Social anxiety and cognitive behavioral therapy

In a recent review, McGuinn and Newmann (2013) tried to take stock of current knowledge on social anxiety, its epidemiological incidence and which treatments are effective.

Social phobia , as it is now known, appears to be the most widespread anxiety disorder, with a prevalence in Western countries of between 3% and 14%. It appears to be more common, albeit not significantly, among women and typically begins in childhood or puberty and rarely after age 25.

The cognitive behavioral approach has proposed explanatory and treatment models that have demonstrated their effectiveness in various scientific studies, leading to the conclusion that this treatment model is the most suitable for these patients.

In particular, it appears that cognitive restructuring and graded in vivo exposure have been shown to be the most effective intervention techniques for social anxiety.

As known, the standard cognitive behavioral model is characterized by being focused on the here and now and tries to intervene in the present, without giving a fundamental weight to the patient's anamnesis and to how the basic pathogenic beliefs that maintain social phobia have developed.

However, some studies have shown the limits of the effectiveness of the standard model and suggested the development of new intervention techniques.

For some years, for example, a line of research and clinical practice has been flourishing that is particularly attentive to the work on mental images (the so-called imagery), to how these images are linked to negative episodes that have occurred in the past, as well as to the possible derivative intervention techniques for the treatment of social anxiety.

In an article just published in Behavior Research and Therapy entitled “Imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: A pilot study”, McEvoy and Saulsman propose a model of group cognitive therapy for social anxiety enhanced of this type.

In the introduction to the article, the authors illustrate how the mind of the patient with social phobia is particularly crowded with negative images about themselves and their actions and how these images, in addition to being anxiety-provoking, appear directly linked to negative and potentially traumatic experiences experienced by the subject during the onset of social phobia , usually in childhood.

This type of discoveries, supported by a great deal of literature by now, has led to the use of techniques aimed at working on mental images, such as imagery rescripting for example, which seem to be very profitable and useful in working with patients with social phobia and with other ailments.

In their research, therefore, the authors tested a group therapy protocol enhanced by imagery-based techniques to understand if this type of intervention was acceptable and usable for patients, what kind of effect it had on symptoms and performance anxiety and whether it was more effective than standard cognitive therapy for social phobia .

In the article, the authors correctly illustrate the protocol, describing the agenda of the 12 sessions that make up the treatment.

The results seem to substantially support the initial hypotheses. 95% of the subjects in the experimental group completed the treatment course, showing good results especially as regards social interaction, less for performance anxiety .

Comparison with standard CBT has shown that the imagery-based protocol is significantly superior as regards social interaction, it is slightly superior, but not statistically significant, as regards performance anxiety.

However, the study has some limitations, such as the small number of the sample (n=19) and the method of comparison between the two protocols: in fact, the patients with social phobia in the experimental group were compared to patients already treated previously (94 subjects with protocol of standard cognitive therapy) at the same clinic.

This is obviously a pilot study, which will need further testing with larger samples, but it still appears to chart a promising new avenue forward, especially for social anxiety patients resistant to standard CBT.