Impacts of imagery-enhanced versus verbally-based cognitive behavioral group therapy on psychophysiological parameters in social anxiety disorder: Results from a randomized-controlled trial. (August 2022)

• Record Type: Journal Article
• Authors: McEvoy, Peter M.; Hyett, Matthew P.; Johnson, Andrew R.; Erceg-Hurn, David M.; Clarke, Patrick J.F.; Kyron, Michael J.; Bank, Samantha R.; Haseler, Luke; Saulsman, Lisa M.; Moulds, Michelle L.; Grisham, Jessica R.; Holmes, Emily A.; Moscovitch, David A.; Lipp, Ottmar V.; Rapee, Ronald M.
• Is Part Of: Behaviour research and therapy. Volume 155(2022)
• Publication Date: 2022-08
• Subjects: Cognitive behavior therapy -- Heart rate variability -- Imagery -- Physiological stress -- Randomized controlled trials -- Social phobia; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2022.104131
• Languages: English
• ISSNs: 0005-7967

Abstract

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. Highlights: People with social anxiety report marked physiological arousal in social situations. Physiological change is rarely reported in treatment studies. RCT of imagery vs. verbal group CBT investigated physiological change. Imagery-enhanced CBT led to lower sympathetic arousal under stress post-treatment. Findings provide insight into biomarkers of emotion regulation in social anxiety.