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Thunnissen MR, de Jong PJ, Weijermans J, Vet LJJ, Rijkeboer MM, Nauta MH. Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention. Clin Psychol Psychother 2024; 31:e3063. [PMID: 39363533 DOI: 10.1002/cpp.3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/29/2024] [Accepted: 09/13/2024] [Indexed: 10/05/2024]
Abstract
Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative 'flashforward' imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1-week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14-17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group-based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary. Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974.
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Affiliation(s)
- Marjolein R Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Jiska Weijermans
- Department of Specialized Mental Health Care and Department of Education, Psy-zo!, Groningen, The Netherlands
| | | | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
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Williams SE, Fergus TA, Ginty AT. Development and Validation of the Ease of Imagery Questionnaire. Assessment 2024:10731911241260233. [PMID: 39054848 DOI: 10.1177/10731911241260233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The present series of studies aimed to develop and provide initial validation of the Ease of Imagery Questionnaire (EIQ)-a measure assessing ease of imaging different positive and negative imagery content reflective of valence and engaging or disengaging in adverse situations. Five studies were conducted to collectively examine the questionnaire's factor structure and concurrent validity. Study 1 (N = 336) and Study 2 (N = 207) informed the development of 16 items of the EIQ, with a four-factor structure supported in Studies 3 (N = 219), 4 (N = 135), and 5 (N = 184) using confirmatory factor analysis. Study 3 also supported concurrent validity with significant bivariate correlations (p < .05) with the similar Sport Imagery Ability Questionnaire subscales, while studies 4 and 5 demonstrated criterion validity in the EIQ's prediction of challenge and threat appraisal tendencies, perceived stress, stress mindset, and anxiety and depressive symptoms. Overall, the EIQ demonstrates a replicable four-factor structure and appears to assess ability to image content associated with positive and negative emotions as well as demanding stress-evoking situations.
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Thunnissen MR, de Jong PJ, Rijkeboer MM, Voncken MJ, Nauta MH. Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes. Clin Psychol Psychother 2024; 31:e2996. [PMID: 38769942 DOI: 10.1002/cpp.2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.
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Affiliation(s)
- Marjolein R Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marisol J Voncken
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
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McEvoy PM, Johnson AR, Kazantzis N, Egan SJ. Predictors of homework engagement in group CBT for social anxiety: client beliefs about homework, its consequences, group cohesion, and working alliance. Psychother Res 2024; 34:68-80. [PMID: 38109521 DOI: 10.1080/10503307.2023.2286993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) is effective, but little data exist on generic relational components of the therapeutic process, such as group cohesion and therapy alliance, and central CBT-specific components such as homework engagement, beliefs, and perceived consequences. The aim of this study was to investigate the relationships between homework, group cohesion, and working alliance during group CBT for social anxiety disorder. METHOD Participants (N = 105) with SAD engaged in 12 sessions of group CBT. Measures of homework, working alliance, and group cohesion were completed at multiple points throughout treatment. Random-intercept cross-lagged panel models were used to evaluate the prospective relationships between measures. RESULTS Prospective relationships between the homework outcomes did not vary throughout the treatment period, with the only significant relationships seen between the random intercepts ("trait" levels). Homework beliefs were a significant negative predictor of future group cohesion, but only in mid- to late-treatment. Homework consequences and working alliance were significantly and positively predictive of each other throughout therapy. CONCLUSION Early homework engagement is associated with higher engagement throughout therapy. Working alliance and homework engagement are important to bolster early in group CBT.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616000579493..
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Affiliation(s)
- Peter M McEvoy
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- North Metropolitan Health Service, Centre for Clinical Interventions, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Department of Computer Science, Aalto University, Helsinki, Finland
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | - Sarah J Egan
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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McEvoy PM, Bendlin M, Johnson AR, Kazantzis N, Campbell BNC, Bank SR, Egan SJ. The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder. Psychother Res 2024; 34:54-67. [PMID: 36630684 DOI: 10.1080/10503307.2022.2161966] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.
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Affiliation(s)
- Peter M McEvoy
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | - Martyna Bendlin
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | | | | | - Sarah J Egan
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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Moscovitch DA, Moscovitch M, Sheldon S. Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1412-1435. [PMID: 36795637 PMCID: PMC10623626 DOI: 10.1177/17456916221141351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example.
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Affiliation(s)
- David A. Moscovitch
- Department of Psychology and Centre for Mental Health Research & Treatment, University of Waterloo
| | - Morris Moscovitch
- Rotman Research Institute and Department of Psychology, Baycrest Centre for Geriatric Care
- Department of Psychology, University of Toronto
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Erceg-Hurn DM, Campbell BNC, McEvoy PM. What explains the failure to identify replicable moderators of symptom change in social anxiety disorder? J Anxiety Disord 2023; 94:102676. [PMID: 36758344 DOI: 10.1016/j.janxdis.2023.102676] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
Trials of cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) have struggled to identify replicable moderators of treatment outcome. This could be due to a genuine lack of effects, or a spurious finding caused by methodological factors such as inadequate testing of theory-driven moderators, use of small homogenous samples, failure to model non-linear relationships, and over-reliance on significance testing. We probed explanations for the field's failure to detect moderators by testing whether 15 theory-driven and atheoretical variables moderated treatment outcome in a large heterogeneous sample treated with group CBT for SAD. Moderation was not assessed by only using p-values for linear models, but also by considering effect sizes, plots, and non-linear relationships. Despite using a comprehensive approach to assess moderation, only two variables - the baseline severity of SAD symptoms and fear of negative evaluation (FNE) - were found to moderate social anxiety symptom trajectories. FNE had a non-linear relationship with symptom change that would have been missed using common research methods. Our findings suggest both a genuine lack of effects and limitations of research methods have contributed to the field's inability to identify moderators. We provide suggestions that may increase the likelihood of future researchers detecting genuine effects.
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Affiliation(s)
- David M Erceg-Hurn
- Centre for Clinical Interventions, Perth, Australia; School of Population Health & enAble Institute, Curtin University, Perth, Australia.
| | | | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Population Health & enAble Institute, Curtin University, Perth, Australia
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Barahmand U, Shamsina N, Rojas K, Geschwind N, Haruna Iya F. Mechanisms Linking Perfectionism and Social Anxiety: The Role of Hostility and Disqualification of Positive Social Outcomes. J Psychiatr Pract 2023; 29:94-103. [PMID: 36928196 DOI: 10.1097/pra.0000000000000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
While considerable research has focused on maladaptive perfectionism as a risk factor for social anxiety, little attention has been given to the mechanisms that mediate the effects. We integrated perfectionism with the bivalent fear of evaluation model of social anxiety to investigate 2 hypothesized mechanisms: hostile attribution bias and disqualification of positive social outcomes (DPSO). Specifically, we hypothesized that individuals with maladaptive perfectionism develop hostile attribution biases which then lead to DPSO, which in turn predisposes them to social anxiety. Participants were 242 individuals from the general population who completed measures of perfectionism, hostile attribution bias, DPSO, and social anxiety. A test of multiple mediators using bootstrapping supported the hypothesized multiple mediator models. The results suggested that maladaptive perfectionism predisposes an individual to social anxiety through hostile attribution bias and DPSO. The results further suggested that DPSO but not hostile attribution bias operates as an individual mediator in the perfectionism-social anxiety relationship. The findings from this study provide support for the bivalent fear of evaluation model of social anxiety; however, the use of a cross-sectional design limited our ability to find true cause-and-effect relationships.
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Affiliation(s)
- Usha Barahmand
- BARAHMAND, SHAMSINA, ROJAS, GESCHWIND, IYA: Queens College, City University of New York, New York, NY
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9
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Suh S, Cho N, Jeoung S, An H. Developing a Psychological Intervention for Decreasing Bedtime Procrastination: The BED-PRO Study. Behav Sleep Med 2022; 20:659-673. [PMID: 34524942 DOI: 10.1080/15402002.2021.1979004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, without having external reasons for doing so. Previous studies have shown that BP has a negative effect on sleep and health, emphasizing the need to develop interventions to decrease BP. This intervention development study is a proof-of-concept study for a psychological intervention designed for decreasing bedtime procrastination, namely BED-PRO. MATERIAL AND METHOD The intervention was developed based on behavioral modification principles and motivational interviewing techniques. The final intervention was a weekly three-session intervention, with one additional booster call. Twenty individuals with high BP participated in the study, and data was collected for pre- and post-intervention, and one-month follow-up. Individuals completed the Bedtime Procrastination Scale, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire, Insomnia Severity Index, and a sleep diary. RESULT Significant changes were found for BPS scores, bedtime procrastination duration (Δ51 mins, 63.8% reduction compared to baseline), wake after sleep onset, sleep efficiency and feeling refreshed upon awakening measured by sleep diaries following the intervention. In addition, changes in BPS, ISI, and ESS scores, wake after sleep onset, sleep efficiency and feeling refreshed upon awakening were maintained or continued to improve at 1-month follow-up. CONCLUSION This study verified the feasibility and acceptability of the BED-PRO intervention and the potential for being the first intervention to target bedtime procrastination. Considering the research about negative implications of BP, we expect that this intervention could be a step forward in considering BP as a serious health behavior.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Nayoung Cho
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Sonhye Jeoung
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Hyeyoung An
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
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An Investigation of Cognitive and Affective Changes During Group Imagery Rescripting for Social Anxiety Disorder. Behav Ther 2022; 53:1050-1061. [PMID: 35987535 DOI: 10.1016/j.beth.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022]
Abstract
Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioral therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.
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McEvoy PM, Hyett MP, Johnson AR, Erceg-Hurn DM, Clarke PJF, Kyron MJ, Bank SR, Haseler L, Saulsman LM, Moulds ML, Grisham JR, Holmes EA, Moscovitch DA, Lipp OV, Rapee RM. Impacts of imagery-enhanced versus verbally-based cognitive behavioral group therapy on psychophysiological parameters in social anxiety disorder: Results from a randomized-controlled trial. Behav Res Ther 2022; 155:104131. [PMID: 35696837 DOI: 10.1016/j.brat.2022.104131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/03/2022] [Accepted: 06/01/2022] [Indexed: 11/24/2022]
Abstract
Social anxiety disorder (SAD) is associated with marked physiological reactivity in social-evaluative situations. However, objective measurement of biomarkers is rarely evaluated in treatment trials, despite potential utility in clarifying disorder-specific physiological correlates. This randomized controlled trial sought to examine the differential impact of imagery-enhanced vs. verbal-based cognitive behavioral group therapy (IE-CBGT, n = 53; VB-CBGT, n = 54) on biomarkers of emotion regulation and arousal during social stress in people with SAD (pre- and post-treatment differences in heart rate variability (HRV) and skin conductance). We acquired psychophysiological data from randomized participants across four social stress test phases (baseline, speech preparation, speech, interaction) at pre-treatment, and 1- and 6-months post-treatment. Analyses revealed that IE-CBGT selectively attenuated heart rate as indexed by increases in median heart rate interval (median-RR) compared to VB-CBGT at post-treatment, whereas one HRV index showed a larger increase in the VB-CBGT condition before but not after controlling for median-RR. Other psychophysiological indices did not differ between conditions. Lower sympathetic arousal in the IE-CBGT condition may have obviated the need for parasympathetic downregulation, whereas the opposite was true for VB-CBGT. These findings provide preliminary insights into the impact of imagery-enhanced and verbally-based psychotherapy for SAD on emotion regulation biomarkers.
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Affiliation(s)
- Peter M McEvoy
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia.
| | - Matthew P Hyett
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - David M Erceg-Hurn
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia
| | - Patrick J F Clarke
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Michael J Kyron
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Samantha R Bank
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia; Centre for Clinical Interventions, Perth, WA, Australia
| | - Luke Haseler
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Lisa M Saulsman
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - David A Moscovitch
- Centre for Mental Health Research and Treatment, Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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van Teffelen MW, Voncken MJ, Peeters F, Mollema ED, Lobbestael J. Imagery-Enhanced Cognitive Restructuring of Hostile Beliefs: A Narrative Description. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Future-oriented imagery rescripting facilitates conducting behavioral experiments in social anxiety. Behav Res Ther 2022; 155:104130. [DOI: 10.1016/j.brat.2022.104130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 12/18/2022]
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14
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McEvoy PM, Hyett MP, Bank SR, Erceg-Hurn DM, Johnson AR, Kyron MJ, Saulsman LM, Moulds ML, Grisham JR, Holmes EA, Moscovitch DA, Lipp OV, Campbell BNC, Rapee RM. Imagery-enhanced v. verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial. Psychol Med 2022; 52:1277-1286. [PMID: 32912351 DOI: 10.1017/s0033291720003001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive 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. METHODS A 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. RESULTS Intention 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). CONCLUSIONS Group 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.
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Affiliation(s)
- Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | | | - Samantha R Bank
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | - David M Erceg-Hurn
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | | | | | - Lisa M Saulsman
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - David A Moscovitch
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
| | - Ottmar V Lipp
- School of Psychology, Curtin University, Perth, Australia
| | | | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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Landkroon E, van Dis EAM, Meyerbröker K, Salemink E, Hagenaars MA, Engelhard IM. Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking. Behav Ther 2022; 53:80-91. [PMID: 35027160 DOI: 10.1016/j.beth.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022]
Abstract
Exposure therapy is the recommended treatment for anxiety disorders, but many anxious individuals are unwilling to expose themselves to feared situations. Episodic simulation of future situations contributes to adaptive emotion regulation and motivates behavior. This study investigated whether future-oriented positive mental imagery reduces anticipatory anxiety and distress during exposure, and increases exposure willingness and duration. Forty-three individuals with moderate public speaking anxiety were randomized to a standardized positive mental imagery exercise about future public speaking or no-task. All participants were then asked to present in a virtual reality environment. Anticipatory anxiety reduced in the positive mental imagery group, but not in the control group. Additionally, the positive mental imagery group reported lower distress during exposure than the control group, but groups did not differ in exposure willingness. Due to limited variance, effects on exposure duration could not be tested. Future-oriented positive mental imagery is promising to prepare individuals for exposure to previously avoided situations.
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van Teffelen MW, Voncken MJ, Peeters F, Mollema ED, Lobbestael J. The efficacy of incorporating mental imagery in cognitive restructuring techniques on reducing hostility: A randomized controlled trial. J Behav Ther Exp Psychiatry 2021; 73:101677. [PMID: 34325236 DOI: 10.1016/j.jbtep.2021.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 07/01/2021] [Accepted: 07/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive restructuring (CR) is an effective intervention for hostility. However, the number of patients who fail to benefit suggest that the efficacy of CR can be further improved. The present study investigated whether enhancing CR with mental imagery techniques can increase its efficacy. METHODS A high hostility sample (28% male, and 72% female) was randomized over one session of imagery enhanced CR (I-CR) (n = 34), traditional CR (n = 32) or an active control session (AC) (n = 21). Changes in hostile beliefs, aggressive tendencies, state anger and hostility traits were assessed pre- and post-treatment, and at one-week follow-up. RESULTS Results showed that both I-CR and CR efficaciously reduced hostile beliefs, aggressive tendencies and anger, to a stronger degree than AC. I-CR was more efficacious and sustainable over time than both CR and AC in reducing hostile beliefs and aggressive tendencies. LIMITATIONS This study was conducted using a small, non-treatment seeking sample. CONCLUSIONS Findings suggest that implementing imagery techniques in CR for hostile beliefs enhances its' efficacy.
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Affiliation(s)
- Martijn W van Teffelen
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Department of Anxiety Disorders, METggz Maastricht, the Netherlands.
| | - Marisol J Voncken
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | | | - Jill Lobbestael
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
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Rescripting Social Trauma: A Pilot Study Investigating Imagery Rescripting as an Adjunct to Cognitive Behaviour Therapy for Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10221-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Saulsman LM, Ji JL, Mcevoy PM. The essential role of mental imagery in cognitive behaviour therapy: What is old is new again. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Lisa M. Saulsman
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
- Cognitive Behaviour Therapy Services Western Australia, Perth, Western Australia, Australia
| | - Julie L. Ji
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter M. Mcevoy
- School of Psychology, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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Warnecke I, Haffinger LM, Konradi H, Reiss N, Luka-Krausgrill U, Rohrmann S. Design of a guided internet-delivered counseling intervention for test anxiety. ACTA ACUST UNITED AC 2020. [DOI: 10.5964/ejcop.v8i1.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Test anxiety is a widespread challenge among university students. Online treatment facilitates a wider distribution and easier access to treatment. In a naturalistic study, a guided internet-delivered counseling program for test anxiety in university students was created and reviewed. Students suffering from self-reported test anxiety were recruited at a university counseling center (n = 40). Test anxiety and psychological distress were measured pre and post treatment. The test anxiety online treatment was administered in six modules over a period of 6 weeks. Therapist contact via written message in the online platform was included once a week. There were two personal contacts before and after treatment. A paired t-test showed a significant reduction of test anxiety (n = 32, p < .01). There was as well a significant reduction of general psychological distress and general anxiety (n = 31, p < .05). Participants were largely satisfied with the helpfulness and composition of the program. Thus, a guided internet-delivered treatment program is an effective treatment for reducing test anxiety in university students.
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Romano M, Moscovitch DA, Huppert JD, Reimer SG, Moscovitch M. The effects of imagery rescripting on memory outcomes in social anxiety disorder. J Anxiety Disord 2020; 69:102169. [PMID: 31862574 DOI: 10.1016/j.janxdis.2019.102169] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/27/2023]
Abstract
Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets negative autobiographical memories. IR has been theorized to work through various memory mechanisms, including modifying the content of negative memory representations, changing memory appraisals, and improving negative schema or core beliefs about self and others. However, no prior studies have investigated the unique effects of rescripting itself relative to other IR intervention components on these proposed mechanisms. In this preliminary study, 33 individuals with SAD were randomized to receive a single session of IR, imaginal exposure (IE), or supportive counselling (SC). Memory outcomes were assessed at 1- and 2-weeks post-intervention and at 3-months follow-up. Results demonstrated that the content of participants' autobiographical memory representations changed in distinct ways across the three conditions. Whereas IR facilitated increases only in positive/neutral memory details, IE facilitated increases in both positive/neutral and negative memory details and SC facilitated no changes in memory details. Although memory appraisals did not differ across conditions, participants who received IR were more likely to update their negative memory-derived core beliefs. These unique effects of rescripting on memory representations and core beliefs enhance our understanding of the memory-based mechanisms of IR within the context of exposure-based learning for people with SAD.
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Affiliation(s)
- Mia Romano
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Canada.
| | | | - Susanna G Reimer
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Canada
| | - Morris Moscovitch
- University of Toronto and the Rotman Research Institute and Department of Psychology, Baycrest Centre for Geriatric Care, Canada
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21
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Imagery Rescripting of Aversive Autobiographical Memories: Effects on Memory Distress, Emotions, and Feelings of Mastery. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10021-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Effectiveness of cognitive behavioural group therapy for social anxiety disorder: long-term benefits and aftercare. Behav Cogn Psychother 2019; 47:501-513. [PMID: 30919793 DOI: 10.1017/s1352465819000079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Empirical research demonstrates the short- to medium-term efficacy and effectiveness of cognitive behavioural group therapy (CBGT) for social anxiety disorder (SAD). Little is known about the durability of gains beyond 1 year following treatment in real-life clinical settings. Literature regarding the impact of aftercare programs as an adjunct to CBGT treatment on SAD is scarce. AIMS To evaluate the long-term effectiveness of CBGT for SAD in a community sample and to explore the relationship between long-term treatment outcomes and aftercare support group attendance. METHOD A longitudinal cohort design evaluated changes in standardized psychological measures assessing aspects of SAD, anxiety and depression. Questionnaires were completed before the program (time 1, N = 457), after the program (time 2, n = 369) and at an average of 4.6 years follow-up (time 3, n = 138). RESULTS Large treatment effect sizes at post-intervention were maintained at long-term follow-up on measures of SAD, anxiety and depression. There was no statistically significant relationship between frequency of attendance at an aftercare support group and degree of improvement from post-treatment severity on any measure. CONCLUSIONS CBGT is an effective intervention in the long-term in a routine clinical setting and should be considered a viable treatment option for SAD. Recommendations for future research, treatment implications and study limitations are considered.
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Abstract
PURPOSE OF REVIEW This review describes (a) key features of the metacognitive model as they relate to anxiety and related disorders, (b) central components of metacognitive therapy (MCT), (c) the current empirical status of MCT, (d) recent developments, (e) controversies and (f) future research directions. RECENT FINDINGS Evidence is accumulating that MCT is effective for anxiety and related disorders. Emerging evidence suggests that MCT may be effective with children and adolescents and compares well to other evidence-supported treatments such as cognitive behaviour therapy and mindfulness-based approaches. Evidence for distinct mechanisms across therapies is mixed. While MCT appears to be effective for anxiety and related disorders, more research is required to evaluate (a) efficacy and unique (vs. common) mechanisms of change compared to other therapies, (b) effectiveness for children and adolescents, (c) alternative delivery methods (e.g., via internet, group vs. individual), (d) transdiagnostic impacts and (e) applications to a broader array of disorders.
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Hyett MP, Bank SR, Lipp OV, Erceg-Hurn DM, Alvares GA, Maclaine E, Puckridge E, Hayes S, McEvoy PM. Attenuated Psychophysiological Reactivity following Single-Session Group Imagery Rescripting versus Verbal Restructuring in Social Anxiety Disorder: Results from a Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 87:340-349. [PMID: 30380535 DOI: 10.1159/000493897] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The effectiveness of psychotherapies for social anxiety disorder (SAD) is typically evaluated using self- and clinician-reported symptom change, while biomarkers of treatment response are rarely measured. The current study aimed to compare biomarkers of response following two brief group interventions for SAD. METHODS This randomized controlled trial evaluated the effectiveness of single-session group interventions for SAD (n = 58) - imagery rescripting (IR) and verbal restructuring (VR) versus waitlist control (WC). The IR intervention guided participants to rescript autobiographical memories through visualization whilst the VR intervention focused on thought challenging. Trial outcomes included change in psychophysiological reactivity (heart rate variability (HRV) and electrodermal responding) to social stress, and symptom-based measures (social interaction anxiety, negative self-portrayal, cognitive avoidance, repetitive negative thinking, memory modification, anxious behaviors). RESULTS Psychophysiological reactivity was selectively attenuated following IR treatment, compared to VR and WC groups. The specific influence of the imagery-based intervention in modulating autonomic reactivity was evident across HRV parameters, including the standard deviation of intervals between heartbeats (IR vs. WC, d = 0.67, p = 0.021; IR vs. VR, d = 0.58, p = 0.041), and high frequency power - an indicator of parasympathetically mediated emotion regulation (IR vs. WC, d = 0.75, p = 0.034; IR vs. VR, d = 0.95, p = 0.006). Few group differences were observed across self-report measures. CONCLUSION The current study highlights the specificity of brief imagery-based interventions in influencing psychophysiological reactivity in SAD and establishes the sensitivity of objective markers of treatment response in quantifying change over symptom-based measurements.
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Affiliation(s)
- Matthew P Hyett
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Samantha R Bank
- School of Psychology, Curtin University, Perth, Washington, Australia.,Centre for Clinical Interventions, Perth, Washington, Australia
| | - Ottmar V Lipp
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - David M Erceg-Hurn
- School of Psychology, Curtin University, Perth, Washington, Australia.,Centre for Clinical Interventions, Perth, Washington, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, Washington, Australia
| | - Ellen Maclaine
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Emily Puckridge
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Sarra Hayes
- School of Psychology, Curtin University, Perth, Washington, Australia
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Washington, .,Centre for Clinical Interventions, Perth, Washington,
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Moscovitch DA, Vidovic V, Lenton-Brym AP, Dupasquier JR, Barber KC, Hudd T, Zabara N, Romano M. Autobiographical memory retrieval and appraisal in social anxiety disorder. Behav Res Ther 2018; 107:106-116. [DOI: 10.1016/j.brat.2018.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/07/2018] [Accepted: 06/21/2018] [Indexed: 12/21/2022]
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26
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Tanaka Y, Yoshinaga N, Tsuchiyagaito A, Sutoh C, Matsuzawa D, Hirano Y, Nakazato M, Shimizu E. Mental imagery in social anxiety disorder: the development and clinical utility of a Japanese version of the Spontaneous Use of Imagery Scale (SUIS-J). ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2018. [DOI: 10.1080/21507686.2018.1487455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yasuko Tanaka
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
- Minami Fujisawa Clinic , Kanagawa, Japan
| | - Naoki Yoshinaga
- Organization for Promotion of Tenure Track, University of Miyazaki , Miyazaki, Japan
| | - Aki Tsuchiyagaito
- Research Center for Child Mental Development, Chiba University , Chiba, Japan
| | - Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
| | - Diasuke Matsuzawa
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University , Chiba, Japan
| | - Michiko Nakazato
- Department of Psychiatry, International University of Health and Welfare, Atami Hospital , Shizuoka, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University , Chiba, Japan
- Research Center for Child Mental Development, Chiba University , Chiba, Japan
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27
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McEvoy PM, Erceg-Hurn DM, Barber KC, Dupasquier JR, Moscovitch DA. Transportability of imagery-enhanced CBT for social anxiety disorder. Behav Res Ther 2018; 106:86-94. [PMID: 29779855 DOI: 10.1016/j.brat.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 11/30/2022]
Abstract
Pilot and open trials suggest that imagery-enhanced group cognitive behaviour therapy (CBT) is highly effective for social anxiety disorder (SAD). However, before being considered reliable and generalisable, the effects of the intervention need to be replicated by clinicians in a setting that is independent of the protocol developers. The current study compared outcomes from clients with a principal diagnosis of SAD at the Australian clinic where the protocol was developed (n = 123) to those from an independent Canadian clinic (n = 46) to investigate whether the large effects would generalise. Trainee clinicians from the independent clinic ran the groups using the treatment protocol without any input from its developers. The treatment involved 12 2-h group sessions plus a one-month follow-up. Treatment retention was comparable across both clinics (74% vs. 78%, ≥9/12 sessions) and the between-site effect size was very small and non-significant on the primary outcome (social interaction anxiety, d = 0.09, p = .752). Within-group effect sizes were very large in both settings (ds = 2.05 vs. 2.19), and a substantial minority (41%-44%) achieved clinically significant improvement at follow-up. Replication of treatment effects within an independent clinic and with trainee clinicians increases confidence that outcomes are generalisable.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Psychology, Curtin University, Perth, Australia.
| | - David M Erceg-Hurn
- Centre for Clinical Interventions, Perth, Australia; School of Psychology, Curtin University, Perth, Australia
| | - Kevin C Barber
- Department of Psychology, Centre for Mental Health Research, University of Waterloo, Canada
| | - Jessica R Dupasquier
- Department of Psychology, Centre for Mental Health Research, University of Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology, Centre for Mental Health Research, University of Waterloo, Canada
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28
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Ahn JK, Kwon JH. Modifying Negative Self-Imagery Increases the Effectiveness of Cognitive Behavior Therapy for Social Anxiety Disorder: A Benchmarking Study. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9918-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Moriya J. Association between Social Anxiety and Visual Mental Imagery of Neutral Scenes: The Moderating Role of Effortful Control. Front Psychol 2018; 8:2323. [PMID: 29375439 PMCID: PMC5768629 DOI: 10.3389/fpsyg.2017.02323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/20/2017] [Indexed: 12/02/2022] Open
Abstract
According to cognitive theories, verbal processing attenuates emotional processing, whereas visual imagery enhances emotional processing and contributes to the maintenance of social anxiety. Individuals with social anxiety report negative mental images in social situations. However, the general ability of visual mental imagery of neutral scenes in individuals with social anxiety is still unclear. The present study investigated the general ability of non-emotional mental imagery (vividness, preferences for imagery vs. verbal processing, and object or spatial imagery) and the moderating role of effortful control in attenuating social anxiety. The participants (N = 231) completed five questionnaires. The results showed that social anxiety was not necessarily associated with all aspects of mental imagery. As suggested by theories, social anxiety was not associated with a preference for verbal processing. However, social anxiety was positively correlated with the visual imagery scale, especially the object imagery scale, which concerns the ability to construct pictorial images of individual objects. Further, it was negatively correlated with the spatial imagery scale, which concerns the ability to process information about spatial relations between objects. Although object imagery and spatial imagery positively and negatively predicted the degree of social anxiety, respectively, these effects were attenuated when socially anxious individuals had high effortful control. Specifically, in individuals with high effortful control, both object and spatial imagery were not associated with social anxiety. Socially anxious individuals might prefer to construct pictorial images of individual objects in natural scenes through object imagery. However, even in individuals who exhibit these features of mental imagery, effortful control could inhibit the increase in social anxiety.
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Affiliation(s)
- Jun Moriya
- Faculty of Sociology, Kansai University, Osaka, Japan
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30
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McEvoy PM, Hayes S, Hasking PA, Rees CS. Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure. J Behav Ther Exp Psychiatry 2017; 57:163-171. [PMID: 28601695 DOI: 10.1016/j.jbtep.2017.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/05/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to examine the frequency, content, and appraisals of thoughts and images occurring during urges to engage in non-suicidal self-injury (NSSI). METHOD Undergraduates (N = 154) with a history of NSSI completed an online survey of their thoughts, images, and appraisals when they acted on urges to engage in NSSI as well as when they resisted urges to self-injure. RESULTS Most (>90%) participants reported experiencing both thoughts and images during urges to engage in NSSI. During urges that resulted in self-injury, self-critical and hopeless thoughts were most distressing, and thoughts about relief from emotional distress were most comforting. Images of the anticipated injury were most common. During urges that did not result in self-injury themes of the futility of NSSI, positive self-talk, and the impact on others were most common. Images were most frequently of the negative impact on self and others, and the anticipated injury. Appraisals encouraging NSSI occurred when individuals did and did not act on their urges, but concurrent strong discouraging appraisals appeared to be protective on occasions when urges did not result in self-injury. LIMITATIONS Retrospective self-report was used to assess cognitive content. Generalisability of findings to non-student samples needs to be assessed. CONCLUSIONS Findings from this study may inform comprehensive assessment of thoughts and images associated with urges to engage in NSSI. NSSI interventions may need to promote thoughts, imagery and appraisals that discourage NSSI whilst simultaneously modifying cognitions that encourage NSSI.
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Affiliation(s)
- Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia.
| | - Sarra Hayes
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Penelope A Hasking
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Clare S Rees
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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31
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Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: Study protocol for a randomized controlled trial. Contemp Clin Trials 2017. [DOI: 10.1016/j.cct.2017.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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32
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Hasking PA, Di Simplicio M, McEvoy PM, Rees CS. Emotional cascade theory and non-suicidal self-injury: the importance of imagery and positive affect. Cogn Emot 2017; 32:941-952. [PMID: 28838289 PMCID: PMC6050645 DOI: 10.1080/02699931.2017.1368456] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Grounded in Emotional Cascade Theory, we explored whether rumination and multisensory imagery-based cognitions moderated the relationships between affect and both odds of non-suicidal self-injury (NSSI), and frequency of the behaviour. A sample of 393 university students completed self-report questionnaires assessing the constructs of interest. Contrary to expectations, rumination did not emerge as a significant moderator of the affect-NSSI relationship. However, the relationship between affect and frequency of NSSI was moderated by the use of imagery. Further, the relationship between negative affect and NSSI was moderated by positive affect, underscoring the need to consider both negative and positive affect in models of NSSI. Most youth who self-injured reported thinking in images while the urge to self-injure was strong, with 53% thinking in images at least half the time. Future work is needed to explore how positive and negative affect work in concert to govern NSSI, and how imagery might either exacerbate or reduce risk of NSSI.
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Affiliation(s)
- Penelope A Hasking
- a School of Psychology & Speech Pathology , Curtin University , Perth , Australia
| | | | - Peter M McEvoy
- a School of Psychology & Speech Pathology , Curtin University , Perth , Australia.,c Centre for Clinical Interventions , Perth , Australia
| | - Clare S Rees
- a School of Psychology & Speech Pathology , Curtin University , Perth , Australia
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Dear BF, Staples LG, Terides MD, Fogliati VJ, Sheehan J, Johnston L, Kayrouz R, Dear R, McEvoy PM, Titov N. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for Social Anxiety Disorder and comorbid disorders: A randomized controlled trial. J Anxiety Disord 2016; 42:30-44. [PMID: 27261562 DOI: 10.1016/j.janxdis.2016.05.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/22/2016] [Accepted: 05/07/2016] [Indexed: 12/14/2022]
Abstract
Disorder-specific (DS-CBT) and transdiagnostic (TD-CBT) cognitive behaviour therapy have both been used to treat social anxiety disorder (SAD). This study compared internet-delivered DS-CBT and TD-CBT for SAD across clinician-guided (CG-CBT) and self-guided (SG-CBT) formats. Participants with SAD (n=233) were randomly allocated to receive internet-delivered TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of SAD (Cohen's d≥1.01; avg. reduction≥30%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d≥1.25; avg. reduction≥39%), generalised anxiety disorder (Cohen's d≥0.86; avg. reduction≥36%) and panic disorder (Cohen's d≥0.53; avg. reduction≥25%) were found immediately post-treatment and were maintained or further improved to 24-month follow-up. No marked differences were observed between TD-CBT and DS-CBT or CG-CBT and SG-CBT highlighting the potential of each for the treatment of SAD and comorbid disorders.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L G Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M D Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - J Sheehan
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L Johnston
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Kayrouz
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - P M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
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McEvoy PM, Erceg-Hurn DM. The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty. J Anxiety Disord 2016; 41:96-107. [PMID: 26898177 DOI: 10.1016/j.janxdis.2016.02.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/29/2016] [Accepted: 02/02/2016] [Indexed: 11/20/2022]
Abstract
The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n=106), social anxiety disorder (n=88), or generalized anxiety disorder (n=62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and 'trans-therapy' process of change. Changes in IU were also associated with symptom relief in the social anxiety disorder and generalized anxiety disorder groups, but not in the depression group. Implications of these findings are discussed within the broader literature of transdiagnostic approaches to emotional disorders.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
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Moscovitch DA. Early memories in social anxiety: A meaningful and enduring collaboration with my Dad. Neuropsychologia 2016; 90:286-92. [PMID: 26994594 DOI: 10.1016/j.neuropsychologia.2016.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/26/2016] [Accepted: 03/15/2016] [Indexed: 12/01/2022]
Abstract
In this short paper in honour of my father's Festschrift, I describe a recent collaboration with him in which we joined forces to investigate the nature of autobiographical images and memories in social anxiety. I outline our work together and the unique insights that were gleaned from our interactive contributions. Then, I reflect on how this collaboration has helped to lay the foundation for subsequent work in my lab and illuminate new directions in my program of research, enhance my career as a scientist-practitioner, and ultimately, enrich both my personal and professional identities. In so doing, I aim to highlight one of the most important and enduring aspects of my father's legacy: the profound positive impact he has on the people with whom he has worked.
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Affiliation(s)
- David A Moscovitch
- Department of Psychology and Centre for Mental Health Research, University of Waterloo, Canada.
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Abstract
Fear of negative evaluation (FNE) is a recognised diagnostic feature of Social Anxiety Disorder (SAD). Recently, the role of fear of positive evaluation (FPE) as a factor contributing to SAD has been a focus of research: there is evidence that FPE is associated with measures of social anxiety independent of measures of FNE and that measures of FPE may be sensitive to interventions for SAD. The present study examined the relationships between FPE, FNE and measures of social anxiety and depression in a sample assessed as suitable for group cognitive behaviour therapy (CBT) for social anxiety (n = 35), and the responsiveness of measures of FPE and FNE to standard group CBT for social anxiety in a subset of this group (n = 20). Measures of FNE and FPE were positively associated with each other and with measures of social interaction anxiety, general social anxiety concerns, and depression. However, the relationship between the FPE measure and measures of general social anxiety concerns and depression was not significant when FNE was statistically controlled. This is consistent with the view that FPE is specifically related to social interaction anxiety. In this sample, a measure of FPE was reduced in a sample receiving standard group CBT for social anxiety compared to a waitlisted group. The implications of these findings for the conceptualisation of SAD and for the delivery of interventions for those with SAD are considered.
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Reimer SG, Moscovitch DA. The impact of imagery rescripting on memory appraisals and core beliefs in social anxiety disorder. Behav Res Ther 2015; 75:48-59. [PMID: 26555157 DOI: 10.1016/j.brat.2015.10.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/21/2015] [Accepted: 10/28/2015] [Indexed: 12/21/2022]
Abstract
Negative mental images in social anxiety disorder (SAD) are often rooted in autobiographical memories of formative, distressing life events. In the present study, 25 participants with SAD retrieved an idiosyncratic negative mental image and associated autobiographical memory. Participants were then randomly assigned either to a single-session of imagery rescripting (IR) targeting the retrieved autobiographical memory or to a non-intervention control condition (no-IR). Outcomes were assessed one week later. Compared to control participants, those who received IR experienced substantial reduction in SAD symptoms accompanied by more positive and less negative appraisals of their autobiographical memories. Moreover, IR relative to no-IR participants reported marked shifts in the content, validity, and accuracy of their memory-derived negative core beliefs about self and others, but not about the world. Results support the promise of IR as a stand-alone intervention for SAD and suggest important directions for future research to enhance our understanding of the cognitive mechanisms that underlie its effects.
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Affiliation(s)
- Susanna G Reimer
- Department of Psychology and Centre for Mental Health Research, University of Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research, University of Waterloo, Canada.
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McEvoy PM, Erceg-Hurn DM, Anderson RA, Campbell BNC, Nathan PR. Mechanisms of change during group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder. J Anxiety Disord 2015; 35:19-26. [PMID: 26311192 DOI: 10.1016/j.janxdis.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/18/2015] [Accepted: 07/29/2015] [Indexed: 11/15/2022]
Abstract
Repetitive negative thinking (RNT) is a transdiagnostic process that serves to maintain emotional disorders. Metacognitive theory suggests that positive and negative metacognitive beliefs guide the selection of RNT as a coping strategy which, in turn, increases psychological distress. The aim of this study was to test the indirect effect of metacognitive beliefs on psychological distress via RNT. Patients (N=52) with primary and non-primary generalized anxiety disorder attended a brief, six-week group metacognitive therapy program and completed measures of metacognitive beliefs, RNT, and symptoms at the first and final treatment sessions, and at a one-month follow-up. Prospective indirect effects models found that negative metacognitive beliefs (but not positive metacognitive beliefs) had a significant indirect effect on psychological distress via RNT. As predicted by metacognitive theory, targeting negative metacognitions in treatment appears to reduce RNT and, in turn, emotional distress. Further research using alternative measures at multiple time points during therapy is required to determine whether the absence of a relationship with positive metacognitive beliefs in this study was a consequence of (a) psychometric issues, (b) these beliefs only being relevant to a subgroup of patients, or (c) a lack of awareness early in treatment.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
| | | | - Rebecca A Anderson
- Centre for Clinical Interventions, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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