Imagery-enhanced cognitive behavioural group therapy for social anxiety disorder: A pilot study

•Evaluated imagery-enhanced cognitive behavioural group therapy (IE-CBGT).•Attrition was very low suggesting that IE-CBGT was acceptable to patients.•Effect sizes were large by session eight and doubled by the end of treatment.•Most patients reliably improved on interaction and performance anxiety.•IE-CBGT was superior to historical controls not receiving imagery enhancements.

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.