Imagery-enhanced cognitive behavioural group therapy for social anxiety disorder: A pilot study
Abstract
Cognitive behavioural group therapy (CBGT) for social anxiety disorder (SAD) is efficacious and effective, however a substantial proportion of patients remain in the clinical range so treatment innovations are required. Research suggests that working within the imagery mode may be more emotionally potent than traditional verbal-linguistic strategies. This study piloted an imagery-enhanced CBGT (IE-CBGT) protocol for SAD. It was hypothesised that IE-CBGT would be acceptable to patients, demonstrate large effect sizes, and compare favourably to historical controls who completed CBGT without the imagery-enhancements. Patients (N=19) were consecutive referrals to a community clinic specialising in anxiety and mood disorders. Primary outcomes were self-reported performance and social interaction anxiety. IE-CBGT was highly acceptable to patients with high attendance and completion rates. Effect sizes were large by mid-treatment and very large at post-treatment and follow-up. A high proportion of patients achieved reliable change. Outcomes compared favourably to published group and individual treatments for SAD but larger randomised controlled trials are now required.
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The three group protocols used in this study had previously been evaluated, found highly effective, and met international benchmarks.
“protocols used in this study have previously been evaluated and found to be highly effective and to meet international benchmarks (i.e.efficacy and effectiveness trials).”
From The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty (2016) · cites this paper as McEvoy & Saulsman, 2014
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
(2012) · Springer eBooks · doi:10.1007/springerreference_121117 · Cited by 20,769 · see citing works
Jacobson, N. S., & Truax, P. (1991) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.59.1.12 · Cited by 7,770 · see citing works
Mattick, R. P., & Clarke, J. C. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10031-6 · Cited by 3,367 · see citing works
A cognitive-behavioral model of anxiety in social phobia
Rapee, R. M., & Heimberg, R. G. (1997) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)00022-3 · Cited by 2,987 · see citing works
A cognitive model of social phobia
Adrian Wells, A. (1995) · Research Explorer (The University of Manchester) · Cited by 2,701 · see citing works
Sheehan, D., Lecrubier, Y., Harnett Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., Schinka, J., Knapp, E., Sheehan, M., & Dunbar, G. (1997) · European Psychiatry · doi:10.1016/s0924-9338(97)83297-x · Cited by 2,149 · see citing works
Social phobia: Diagnosis, assessment, and treatment
Franklin, M. E. (1996) · Clinical Psychology Review · doi:10.1016/s0272-7358(96)00036-0 · Cited by 1,389 · see citing works
Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010) · Psychological Review · doi:10.1037/a0018113 · Cited by 1,226 · see citing works
Generalized anxiety disorder: advances in research and practice
(2005) · Choice Reviews Online · doi:10.5860/choice.42-3716 · Cited by 1,073 · see citing works
Mental imagery in emotion and emotional disorders
Holmes, E. A., & Mathews, A. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.01.001 · Cited by 976 · see citing works
Andrews, G., Henderson, S., & Hall, W. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.178.2.145 · Cited by 933 · see citing works
(2004) · Cited by 863 · see citing works
Mini International Neuropsychiatric Interview
Sheehan, D., Janavs, J., Baker, R., Harnett-Sheehan, K., Knapp, E., Sheehan, M., Lecrubier, Y., Weiller, E., Hergueta, T., Amorim, P., et al. (2013) · PsycTESTS Dataset · doi:10.1037/t18597-000 · Cited by 841 · see citing works
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.3.568 · Cited by 603 · see citing works
Recurrent images and early memories in social phobia
Hackmann, A., Clark, D. M., & McManus, F. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00161-8 · Cited by 489 · see citing works
Treatment of childhood memories: Theory and practice
Arntz, A., & Weertman, A. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00173-9 · Cited by 488 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Salkind, N. J. (2005) · Encyclopedia of Human Development · doi:10.4135/9781412952484.n193 · Cited by 467 · see citing works
Holmes, E. A., Lang, T. J., & Shah, D. M. (2009) · Journal of Abnormal Psychology · doi:10.1037/a0012590 · Cited by 400 · see citing works
Positive Interpretation Training: Effects of Mental Imagery Versus Verbal Training on Positive Mood
Holmes, E. A., Mathews, A., Dalgleish, T., & Mackintosh, B. (2006) · Behavior Therapy · doi:10.1016/j.beth.2006.02.002 · Cited by 391 · see citing works
Exposure and cognitive restructuring for social phobia: A controlled study
Mattick, R. P., Peters, L., & Clarke, J. (1989) · Behavior Therapy · doi:10.1016/s0005-7894(89)80115-7 · Cited by 372 · see citing works
Pathological anxiety : emotional processing in etiology and treatment
ROTHBAUM, B. O. (2006) · Cited by 358 · see citing works
Oxford Guide to Imagery in Cognitive Therapy
(2011) · Oxford University Press eBooks · doi:10.1093/med:psych/9780199234028.001.0001 · Cited by 236 · see citing works
McEvoy, P. M., Grove, R., & Slade, T. (2011) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2011.624083 · Cited by 229 · see citing works
Self-citationTesting the efficacy of theoretically derived improvements in the treatment of social phobia.
Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0014800 · Cited by 221 · see citing works
Negative self-imagery in social anxiety contaminates social interactions
Hirsch, C., Meynen, T., & Clark, D. (2004) · Memory · doi:10.1080/09658210444000106 · Cited by 216 · see citing works
Rescripting early memories linked to negative images in social phobia: A pilot study
Wild, J., Hackmann, A., & Clark, D. M. (2008) · Behavior Therapy · doi:10.1016/j.beth.2007.04.003 · Cited by 212 · see citing works
Imagery rescripting as a brief stand-alone treatment for depressed patients with intrusive memories
Brewin, C. R., Wheatley, J., Patel, T., Fearon, P. R. M., Hackmann, A., Adrian Wells, A., Fisher, P., & Myers, S. G. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.03.008 · Cited by 190 · see citing works
When the present visits the past: Updating traumatic memories in social phobia
Wild, J., Hackmann, A., & Clark, D. M. (2007) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2007.07.003 · Cited by 177 · see citing works
Iterative stepwise regression imputation using standard and robust methods
Templ, M., Kowarik, A., & Filzmoser, P. (2011) · Computational Statistics & Data Analysis · doi:10.1016/j.csda.2011.04.012 · Cited by 169 · see citing works
A Comparison of Social Phobia Outcome Measures in Cognitive-Behavioral Group Therapy
Cox, B. J., Ross, L. M., Swinson, R. P., & Direnfeld, D. M. (1998) · Behavior Modification · doi:10.1177/01454455980223004 · Cited by 151 · see citing works
Imagery Rescripting of Early Traumatic Memories in Social Phobia
Wild, J., & Clark, D. M. (2011) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.03.002 · Cited by 147 · see citing works
The efficacy of imagery rescripting (IR) for social phobia: A randomized controlled trial
Lee, S. W., & Kwon, J.-H. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.03.001 · Cited by 105 · see citing works
Effectiveness of an empirically supported treatment for social phobia in the field.
Lincoln, T., Rief, W., Hahlweg, K., Frank, M., von Witzleben, I., Schroeder, B., & Fiegenbaum, W. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00038-x · Cited by 103 · see citing works
Imagery rescripting of early memories in social anxiety disorder: An experimental study
Nilsson, J.-E., Lundh, L., & Viborg, G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.03.004 · Cited by 97 · see citing works
McEvoy, P. M., Nathan, P., Rapee, R. M., & Campbell, B. N. C. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.01.009 · Cited by 60 · see citing works
Self-citationImagery rescripting as a stand-alone treatment for patients with social phobia: A case series
Frets, P. G., Kevenaar, C., & van der Heiden, C. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.09.006 · Cited by 58 · see citing works
Grunert, B. K., Smucker, M. R., Weis, J. M., & Rusch, M. D. (2003) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(03)80051-2 · Cited by 56 · see citing works
IMAGERY AND ITS CHARACTERISTICS IN PEOPLE WHO ARE ANXIOUS ABOUT SPIDERS
Pratt, D., Cooper, M. J., & Hackmann, A. (2004) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001158 · Cited by 54 · see citing works
Chiupka, C. A., Moscovitch, D., & Bielak, T. (2012) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2012.31.8.783 · Cited by 38 · see citing works
Flagged first, then by citations
3 of the 44 references couldn’t be matched to a known paper.
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Sorted by citations
McEvoy, P. M., & Erceg-Hurn, D. M. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.002 · Cited by 155 · see citing works
Self-citationPearl, S. B., & Norton, P. J. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.07.004 · Cited by 156 · see citing works
The impact of imagery rescripting on memory appraisals and core beliefs in social anxiety disorder
Reimer, S. G., & Moscovitch, D. A. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.10.007 · Cited by 86 · see citing works
Emotional cascade theory and non-suicidal self-injury: the importance of imagery and positive affect
Hasking, P. A., Simplicio, M. C. D., McEvoy, P. M., & Rees, C. S. (2017) · Cognition & Emotion · doi:10.1080/02699931.2017.1368456 · Cited by 72 · see citing works
Self-citationMcEvoy, P. M., Erceg-Hurn, D. M., Saulsman, L. M., & Thibodeau, M. A. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.12.011 · Cited by 69 · see citing works
Self-citationThe essential role of mental imagery in cognitive behaviour therapy: What is old is new again
Saulsman, L. M., Ji, J. L., & Mcevoy, P. M. (2019) · Australian Psychologist · doi:10.1111/ap.12406 · Cited by 49 · see citing works
Self-citationBlackwell, S. E. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-021-00102-0 · Cited by 52 · see citing works
Moscovitch, D. A., Moscovitch, M., & Sheldon, S. (2023) · Perspectives on Psychological Science · doi:10.1177/17456916221141351 · Cited by 45 · see citing works
Strachan, L. P., Hyett, M. P., & McEvoy, P. M. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-1139-4 · Cited by 40 · see citing works
Self-citationDeveloping a Psychological Intervention for Decreasing Bedtime Procrastination: The BED-PRO Study
Suh, S. A., Cho, N., Jeoung, S., & An, H. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2021.1979004 · Cited by 38 · see citing works
McEvoy, P. M., Hyett, M. P., Bank, S. R., Erceg‐Hurn, D. M., Johnson, A. R., Kyron, M. J., Saulsman, L. M., Moulds, M. L., Grisham, J. R., Holmes, E. A., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720003001 · Cited by 36 · see citing works
Self-citationFogarty, C., Hevey, D., & McCarthy, O. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000079 · Cited by 27 · see citing works
Hyett, M. P., Bank, S. R., Lipp, O. V., Erceg‐Hurn, D. M., Alvares, G. A., Maclaine, E., Puckridge, E., Hayes, S., & McEvoy, P. M. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000493897 · Cited by 25 · see citing works
Self-citationCao, J., Liu, Q., Li, Y., Yang, J., Gu, R., Liang, J., Qi, Y., Wu, H., & Liu, X. (2017) · Behavioral and Brain Functions · doi:10.1186/s12993-017-0130-7 · Cited by 23 · see citing works
Lloyd, J., & Marczak, M. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246582200008x · Cited by 24 · see citing works
Transportability of imagery-enhanced CBT for social anxiety disorder
McEvoy, P. M., Erceg-Hurn, D. M., Barber, K. C., Dupasquier, J. R., & Moscovitch, D. A. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.05.007 · Cited by 17 · see citing works
Self-citationAhn, J.-K., & Kwon, J. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9918-5 · Cited by 16 · see citing works
Norton, A. R., Abbott, M. J., Dobinson, K. A., Pepper, K. L., & Guastella, A. J. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10221-9 · Cited by 15 · see citing works
McEvoy, P. M., Moulds, M. L., Grisham, J. R., Holmes, E. A., Moscovitch, D. A., Hendrie, D. V., Saulsman, L. M., Lipp, O. V., Kane, R. T., Rapee, R. M., et al. (2017) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.06.010 · Cited by 14 · see citing works
Self-citationThe Relationship Between Negative Self-imagery and Social Anxiety in a Clinically Diagnosed Sample
Dobinson, K. A., Norton, A. R., & Abbott, M. J. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10051-w · Cited by 13 · see citing works
Erceg-Hurn, D. M., Campbell, B. N. C., & McEvoy, P. M. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102676 · Cited by 13 · see citing works
Self-citationNg, A. S., & Abbott, M. J. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9751-z · Cited by 12 · see citing works
Moriya, J. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.02323 · Cited by 12 · see citing works
Sapach, M. J. N. T., & Carleton, R. N. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102225 · Cited by 11 · see citing works
Chen, J., McLean, J. E., & Kemps, E. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.11.006 · Cited by 10 · see citing works
O'Toole, M. S., Watson, L., Rosenberg, N. K., & Berntsen, D. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.01.007 · Cited by 8 · see citing works
Bielak, T., Moscovitch, D. A., & Waechter, S. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.05.005 · Cited by 8 · see citing works
van Teffelen, M. W., Voncken, M. J., Peeters, F. P. M. L., Mollema, E. D., & Lobbestael, J. (2021) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2021.101677 · Cited by 9 · see citing works
Thunnissen, M. R., de Jong, P. J., Weijermans, J., Vet, L. J. J., Rijkeboer, M. M., & Nauta, M. H. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.3063 · Cited by 6 · see citing works
Meral, Y., & Vriends, N. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000424 · Cited by 6 · see citing works
Strohm, M., Siegesleitner, M., Kunze, A. E., Ehring, T. W., & Wittekind, C. E. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.5303 · Cited by 5 · see citing works
McCarthy, A., Bank, S. R., Campbell, B. N. C., Summers, M., Burgess, M. M., & McEvoy, P. M. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.04.012 · Cited by 5 · see citing works
Self-citationYalçın, M., & Sütcü, S. T. (2016) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.28154 · Cited by 5 · see citing works
Elkington, S., Brown, M. C., Wright, K. A., Regan, J. L., Pattarnaraskouwski, K., Steel, C., Hales, S. A., Holmes, E. A., & Morant, N. J. (2024) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12538 · Cited by 4 · see citing works
Self‐guided imagery rescripting for worry images: A preliminary experimental investigation
Stavropoulos, L., Briggs, N., & Grisham, J. R. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23660 · Cited by 4 · see citing works
Stavropoulos, L., Sabel, I., Cooper, D. D. J., Newby, J. M., & Grisham, J. R. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104915 · Cited by 3 · see citing works
Winter, H. R., Norton, A. R., & Wootton, B. M. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107298 · Cited by 3 · see citing works
Early memories in social anxiety: A meaningful and enduring collaboration with my Dad
Moscovitch, D. A. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.03.016 · Cited by 3 · see citing works
Imagery-Enhanced Cognitive Restructuring of Hostile Beliefs: A Narrative Description
van Teffelen, M. W., Voncken, M. J., Peeters, F. P. M. L., Mollema, E. D., & Lobbestael, J. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.12.010 · Cited by 2 · see citing works
Bielak, T. (2016) · UWSpace (University of Waterloo)
Exploring the Relationship Between Negative Social Experiences and Social Anxiety
Sapach, T., & Nora, M. J. (2015)
McEvoy, P. M. (2016) · Journal of Experimental Psychopathology · doi:10.1177/204380871600700401
Self-citationRelationships among Intolerance of Uncertainty, Experiential Avoidance, and Social Anxiety
송정선 (2017) · The Journal of Saramdaum Education · doi:10.18015/edumca.11.2.201708.89
Feeding and extinguishing the flame
van Teffelen, M. W. (2021) · doi:10.26481/dis.20210312mt
Fergus, T. A., Tyra, A. T., Ginty, A. T., & Williams, S. E. (2026) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2026.2705534
- Authors
- McEvoy, P. M., & Saulsman, L. M.
- Affiliations
- Curtin University (AU)
- Centre for Clinical Interventions (AU)
- Corresponding author
- McEvoy, Peter M.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 55
- Pages
- 1-6
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2082961108
- Cited by
- 44
- References
- 44
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 8 · 2020: 3 · 2019: 3 · 2018: 6 · 2017: 5 · 2016: 7 · 2015: 2 · 2014: 1
- FWCI
- 6.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- social anxiety disorder, group cognitive behavioral therapy, social interaction anxiety, treatment acceptability, medication adherence, community mental health centers
- MeSH terms
- Adult, Anxiety Disorders, Combined Modality Therapy, Female, Humans, Male, Pilot Projects, Psychotherapy, Group, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction, Imagery, Psychotherapy, Benchmarking, Young Adult
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