People with social anxiety disorder benefit greatly from group therapy that targets the negative mental images they have of themselves and others, according to a study at the University of Waterloo. 

Called “imagery-enhanced” cognitive behavioural therapy (CBT), the new group treatment helps relieve symptoms including social performance and interaction anxiety, depression and stress. 

More than four million Canadians will develop social anxiety disorder at some point in their lives. Without treatment, the disorder can impair people’s functioning at school, work and relationships. 

David Moscovitch

David Moscovitch

“Research has shown that mental imagery is strongly connected to emotions, and many people living with social anxiety disorder have negative images of themselves that perpetuate their symptoms,” said co-author David Moscovitch, a professor of psychology at Waterloo and executive director of the University of Waterloo Centre for Mental Health Research (CMHR). “The benefits we’re seeing with this novel CBT group from before to after treatment are very large, with 4 out of every 5 of our patients reporting that their social anxiety symptoms were substantially reduced and interfering much less with their ability to function in their day-to-day lives.” 
Researchers recruited people with a diagnosis of social anxiety disorder at the CMHR and the Centre for Clinic Interventions in Perth, Australia, where the therapy was originally developed. The 13-session treatment used specialized exercises including video feedback and imagery rescripting, where patients are guided to reimagine the outcomes of past negative experiences and to challenge distorted images of themselves and others. 

The goal was to see if the successes achieved in a pilot and open trial could be replicated in a different setting — without input from the treatment developers. The results were strikingly similar in treatment retention and symptom improvement – strongly suggesting that imagery-enhanced group CBT is effective. 

The study suggests that this new group therapy may work as well as individual therapy, but costs half as much per patient. 

“These initial findings are very promising, as they suggest that there’s potential to reduce cost and improve access to evidence-based treatments that work,” said Moscovitch. “Many Canadians don’t have access to treatment they need because there aren’t enough well-trained clinicians and health care plans don’t provide sufficient coverage.”

The study, “Transportability of imagery-enhanced CBT for social anxiety disorder” appears in Behaviour Research and Therapy.