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Hansen B, Eide TO, Reiråskag MA, Tjelle KA, Solem S, Hagen K. The Bergen 4-day treatment for social anxiety disorder: a pilot study. BMC Psychiatry 2024; 24:145. [PMID: 38383324 PMCID: PMC10880199 DOI: 10.1186/s12888-024-05607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have examined the use of concentrated and intensified cognitive behaviour therapy for treating social anxiety disorder (SAD). The aim of this study was to examine the feasibility of the Bergen 4-Day Treatment (B4DT) for treating SAD. METHODS This study adopted an open trial design without a control group. Thirty consecutively referred patients who were diagnosed with SAD were treated and assessed at pre-treatment, at post-treatment, and at the 3-month follow-up. The Liebowitz Social Anxiety Scale was used to assess symptoms of SAD; the Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms; and the Patient Health Questionnaire-9 was used to assess symptoms of anxiety and depression. The Client Satisfaction Questionnaire-8 was administered posttreatment. RESULTS Overall, patients reported a high level of satisfaction with the B4DT. Large effect sizes were observed for symptoms of SAD (d = 1.94-2.66) and for the secondary outcomes, i.e., generalized anxiety (d = 0.86-0.99) and depression (d = 0.62-0.83). The remission rate was 55.2% at follow-up, while the treatment response rate was 89.7%. CONCLUSIONS The B4DT is a promising treatment approach for patients with SAD. In the future, controlled trials should be performed to compare the efficacy of this treatment approach with standard outpatient treatment. Practical consequences, policy implications, and suggestions for future research are discussed herein.
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Affiliation(s)
- Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Thorstein Olsen Eide
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway
| | | | - Kristian August Tjelle
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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Norton AR, Penney E, Abbott MJ. An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization. J Clin Psychol 2023; 79:1021-1038. [PMID: 36383710 DOI: 10.1002/jclp.23457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/05/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals. METHOD Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style. RESULTS Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother. CONCLUSION Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.
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Affiliation(s)
- Alice R Norton
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Erika Penney
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Maree J Abbott
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
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O'Shannessy DM, Waters AM, Donovan CL. Feasibility of an Intensive, Disorder-Specific, Group-Based Cognitive Behavioural Therapy Intervention for Adolescents with Social Anxiety Disorder. Child Psychiatry Hum Dev 2023; 54:546-557. [PMID: 34669067 PMCID: PMC8526989 DOI: 10.1007/s10578-021-01265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
This study examined the preliminary acceptability and efficacy of an intensive, group-based, disorder-specific cognitive behavioural therapy (CBT) intervention for adolescents with social anxiety disorder (SAD). Fourteen Australian adolescents with SAD (78.6% female, M age = 13.93 years) and their parents completed the program plus measures of treatment satisfaction, and provided feedback. Clinical interviews and surveys were administered pre-treatment, post-treatment, and at 6-month follow-up to determine diagnostic status and assess related variables. Post-treatment satisfaction scores were very high for adolescents and parents. Post-treatment, 32.3% of participants no longer met criteria for SAD diagnosis, increasing to 42.9% at follow-up. Participants showed sizeable reductions in comorbid diagnoses, significant improvements in global functioning, social anxiety symptoms, and internalising symptoms from pre- to post-treatment (maintained at follow-up), and significant improvements in social skills and social competence from pre-treatment to follow-up. This study supports the use of an intensive CBT program for adolescents with SAD.
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Affiliation(s)
- Dustin M O'Shannessy
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia.
| | - Allison M Waters
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia
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Jain N, Stech E, Grierson AB, Sharrock MJ, Li I, Mahoney AEJ, Newby JM. A pilot study of intensive 7-day internet-based cognitive behavioral therapy for social anxiety disorder. J Anxiety Disord 2021; 84:102473. [PMID: 34534800 DOI: 10.1016/j.janxdis.2021.102473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/17/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Accessible, affordable cognitive behavioral therapy (CBT) options for Social Anxiety Disorder (SAD) that allow for rapid symptom improvement are needed. The present study investigated the first intensive, 7-day internet-based CBT for SAD. An open pilot trial was conducted to test the acceptability, feasibility and preliminary outcomes of the program in a sample of 16 participants (9 females, M age = 40.34, SD = 10.55) with a DSM-5 diagnosis of SAD. Participants were enrolled into the 6-lesson online program, and completed the Social Phobia Scale [SPS], Social Interaction Anxiety Scale [SIAS], Patient Health Questionnaire-9 (PHQ-9), and Work and Social Adjustment Scale (WSAS) at baseline, post and one month follow-up. We found support for the feasibility and acceptability of the program; 15 participants (93.8%) completed the program, and all participants reported the program was satisfactory. Large, significant reductions in social anxiety severity on both the SPS and SIAS (Hedges' gs = 1.26-1.9) and functional impairment (WSAS; gs = 0.88-0.98) were found at post-treatment and follow-up. Medium, significant reductions in depressive symptom severity were also found (gs = 0.88-0.98 at post and follow-up, respectively). A third of participants scored below the clinical cut-off on both the SPS and SIAS at post-treatment and follow-up. A randomized controlled trial with longer follow-up is needed to evaluate the efficacy of this intensive internet-based treatment for SAD. Implications and future research directions are discussed.
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Affiliation(s)
- Natasha Jain
- School of Psychology, University of New South Wales Sydney, New South Wales 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Eileen Stech
- School of Psychology, University of New South Wales Sydney, New South Wales 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Ashlee B Grierson
- School of Psychiatry, University of New South Wales Sydney, New South Wales 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Maria J Sharrock
- School of Psychiatry, University of New South Wales Sydney, New South Wales 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Ian Li
- School of Psychiatry, University of New South Wales Sydney, New South Wales 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Alison E J Mahoney
- School of Psychiatry, University of New South Wales Sydney, New South Wales 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales Sydney, New South Wales 2052, Australia; Black Dog Institute, Randwick, New South Wales 2031, Australia.
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5
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Penney ES, Norton AR. A Novel Application of the Schema Therapy Mode Model for Social Anxiety Disorder: A Naturalistic Case Study. Clin Case Stud 2021. [DOI: 10.1177/15346501211027866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Social Anxiety Disorder (SAD) is a condition defined by an excessive and persistent fear of negative evaluation in social or performance situations. Whilst Cognitive Behaviour Therapy (CBT) is the gold standard treatment, not all individuals with SAD respond to CBT. The Schema Therapy Mode Model is frequently applied to chronic and hard-to-treat conditions and therefore may be applicable for SAD individuals who are non-responders to CBT. This case study describes how the Mode Model was successfully used to treat a woman in her 20s who presented with excessive fears of negative evaluation and pervasive social avoidance. Experiential techniques, such as chair dialogues and imagery rescripting, resulted in cognitive modification of negative core beliefs, reduced experiential discomfort and increased engagement in social and relational activities. This case offers a preliminary indication that the Schema Therapy Mode Model may be an effective treatment for socially anxious individuals and that further theoretical and empirical study in this area is warranted.
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Parker EL, Banfield M, Fassnacht DB, Hatfield T, Kyrios M. Contemporary treatment of anxiety in primary care: a systematic review and meta-analysis of outcomes in countries with universal healthcare. BMC FAMILY PRACTICE 2021; 22:92. [PMID: 33992082 PMCID: PMC8126070 DOI: 10.1186/s12875-021-01445-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/26/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent mental health conditions and are managed predominantly in primary care. We conducted a systematic review and meta-analysis of psychological and pharmacological treatments in countries with universal healthcare, and investigated the influence of treatment provider on the efficacy of psychological treatment. METHOD PubMed, Cochrane, PsycINFO, CINAHL, and Scopus were searched in April 2017 for controlled studies of evidence-based anxiety treatment in adults in primary care, published in English since 1997. Searches were repeated in April 2020. We synthesised results using a combination of meta-analysis and narrative methods. Meta-analysis was conducted using a random-effects multi-level model to account for intercorrelation between effects contributed different treatment arms of the same study. Moderator variables were explored using meta-regression analyses. RESULTS In total, 19 articles (from an initial 2,247) reporting 18 studies were included. Meta-analysis including ten studies (n = 1,308) found a pooled effect size of g = 1.16 (95%CI = 0.63 - 1.69) for psychological treatment compared to waitlist control, and no significant effect compared to care as usual (p = .225). Substantial heterogeneity was present (I2 = 81.25). Specialist treatment produced large effects compared to both waitlist control (g = 1.46, 95%CI = 0.96 - 1.96) and care as usual (g = 0.76, 95%CI = 0.27 - 1.25). Treatment provided by non-specialists was only superior to waitlist control (g = 0.80, 95%CI = 0.31 - 1.28). We identified relatively few studies (n = 4) of medications, which reported small to moderate effects for SSRI/SNRI medications and hydroxyzine. The quality of included studies was variable and most studies had at least "unclear" risk of bias in one or more key domains. CONCLUSIONS Psychological treatments for anxiety are effective in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (GP, nurse, trainee). However, non-specialists provide effective treatment compared with no care at all. Limited research into the efficacy of pharmacological treatments in primary care needs to be considered carefully by prescribers TRIAL REGISTRATION: PROSPERO registration number CRD42018050659.
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Affiliation(s)
- Erin L Parker
- Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia.
| | - Michelle Banfield
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Daniel B Fassnacht
- Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Timothy Hatfield
- Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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7
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Challacombe FL, Potts L, Carter B, Lawrence V, Husbands A, Howard LM. Optimising psychological treatment for Anxiety DisordErs in Pregnancy (ADEPT): study protocol for a feasibility trial of time-intensive CBT versus weekly CBT. Pilot Feasibility Stud 2021; 7:101. [PMID: 33931111 PMCID: PMC8085465 DOI: 10.1186/s40814-021-00838-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moderate to severe anxiety disorders such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social phobia and panic disorder are common, and affect approximately 11-16% of women in pregnancy. Psychological treatments for anxiety disorders, primarily cognitive behaviour therapy (CBT), have a substantial evidence base and recently time-intensive versions have been found as effective as weekly treatments. However, this has not been trialled in women who are pregnant, where a shorter intervention may be desirable. METHODS The ADEPT study is a feasibility randomised controlled trial with two parallel intervention groups. Time-intensive one-to-one CBT and standard weekly one-to-one CBT delivered during pregnancy will be compared. Feasibility outcomes including participation and follow-up rates will be assessed, alongside the acceptability of the interventions using qualitative methods. DISCUSSION The study will provide preliminary data to inform the design of a full-scale randomised controlled trial of a time-intensive intervention for anxiety during pregnancy. This will include information on the acceptability of time-intensive interventions for pregnant women with anxiety disorders. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN81203286 prospectively registered 27/6/2019.
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Affiliation(s)
- Fiona L Challacombe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Laura Potts
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Ben Carter
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Alaina Husbands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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8
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Jeong HS, Lee JH, Kim HE, Kim JJ. Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder. J Clin Med 2021; 10:jcm10050915. [PMID: 33652739 PMCID: PMC7956456 DOI: 10.3390/jcm10050915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 01/15/2023] Open
Abstract
Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.
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Affiliation(s)
- Hyu Seok Jeong
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jee Hyun Lee
- Department of Social Work and Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jae-Jin Kim
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence:
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9
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Ouyang X, Cai Y, Tu D. Psychometric Properties of the Short Forms of the Social Interaction Anxiety Scale and the Social Phobia Scale in a Chinese College Sample. Front Psychol 2020; 11:2214. [PMID: 33192750 PMCID: PMC7641606 DOI: 10.3389/fpsyg.2020.02214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
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10
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Fawcett E, Neary M, Ginsburg R, Cornish P. Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:430-437. [PMID: 30849287 DOI: 10.1080/07448481.2019.1577862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/28/2018] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants' randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.
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Affiliation(s)
- Emily Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | | | - Peter Cornish
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Thew GR. IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings. COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e4. [PMID: 34567240 PMCID: PMC8442601 DOI: 10.1017/s1754470x20000033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/21/2019] [Accepted: 01/30/2020] [Indexed: 02/05/2023]
Abstract
Compared with the traditional face-to-face format, therapist-guided internet interventions offer a different approach to supporting clients in learning skills to manage and overcome mental health difficulties. Such interventions are already in use within IAPT (Improving Access to Psychological Therapies) and other routine care settings, but given their potential to deliver treatment more efficiently and therefore increase availability and access to evidence-based interventions, their use is likely to increase significantly over the coming years. This article outlines what is meant by therapist-guided internet interventions and why an online format is thought to be advantageous for clients, therapists, services, and communities more broadly. It reviews the current evidence in the context of common therapist beliefs about internet-based treatment. It aims to identify gaps where further research is required, particularly in relation to the broader implementation of these treatments in IAPT and other routine clinical services. Specifically, it emphasises the importance of choosing the right programmes, providing adequate therapist training in their use, and considering practical and organisational issues, all of which are likely to determine the success of implementation efforts. KEY LEARNING AIMS To understand what therapist-guided internet interventions are and their potential advantages.To understand the current evidence base for these interventions.To learn where further research is needed with regard to both the interventions themselves, and to their broader implementation in IAPT.
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Affiliation(s)
- Graham R. Thew
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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12
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Benbow AA, Anderson PL. Long-Term Improvements in Probability and Cost Biases Following Brief Cognitive Behavioral Therapy for Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9947-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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Kuru E, Safak Y, Özdemir İ, Tulacı R, Özdel K, Özkula N, Örsel S. Cognitive distortions in patients with social anxiety disorder: Comparison of a clinical group and healthy controls. EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Reiss N, Warnecke I, Tolgou T, Krampen D, Luka-Krausgrill U, Rohrmann S. Effects of cognitive behavioral therapy with relaxation vs. imagery rescripting on test anxiety: A randomized controlled trial. J Affect Disord 2017; 208:483-489. [PMID: 27825724 DOI: 10.1016/j.jad.2016.10.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/20/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Test anxiety is a common condition in students, which may lead to impaired academic performance as well as to distress. The primary objective of this study was to evaluate the effectiveness of two cognitive-behavioral interventions designed to reduce test anxiety. Test anxiety in the participants was diagnosed as social or specific phobia according to DSM-IV. Subsequently subjects were randomized to three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or imagery rescripting were applied. METHODS Students suffering from test anxiety were recruited at two German universities (n=180). The randomized controlled design comprised three groups which received test anxiety treatment in weekly three-hour sessions over a period of five weeks. Treatment outcome was assessed with a test anxiety questionnaire, which was administered before and after treatment, as well as in a six-month follow-up. RESULTS A repeated-measures ANOVA for participants with complete data (n=59) revealed a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups (p<.001). LIMITATIONS Participants were included if they had a clinical diagnosis of test anxiety. The sample may therefore represent only more severe forms of text anxiety . Moreover, the sample size in this study was small, the numbers of participants per group differed, and treatment results were based on self-report. Due to the length of the treatment, an implementation of the group treatments used in this study might not be feasible in all settings. CONCLUSIONS Group treatments constitute an effective method of treating test anxiety, e.g. in university settings. Imagery rescripting may particularly contribute to treatment efficacy.
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Affiliation(s)
- Neele Reiss
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Irene Warnecke
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Student Counseling, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Theano Tolgou
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Dorothea Krampen
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Sonja Rohrmann
- Center for Student Counseling, Johannes Gutenberg University Mainz, Mainz, Germany
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15
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Mörtberg E, Reuterskiöld L, Tillfors M, Furmark T, Öst LG. Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population. Cogn Behav Ther 2016; 46:300-314. [PMID: 27894213 DOI: 10.1080/16506073.2016.1258723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.
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Affiliation(s)
- Ewa Mörtberg
- a Department of Psychology , Stockholm University , Stockholm SE-106 91 , Sweden.,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Lena Reuterskiöld
- a Department of Psychology , Stockholm University , Stockholm SE-106 91 , Sweden
| | - Maria Tillfors
- c Department of Law, Psychology and Social Work , Örebro University , Örebro , Sweden
| | - Tomas Furmark
- d Department of Psychology , Uppsala University , Uppsala , Sweden
| | - Lars-Göran Öst
- a Department of Psychology , Stockholm University , Stockholm SE-106 91 , Sweden.,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
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Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder: Results from a 4–6 Year Follow-Up. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9820-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reduction of depersonalization during social stress through cognitive therapy for social anxiety disorder: A randomized controlled trial. J Anxiety Disord 2016; 43:99-105. [PMID: 27648752 DOI: 10.1016/j.janxdis.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/30/2016] [Accepted: 09/13/2016] [Indexed: 11/23/2022]
Abstract
Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome. In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT (n=20) or a waitlist period (n=20) and were compared to healthy controls (n=21). Self-reported depersonalization was measured immediately after each stress test. Depersonalization significantly decreased following CT, especially in treatment responders (ηp2=0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety. Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy.
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Barkowski S, Schwartze D, Strauss B, Burlingame GM, Barth J, Rosendahl J. Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials. J Anxiety Disord 2016; 39:44-64. [PMID: 26953823 DOI: 10.1016/j.janxdis.2016.02.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 01/15/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g=0.84, 95% CI [0.72; 0.97] and general psychopathology: g=0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats.
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Affiliation(s)
- Sarah Barkowski
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystrasse 3, 07740 Jena, Germany
| | - Dominique Schwartze
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystrasse 3, 07740 Jena, Germany
| | - Bernhard Strauss
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystrasse 3, 07740 Jena, Germany
| | - Gary M Burlingame
- Brigham Young University, Department of Psychology, 238 TLRB, Provo, UT 84602, USA
| | - Jürgen Barth
- University Hospital Zurich and University of Zurich, Institute for Complementary and Integrative Medicine, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Jenny Rosendahl
- Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Stoystrasse 3, 07740 Jena, Germany.
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Mavranezouli I, Mayo-Wilson E, Dias S, Kew K, Clark DM, Ades AE, Pilling S. The Cost Effectiveness of Psychological and Pharmacological Interventions for Social Anxiety Disorder: A Model-Based Economic Analysis. PLoS One 2015; 10:e0140704. [PMID: 26506554 PMCID: PMC4624770 DOI: 10.1371/journal.pone.0140704] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
Background Social anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder. Methods A decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs) of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion. Results Individual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT), phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs. Conclusion Various forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately the long-term comparative benefits and harms of psychological and pharmacological interventions for social anxiety disorder and establish their relative cost effectiveness with greater certainty.
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Affiliation(s)
- Ifigeneia Mavranezouli
- National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
- * E-mail:
| | - Evan Mayo-Wilson
- National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Sofia Dias
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Kayleigh Kew
- National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - David M. Clark
- Department of Experimental Psychology, University of Oxford & Oxford Cognitive Health NIHR Clinical Research Facility, Oxford, United Kingdom
| | - A. E. Ades
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Stephen Pilling
- National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
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20
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Heimberg RG. Relative efficacy of psychological and pharmacological treatments for social anxiety disorder. EVIDENCE-BASED MENTAL HEALTH 2015; 18:63. [PMID: 25854826 PMCID: PMC11234972 DOI: 10.1136/eb-2014-102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/21/2015] [Accepted: 03/18/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Richard G Heimberg
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA;
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21
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De Castella K, Goldin P, Jazaieri H, Heimberg RG, Dweck CS, Gross JJ. Emotion Beliefs and Cognitive Behavioural Therapy for Social Anxiety Disorder. Cogn Behav Ther 2014; 44:128-41. [DOI: 10.1080/16506073.2014.974665] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Williams KC, Falkum E, Martinsen EW. A cognitive therapy program for hearing-impaired employees suffering from mental distress. Int J Audiol 2014; 54:227-33. [PMID: 25328031 PMCID: PMC4438347 DOI: 10.3109/14992027.2014.958621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To develop a cognitive therapy program to reduce mental distress among hearing-impaired employees. Design: In a pilot study we measured the development of mental distress and avoidant coping among hearing-impaired employees. Levels of mental distress were assessed using the hospital anxiety and depression scale (HAD), and the extent of avoidance with conversation tactics checklist CONV(AVOID). The findings were compared with the development in a treatment as usual (TAU) sample. Study sample: Fifteen participants with an equal distribution of male and female participants (M = 49.2 years) took part. The majority had mild to moderate hearing impairment. Results: The program appeared to be feasible and the adherence was good. The mean depression score was identical at pre- and post-intervention in the intervention group, and increased from 2.9 (SD 2.1) to 3.1 (SD 2.0) in the TAU group. Symptoms of anxiety (p < 0.01, 95 % CI (.82, 3.98)) and avoidant communication (p < 0.05, 95% CI (.5, 4.61)) decreased significantly in the intervention group, while an opposite pattern was observed during the TAU program. Conclusions: The program showed promising results. However, the preliminary results should be further investigated in a randomized controlled trial using a larger sample.
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Affiliation(s)
- Katharine Cecilia Williams
- Divison of Mental Health and Addiction, National Centre for Hearing Impairment and Mental Health, Oslo University Hospital , Oslo , Norway
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24
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Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 2014; 1:368-76. [PMID: 26361000 PMCID: PMC4287862 DOI: 10.1016/s2215-0366(14)70329-3] [Citation(s) in RCA: 343] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Social anxiety disorder-a chronic and naturally unremitting disease that causes substantial impairment-can be treated with pharmacological, psychological, and self-help interventions. We aimed to compare these interventions and to identify which are most effective for the acute treatment of social anxiety disorder in adults. METHODS We did a systematic review and network meta-analysis of interventions for adults with social anxiety disorder, identified from published and unpublished sources between 1988 and Sept 13, 2013. We analysed interventions by class and individually. Outcomes were validated measures of social anxiety, reported as standardised mean differences (SMDs) compared with a waitlist reference. This study is registered with PROSPERO, number CRD42012003146. FINDINGS We included 101 trials (13 164 participants) of 41 interventions or control conditions (17 classes) in the analyses. Classes of pharmacological interventions that had greater effects on outcomes compared with waitlist were monoamine oxidase inhibitors (SMD -1·01, 95% credible interval [CrI] -1·56 to -0·45), benzodiazepines (-0·96, -1·56 to -0·36), selective serotonin-reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs; -0·91, -1·23 to -0·60), and anticonvulsants (-0·81, -1·36 to -0·28). Compared with waitlist, efficacious classes of psychological interventions were individual cognitive-behavioural therapy (CBT; SMD -1·19, 95% CrI -1·56 to -0·81), group CBT (-0·92, -1·33 to -0·51), exposure and social skills (-0·86, -1·42 to -0·29), self-help with support (-0·86, -1·36 to -0·36), self-help without support (-0·75, -1·25 to -0·26), and psychodynamic psychotherapy (-0·62, -0·93 to -0·31). Individual CBT compared with psychological placebo (SMD -0·56, 95% CrI -1·00 to -0·11), and SSRIs and SNRIs compared with pill placebo (-0·44, -0·67 to -0·22) were the only classes of interventions that had greater effects on outcomes than appropriate placebo. Individual CBT also had a greater effect than psychodynamic psychotherapy (SMD -0·56, 95% CrI -1·03 to -0·11) and interpersonal psychotherapy, mindfulness, and supportive therapy (-0·82, -1·41 to -0·24). INTERPRETATION Individual CBT (which other studies have shown to have a lower risk of side-effects than pharmacotherapy) is associated with large effect sizes. Thus, it should be regarded as the best intervention for the initial treatment of social anxiety disorder. For individuals who decline psychological intervention, SSRIs show the most consistent evidence of benefit. FUNDING National Institute for Health and Care Excellence.
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25
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Hedman E, El Alaoui S, Lindefors N, Andersson E, Rück C, Ghaderi A, Kaldo V, Lekander M, Andersson G, Ljótsson B. Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-Year follow-up of a randomized trial. Behav Res Ther 2014; 59:20-9. [DOI: 10.1016/j.brat.2014.05.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/23/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022]
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Ginsburg GS, Becker EM, Keeton CP, Sakolsky D, Piacentini J, Albano AM, Compton SN, Iyengar S, Sullivan K, Caporino N, Peris T, Birmaher B, Rynn M, March J, Kendall PC. Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry 2014; 71:310-8. [PMID: 24477837 PMCID: PMC3969570 DOI: 10.1001/jamapsychiatry.2013.4186] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication. OBJECTIVE To determine whether acute clinical improvement and treatment type (i.e., cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up. DESIGN, SETTING, AND PARTICIPANTS This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0% of the original CAMS sample. EXPOSURES Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use. MAIN OUTCOMES AND MEASURES Remission, defined as the absence of all study entry anxiety disorders. RESULTS Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95% CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified. CONCLUSIONS AND RELEVANCE Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00052078.
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Affiliation(s)
- Golda S Ginsburg
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily M Becker
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Courtney P Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, New York
| | - Scott N Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - Satish Iyengar
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin Sullivan
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - Nicole Caporino
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Tara Peris
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Moira Rynn
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, New York
| | - John March
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
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27
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Hofmann SG, Wu JQ, Boettcher H. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. J Consult Clin Psychol 2014; 82:375-91. [PMID: 24447006 DOI: 10.1037/a0035491] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although cognitive-behavioral therapy (CBT) is effective for treating anxiety disorders, little is known about its effect on quality of life. To conduct a meta-analysis of CBT for anxiety disorders on quality of life, we searched for relevant studies in PubMed, PsycINFO, and the Cochrane Library and conducted manual searches. METHOD The search identified 44 studies that included 59 CBT trials, totaling 3,326 participants receiving CBT for anxiety disorders. We estimated the controlled and within-group random effects of the treatment changes on quality of life. RESULTS The pre-post within-group and controlled effect sizes were moderately strong (Hedges's g = 0.54 and Hedges's g = 0.56, respectively). Improvements were greater for physical and psychological domains of quality of life than for environmental and social domains. The overall effect sizes decreased with publication year and increased with treatment duration. Face-to-face treatments delivered individually and in groups produced significantly higher effect sizes than Internet-delivered treatments. CONCLUSION CBT for anxiety disorders is moderately effective for improving quality of life, especially in physical and psychological domains. Internet-delivered treatments are less effective than face-to-face treatments in improving quality of life.
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Affiliation(s)
| | - Jade Q Wu
- Department of Psychology, Boston University
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28
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Steinert C, Hofmann M, Leichsenring F, Kruse J. What do we know today about the prospective long-term course of social anxiety disorder? A systematic literature review. J Anxiety Disord 2013; 27:692-702. [PMID: 24176803 DOI: 10.1016/j.janxdis.2013.08.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/28/2013] [Accepted: 08/16/2013] [Indexed: 12/18/2022]
Abstract
While we know that social anxiety disorder (SAD) is today's most common anxiety disorder knowledge on its prospective long-term course is sparse. We conducted a systematic literature search using databases Medline and PsycINFO for naturalistic and psychotherapy outcome studies with follow-up durations of at least 24 months. Four naturalistic cohorts and nine psychotherapy trials were included in the review. The naturalistic course in clinical was less favorable than in non-clinical samples (27% vs. 40% recovery rate after 5 years). Psychotherapy trials, all applying (cognitive) behavioral methods, yielded stable outcomes with overall large pre- to follow-up effect sizes on self-report scales. Observer rated remission rates varied considerably (36% to 100%) depending on study design and follow-up length. The results of psychotherapy trials and that of naturalistic studies can hardly be compared due to differences in methodology. More standardized remission and recovery criteria are needed to enhance the understanding of the longitudinal course.
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Affiliation(s)
- Christiane Steinert
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany.
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30
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Yuen EK, Herbert JD, Forman EM, Goetter EM, Comer R, Bradley JC. Treatment of social anxiety disorder using online virtual environments in second life. Behav Ther 2013; 44:51-61. [PMID: 23312426 DOI: 10.1016/j.beth.2012.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/30/2022]
Abstract
Over 80% of people with social anxiety disorder (SAD) do not receive any type of treatment, despite the existence of effective evidence-based treatments. Barriers to treatment include lack of trained therapists (particularly in nonmetropolitan areas), logistical difficulties (e.g., cost, time, transportation), concerns regarding social stigma, and fear of negative evaluation from health care providers. Interventions conducted through electronic communication media, such as the Internet, have the potential to reach individuals who otherwise would not have access to evidence-based treatments. Second Life is an online virtual world that holds great promise in the widespread delivery of evidence-based treatments. We assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavior therapy in Second Life to treat adults with generalized SAD. Participants (n=14) received 12 sessions of weekly therapy and were assessed at pretreatment, midtreatment, posttreatment, and follow-up. Participants and therapists rated the treatment program as acceptable and feasible, despite frequently encountered technical difficulties. Analyses showed significant pretreatment to follow-up improvements in social anxiety symptoms, depression, disability, and quality of life, with effect sizes comparable to previously published results of studies delivering in-person cognitive behavior therapy for SAD. Implications and future directions are discussed.
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Affiliation(s)
- Erica K Yuen
- Medical University of South Carolina, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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