Trial

Official title:

Imagery-based CBT for Social Anxiety Disorder: Piloting a Treatment Augmentation Protocol

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02659436
• Other study ID #: 0986
• Status: Completed
• Phase: N/A
• First received: January 14, 2016
• Last updated: December 28, 2016
• Start date: January 2016
• Est. completion date: December 2016

Study information

• Verified date: December 2016
• Source: St. Joseph's Healthcare Hamilton
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ethics Review Committee
• Study type: Interventional

Clinical Trial Summary

The purpose of this pilot study is to explore whether there is a differential impact of verbal versus imagery-based cognitive behavioural therapy (CBT) as a treatment augmentation strategy for individuals with social anxiety disorder (SAD). Clients who have not demonstrated clinically significant change following group CBT for SAD will receive four additional sessions of either verbal-based CBT or imagery-based CBT. We hypothesize that that individuals who receive imagery-based CBT will experience even stronger improvements and be more satisfied with their treatment than individuals who received traditional verbal-linguistic CBT.

Description:

Social Anxiety Disorder (SAD) is a debilitating disorder, marked by significant functional impairment and high personal distress for those who suffer. Psychological treatment for SAD has traditionally been verbal-linguistic cognitive behavioural therapy (CBT). However, a significant number of individuals who complete CBT for SAD do not achieve full response and continue to struggle with significant residual symptoms. One innovation that has received attention recently in the literature is using imagery-based CBT as a way to augment treatment outcome in SAD. Results from a pilot and benchmarking study suggest that participants who received imagery-based CBT were more likely to complete treatment than those who received traditional CBT and treatment outcome was strong for both groups, but stronger in the imagery-based CBT group.

However, before re-training hundreds of practitioners in using a completely novel treatment approach, it is important to see if a brief augmentation of traditional CBT programs is effective in producing further change for individuals with residual symptoms after group CBT. It is possible that individuals just require a few more sessions of the same verbal-linguistic CBT to consolidate treatment gains or work on lingering triggers of anxiety. It is also possible that more of the same is not as valuable as offering therapy using a different modality, such as imagery. Therefore, we propose to evaluate a brief imagery-based augmentation of traditional group CBT to explore its effects on further symptom reduction.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 9
• Est. completion date: December 2016
• Est. primary completion date: December 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Completed eight out of twelve sessions of standard verbal-linguistic group cognitive behavioural therapy for social anxiety disorder

• Presented with a Social Phobia Inventory (SPIN) score of greater than 19 post-treatment

• Interested in further treatment

Exclusion Criteria:

• Has another mental health concern of greater importance than social anxiety disorder

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Anxiety Disorders
• Disease
• Phobic Disorders
• Social Anxiety Disorder

Intervention

Other:
• Verbal-linguistic CBT
Participants will receive 4 sessions of individual therapy focused on traditional cognitive restructuring and exposure therapy.
• Imagery-based CBT
Participants will receive 4 sessions of individual therapy focused on imagery-based cognitive work and behavioural experiments.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
St. Joseph's Healthcare Hamilton

References & Publications (13)

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th edition). Washington, DC: APA.

Antony MM, Roth D, Swinson RP, Huta V, Devins GM. Illness intrusiveness in individuals with panic disorder, obsessive-compulsive disorder, or social phobia. J Nerv Ment Dis. 1998 May;186(5):311-5. — View Citation

Bieling, P.J., Rowa, K., Antony, M.M., Summerfeldt, L.J., & Swinson, R.P. (2001). Factor structure of the Illness Intrusiveness Ratings Scale in patients diagnosed with anxiety disorders. Journal of Psychopathology and Behavioral Assessment, 23, 223-230. doi: 10.1023/A:1012723318964

Carleton RN, Collimore KC, Asmundson GJ. Social anxiety and fear of negative evaluation: construct validity of the BFNE-II. J Anxiety Disord. 2007;21(1):131-41. Erratum in: J Anxiety Disord. 2007;21(4):600-1. — View Citation

Devins GM, Dion R, Pelletier LG, Shapiro CM, Abbey S, Raiz LR, Binik YM, McGowan P, Kutner NG, Beanlands H, Edworthy SM. Structure of lifestyle disruptions in chronic disease: a confirmatory factor analysis of the Illness Intrusiveness Ratings Scale. Med Care. 2001 Oct;39(10):1097-104. — View Citation

Devins GM. Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. Adv Ren Replace Ther. 1994 Oct;1(3):251-63. Review. — View Citation

Hackmann A, Clark DM, McManus F. Recurrent images and early memories in social phobia. Behav Res Ther. 2000 Jun;38(6):601-10. — View Citation

Hirsch CR, Clark DM, Mathews A, Williams R. Self-images play a causal role in social phobia. Behav Res Ther. 2003 Aug;41(8):909-21. — View Citation

Holmes EA, Lang TJ, Shah DM. Developing interpretation bias modification as a "cognitive vaccine" for depressed mood: imagining positive events makes you feel better than thinking about them verbally. J Abnorm Psychol. 2009 Feb;118(1):76-88. doi: 10.1037/a0012590. — View Citation

Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-376. doi: 10.1177/0146167283093007

McEvoy PM, Erceg-Hurn DM, Saulsman LM, Thibodeau MA. Imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: a benchmarking study. Behav Res Ther. 2015 Feb;65:42-51. doi: 10.1016/j.brat.2014.12.011. — View Citation

McEvoy PM, Saulsman LM. Imagery-enhanced cognitive behavioural group therapy for social anxiety disorder: a pilot study. Behav Res Ther. 2014 Apr;55:1-6. doi: 10.1016/j.brat.2014.01.006. — View Citation

Moscovitch DA, Gavric DL, Merrifield C, Bielak T, Moscovitch M. Retrieval properties of negative vs. positive mental images and autobiographical memories in social anxiety: outcomes with a new measure. Behav Res Ther. 2011 Aug;49(8):505-17. doi: 10.1016/j.brat.2011.05.009. — View Citation

* Note: There are 13 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Social Phobia Inventory	Measures social anxiety symptoms	This will be administered at the end of the 4 session protocol which will take place approximately 4 -6 weeks after entry into the study.	No
Secondary	Vividness of Visual Imagery Questionnaire	Measures the ability to visualize several visual images	This will be administered at the end of the 4 session protocol which will take place approximately 4 -6 weeks after entry into the study.	No
Secondary	Homework Adherence Scale	Measures the quality of homework completion	This will be administered at the end of the 4 session protocol which will take place approximately 4 -6 weeks after entry into the study.	No
Secondary	Treatment Satisfaction Scale	Measures the participant's satisfaction with their treatment	This will be administered at the end of the 4 session protocol which will take place approximately 4 -6 weeks after entry into the study.	No
Secondary	Brief Fear of Negative Evaluation Scale	Measures fears about being negatively evaluated by others	This will be administered at the end of the 4 session protocol which will take place approximately 4 -6 weeks after entry into the study.	No
Secondary	Illness Intrusiveness Rating Scale	Measures how much anxiety interferes with functioning	This will be administered at the end of the 4 session protocol which will take place approximately 4 -6 weeks after entry into the study.	No