Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
Child Study Center, Accare, Groningen, The Netherlands.
Clin Psychol Psychother. 2024 Sep-Oct;31(5):e3063. doi: 10.1002/cpp.3063.
Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative 'flashforward' imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1-week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14-17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group-based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary. Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974.
心理治疗社交焦虑障碍（SAD）在青少年中表现出比其他焦虑障碍更差的结果。一个相关的因素，以改善结果可能是消极的意象。在这项初步研究中，我们检查了患有 SAD 的青少年对恐惧灾难性后果的消极“闪回”意象，并评估了针对这种意象的短期眼动脱敏再处理（EMDR）干预的可行性和初步结果。我们使用了一个为期 1 周的基线期的病例系列设计。结果包括与选定的社交情境相关的社交焦虑和回避症状，以及作为干预期间变化的潜在机制的相关闪回意象的特征。我们发现，七名评估的青少年中有六名报告经历过闪回，并对图像的痛苦、生动性和威胁评估进行了高评分。在这六名参与者（年龄在 14 至 17 岁之间）中，短期 EMDR 闪回干预似乎是可行的，随后五名参与者的社交焦虑和回避症状有所减少，而在基线期没有观察到明显的变化。此外，我们观察到至少五名参与者的闪回意象特征有所减少。对干预期间总体（基于组的）变化的非参数检验部分支持了这些发现。局限性包括样本量小和缺乏对照组。结果表明，生动和痛苦的闪回意象是一种常见的体验，而用 EMDR 来针对闪回可能对治疗青少年的社交焦虑有益。需要进一步的实验研究来评估其效果和对现有治疗方法的附加价值。
荷兰临床试验注册处（国家试验登记处[NTR]）：NL8974。
