Imagery-Enhanced CBT for Social Anxiety Disorder

298 Pages·2018·13.207 MB·English

by  Peter M. McEvoy, Lisa M. Saulsman, Ronald M. Rapee

IMAGERY-ENHANCED CBT FOR SOCIAL ANXIETY DISORDER
Also Available
Fight or Flight: Overcoming Panic and Agoraphobia [video]
Featuring Ronald M. Rapee
I Think They Think . . . : Overcoming Social Phobia [video]
Featuring Ronald M. Rapee
Imagery-Enhanced CBT for
Social Anxiety Disorder
Peter M. McEvoy
Lisa M. Saulsman
Ronald M. Rapee
THE GUILFORD PRESS
New York London
Copyright © 2018 The Guilford Press
A Division of Guilford Publications, Inc.
370 Seventh Avenue, Suite 1200, New York, NY 10001
www.guilford.com
All rights reserved
Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,
microfilming, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
LIMITED DUPLICATION LICENSE
These materials are intended for use only by qualified mental health professionals.
The publisher grants to individual purchasers of this book nonassignable permission to
reproduce all materials for which photocopying permission is specifically granted in a footnote.
This license is limited to you, the individual purchaser, for personal use or use with clients. This
license does not grant the right to reproduce these materials for resale, redistribution, electronic
display, or any other purposes (including but not limited to books, pamphlets, articles, video- or
audiotapes, blogs, file-sharing sites, Internet or intranet sites, and handouts or slides for lectures,
workshops, or webinars, whether or not a fee is charged). Permission to reproduce these
materials for these and any other purposes must be obtained in writing from the Permissions
Department of Guilford Publications.
The authors have checked with sources believed to be reliable in their efforts to provide
information that is complete and generally in accord with the standards of practice that are
accepted at the time of publication. However, in view of the possibility of human error or
changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and
publisher, nor any other party who has been involved in the preparation or publication of this
work warrants that the information contained herein is in every respect accurate or complete, and
they are not responsible for any errors or omissions or the results obtained from the use of such
information. Readers are encouraged to confirm the information contained in this book with
other sources.
Library of Congress Cataloging-in-Publication Data
Names: McEvoy, Peter M., author.
Title: Imagery-enhanced CBT for social anxiety disorder / Peter M. McEvoy,
Lisa M. Saulsman, Ronald M. Rapee.
Description: New York : The Guilford Press, [2018] | Includes bibliographical
references and index.
Identifiers: LCCN 2017023840 | ISBN 9781462533053 (paperback : alk. paper) |
ISBN 9781462535491 (hardcover : alk. paper)
Subjects: LCSH: Social phobia—Treatment. | Cognitive therapy. | BISAC:
PSYCHOLOGY / Psychopathology / Anxieties & Phobias. | MEDICAL / Psychiatry
/ General. | SOCIAL SCIENCE / Social Work.
Classification: LCC RC552.S62 M39 2018 | DDC 616.85/225—dc23
LC record available at https://lccn.loc.gov/2017023840
About the Authors
Peter M. McEvoy, PhD, is Professor in the School of Psychology and Speech Pathol-
ogy at Curtin University in Perth, Australia. He is also Clinical Research Director at the
Centre for Clinical Interventions of the Western Australia Department of Health. An
associate editor of the Journal of Anxiety Disorders and the Journal of Experimental Psycho-
pathology, Dr. McEvoy has published articles on the treatment of anxiety and depression,
transdiagnostic approaches to mental disorders, and mechanisms of change.
Lisa M. Saulsman, PhD, has spent the majority of her career as a senior clinical
psychologist at the Centre for Clinical Interventions of the Western Australia Depart-
ment of Health. She is experienced in providing individual and group interventions for
adults with anxiety and depression and training mental health professionals in evidence-
supported treatments for emotional disorders. Dr. Saulsman has published articles on
the use of imagery to enhance CBT and the role of personality in psychopathology. She
is now Director of Cognitive Behaviour Therapy Services, Western Australia, offering
CBT-based training and workshops to professionals, businesses, and the general public.
Ronald M. Rapee, PhD, is Distinguished Professor of Psychology at Macquarie Uni-
versity, in Sydney, Australia, and former Director of the University’s Centre for Emo-
tional Health. He is best known for his theoretical models of the development of anxiety
disorders and his creation of empirically validated intervention programs that are widely
used internationally. Dr. Rapee is a recipient of the Distinguished Career Award from
the Australian Association for Cognitive and Behaviour Therapy and the Distinguished
Contribution to Science Award from the Australian Psychological Society. He is an Aus-
tralian Research Council Laureate Fellow and has been appointed as a Member of the
Order of Australia for his contributions to clinical psychology.
v

Preface
Human beings are social creatures living in a world built around relationships, so almost
any life circumstance can be seen as threatening to socially anxious persons. From direct
group or individual social interactions of any kind, to the possibility of being observed
when stepping out of the front door of their home, to the inadequacy of their “perfor-
mance” on virtually any task—social threat can be perceived everywhere. Social anxiety
disorder (SAD) is a common and distressing condition that, without being treated, can
be disabling and lifelong.
SAD can be challenging for therapists, but it is also tremendously rewarding to
treat. People with SAD want to relate well to people—they desire close, genuine, and
fulfilling relationships. They are people people, although they may not believe this about
themselves when they first seek help. People with SAD care about others, have a high
degree of empathy, and are keen to please—personal qualities that are highly valued by
others. The problem is they care too much. The probability and cost of not pleasing oth-
ers are perceived to be extremely high. Social situations are seen as threatening, which
triggers a cascade of anxiety symptoms, negative beliefs, and avoidant behaviors. In
severe SAD, “life” is threatening and virtually nowhere is safe. We hope the treatment
in this book helps to ease the suffering of people with SAD by helping them to abandon
the psychological factors that maintain their constant expectation of social catastrophe,
while allowing them to retain the wonderful personal qualities they have that facilitate
genuine and fulfilling relationships.
Cognitive-behavioral therapy (CBT) has been shown to be very helpful for SAD
over many research trials with clients who have severe and complex cases of the disorder.
CBT has been successfully delivered on a one-to-one basis and in groups, and in both
research units and “real-world” clinics. As our understanding of the mechanisms behind
SAD has improved, specific treatment enhancements have been designed to target these
mechanisms to attain even better outcomes. The core components of the program in this
vii
viii Preface
book have been extensively evaluated and shown to work, and they are more effective
than traditional cognitive-behavioral approaches. The novel contribution of this book
is the detailed description of an innovation from our own clinic—imagery-enhanced
CBT for SAD—that has been shown to improve our clients’ engagement and outcomes.
Since including the imagery enhancements in our protocol, treatment completion rates
have increased from 65% to 90%, and the impact on social anxiety symptoms has also
greatly improved.
Imagery-based CBT “enhances” traditional approaches by emphasizing the ben-
efits of facilitating cognitive and emotional change via the imagery mode. Multisensory
imagery is highly emotionally evocative, and more so than verbal activity. If our pri-
mary aim in therapy is to enable our clients to change their extreme emotional reac-
tions, it follows that therapy will be more potent within the imagery mode. Clients are
encouraged to incorporate vivid, multisensory imagery into every aspect of the treat-
ment described in this book.
We are bringing this book to you in the hope that your clients can benefit from
the very latest therapeutic developments. We hope these innovations help you to enjoy
working with clients suffering from SAD as much as we do and, most important, to ease
their suffering.
A brief note about pronouns: With the exception of specific examples, we alternate
between masculine and feminine pronouns throughout the book to avoid awkward
sentences.
Acknowledgments
We owe a considerable debt of gratitude to the clinicians and clinical researchers (and
their clients) whose contributions this book builds on. Arnoud Arntz, David Barlow,
Aaron Beck, Judith Beck, James Bennett-Levy, Chris Brewin, David M. Clark, Albert
Ellis, Melanie Fennell, Jessica Grisham, Ann Hackmann, Richard Heimberg, Emily
Holmes, Michael Liebowitz, Michelle Moulds, David Moscovitch, Christine Padesky,
and Jennifer Wild are just a few of the giants on whose achievements our work relies.
Colleagues in our own services have also been tremendously influential, including Paula
Nathan, Jonathan Gaston, Maree Abbott, Bruce Campbell, and Mark Summers. We
are grateful to the National Health and Medical Research Council of Australia for its
support of our work through Project Grant APP1104007. We would also like to express
our appreciation to our families for their love and support. Finally, we acknowledge the
courageous socially anxious clients who have participated in this treatment within our
programs. Your experiences have helped shape this treatment and taught us so much.
ix