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Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: A Development Pilot Series

  • Richard Stott (a1), Jennifer Wild (a2), Nick Grey (a3), Sheena Liness (a1), Emma Warnock-Parkes (a4), Siobhan Commins (a1), Jennifer Readings (a1), Georgina Bremner (a4), Elizabeth Woodward (a2), Anke Ehlers (a2) and David M. Clark (a2)...
Abstract

Background: Randomized controlled trials have established that individual cognitive therapy based on the Clark and Wells (1995) model is an effective treatment for social anxiety disorder that is superior to a range of alternative psychological and pharmacological interventions. Normally the treatment involves up to 14 weekly face-to-face therapy sessions. Aim: To develop an internet based version of the treatment that requires less therapist time. Method: An internet-delivered version of cognitive therapy (iCT) for social anxiety disorder is described. The internet-version implements all key features of the face-to-face treatment; including video feedback, attention training, behavioural experiments, and memory focused techniques. Therapist support is via a built-in secure messaging system and by brief telephone calls. A cohort of 11 patients meeting DSM-IV criteria for social anxiety disorder worked through the programme and were assessed at pretreatment and posttreatment. Results: No patients dropped out. Improvements in social anxiety and related process variables were within the range of those observed in randomized controlled trials of face-to-face CT. Nine patients (82%) were classified as treatment responders and seven (64%) achieved remission status. Therapist time per patient was only 20% of that in face-to-face CT. Conclusions: iCT shows promise as a way of reducing therapist time without compromising efficacy. Further evaluation of iCT is ongoing.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
Reprint requests to David M. Clark, Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford OX1 3UD, UK. E-mail: david.clark@psy.ox.ac.uk
References
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Alden L. E. and Taylor C. T. (2011). Relational treatment strategies increase social approach behaviors in patients with Generalized Social Anxiety Disorder. Journal of Anxiety Disorders, 25, 309318. doi: S0887-6185(10)00208-2 [pii] 10.1016/j.janxdis.2010.10.003
American Psychiatric Association (2004). Diagnostic and Statistical Manual of Mental Disorders (4th edn). Washington, DC: American Psychiatric Association.
Andersson G., Carlbring P. and Furmark T. (2012). Therapist experience and knowledge acquisition in internet-delivered CBT for social anxiety disorder: a randomized controlled trial. PLoS One, 7, e37411. doi: 10.1371/journal.pone.0037411
Andrews G., Davies M. and Titov N. (2011). Effectiveness randomized controlled trial of face to face versus internet cognitive behaviour therapy for social phobia. Australian and New Zealand Journal of Psychiatry, 45, 337340. doi: 10.3109/00048674.2010.538840
Baker S. L., Heinrichs N., Kim H.-J. and Hofmann S. G. (2002). The Liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis. Behaviour Research and Therapy, 40, 701715.
Bandelow B., Baldwin D. S., Dolberg O. T., Andersen H. F. and Stein D. J. (2006). What is the Threshold for Symptomatic Response and Remission for Major Depressive Disorder, Panic Disorder, Social Anxiety Disorder, and Generalized Anxiety Disorder? (Vol. 67). Memphis, TN, ETATS-UNIS: Physicians Postgraduate Press.
Berger T., Hohl E. and Caspar F. (2009). Internet-based treatment for social phobia: a randomized controlled trial. Journal of Clinical Psychology, 65, 10211035. doi: 10.1002/jclp.20603
Brown T. A., Di Nardo P. A. and Barlow D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV. Albany, NY: Graywind Publications.
Bruce S. E., Yonkers K. A., Otto M. W., Eisen J. L., Weisberg R. B., Pagano M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry, 162, 11791187.
Carlbring P., Gunnarsdottir M., Hedensjo L., Andersson G., Ekselius L. and Furmark T. (2007). Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry, 190, 123128.
Clark D. M. (2005). Three questionaires for measuring central constructs in the cognitive model of social phobia. Unpublished manuscript. Kings College London, UK.
Clark D. M., Ehlers A., Hackmann A., McManus F., Fennell M. J. V., Grey N., et al. (2006). Cognitive therapy and exposure plus applied relaxation in social phobia: a randomised controlled trial. Journal of Consulting and Clinical Psychology, 74, 568578.
Clark D. M., Ehlers A., McManus F., Hackmann A., Fennell M., Campbell H., et al. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 10581067.
Clark D. M. and Wells A. (1995). A cognitive model of social phobia. In Heimberg R., Liebowitz M., Hope D. A. and Schneier F. R. (Eds.), Social Phobia: diagnosis, assessment and treatment (pp. 6993). New York: Guilford Press.
Clark D. M., Wild J., Grey N., Stott R., Liness S., Deale A., et al. (2012). Doubling the clinical benefit of each hour of psychotherapy: a randomized controlled trial of self-study assisted cognitive therapy for social anxiety disorder. Manuscript submitted for publication.
Connor K. M., Davidson J. R. T., Churchill L. E., Sherwood A., Foa E. and Weisler R. H. (2000). Psychometric properties of the social phobia inventory (SPIN): new self-rating scale. British Journal of Psychiatry, 176, 379386.
Davidson J. R., Foa E. B., Huppert J. D., Keefe F. J., Franklin M. E., Compton J. S., et al. (2004). Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Archives of General Psychiatry, 61, 10051013.
Department of Health (2011). The IAPT Data Handbook: guidance on recording and monitoring outcomes to support local evidence-based practice. London: DoH. Available at www.iapt.nhs.uk
First B. M., Gibbon M., Spitzer R. L., Williams J. B. W. and Benjamin L. S. (1997). User's Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders: SCID II. Washington, DC: American Psychiatric Press.
First B. M., Spitzer R. L., Gibbon M. and Williams J. B. W. (1995). User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders: SCID-I clinician version. Washington DC: American Psychiatric Press.
Fresco D. M., Coles M. E., Heimberg R. G., Liebowitz M. R., Hami S., Stein M. B., et al. (2001). The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine, 31, 10251035.
Furmark T., Carlbring P., Hedman E., Sonnenstein A., Clevberger P., Bohman B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. The British Journal of Psychiatry, 195, 440447. doi: 10.1192/bjp.bp.108.060996
Hedman E., Furmark T., Carlbring P., Ljótsson B., Rück C., Lindefors N., et al. (2011). A 5-year follow-up of internet-based cognitive behavior therapy for social anxiety disorder. Journal of Medical Internet Research, 13, e39. doi: v13i2e39 [pii] 10.2196/jmir.1776
Heimberg R. G., Dodge C. S., Hope D. A., Kennedy C. R., Zollo L. J., and Becker R. E. (1990). Cognitive behavioural group treatment for social phobia: comparison with a credible placebo control. Cognitive Therapy and Research, 14, 123.
Heimberg R. G., Liebowitz M. R., Hope D. A., Schneier F. R., Holt C. S., Welkowitz L. A., et al. (1998). Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Archives of General Psychiatry, 55, 11331141.
Hofmann S. G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology, 72, 393399.
Hope D. A., Heimberg R. G. and Bruch M. A. (1995). Dismantling cognitive-behavioural group therapy for social phobia. Behaviour Research and Therapy, 33, 637650.
Jacobson N. S. and Truax P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Kessler R. C., Berglund P., Demler O., Jin R., Merikangas K. R. and Walters E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593602.
Kroenke K., Spitzer R. L. and Williams J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606613. doi: 10.1046/j.1525-1497.2001.016009606.x
Ledley D. R., Heimberg R. G., Hope D. A., Hayes S. A., Zaider T. I., Dyke M. V., et al. (2009). Efficacy of a manualized and workbook-driven individual treatment for social anxiety disorder. Behavior Therapy, 40, 414424. doi: 10.1016/j.beth.2008.12.001
Leichsenring F. (2012). The Social Phobia Psychotherapy Research Network (SOPHONET): structure and preliminary results. Paper presented at the “Milestones in Research and Practice” Psychotherapy Congress, Medical University of Hanover, Germany. April.
Liebowitz M. R. (1987). Social phobia. Modern Problems in Pharmacopsychiatry, 22, 141173.
McManus F., Clark D. M., Grey N., Wild J., Hirsch C., Fennell M., et al. (2009). A demonstration of the efficacy of two of the components of cognitive therapy for social phobia. Journal of Anxiety Disorders, 23, 496503.
Mortberg E., Clark D. M., Sundin O. and Wistedt A. A. (2007). Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: a randomized controlled trial. Acta Psychiatrica Scandinavica, 115, 142154. doi: Doi 10.1111/J.1600-0447.2006.00839.X
Palmqvist B., Carlbring P. and Andersson G. (2007). Internet-delivered treatments with or without therapist input. Expert Review of Pharmacoeconomics Outcomes Research, 7, 291297. doi: 10.1586/14737167.7.3.291
Pilling S., Mayo-Wilson E., Mavranezouli I., Kew K., Taylor C. and Clark D. M. (in press). Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance. British Medical Journal.
Rapee R. M. and Heimberg R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741756.
Rapee R. M., Abbott M. J., Baillie A. J. and Gaston J. E. (2007). Treatment of social phobia through pure self-help and therapist augmented self-help. British Journal of Psychiatry, 191, 246252. doi: 10.1192/bjp.bp.106.028167
Rapee R. M., Gaston J. E. and Abbott M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317327.
Spitzer R. l., Kroenke K., Williams J. W. and Löwe B. (2006). A brief measure for assessing generalized anxiety disorder: the gad-7. Archives of Internal Medicine, 166, 10921097. doi: 10.1001/archinte.166.10.1092
Stangier U., Heidenreich T., Peitz M., Lauterbach W. and Clark D. M. (2003). Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy, 41, 9911007.
Stangier U., Schramm E., Heidenreich T., Berger M. and Clark D. M. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Archives of General Psychiatry, 68, 692700. doi: 10.1001/archgenpsychiatry.2011.67
Titov N., Andrews G., Choi I., Schwencke G. and Mahoney A. (2008). Shyness 3: randomized controlled trial of guided versus unguided Internet-based CBT for social phobia. Australian and New Zealand Journal of Psychiatry, 42, 10301040. doi: 905606265 [pii] 10.1080/00048670802512107
Titov N., Andrews G. and Schwencke G. (2008). Shyness 2: treating social phobia online: replication and extension. Australian and New Zealand Journal of Psychiatry, 42, 595605. doi: 794820392 [pii] 10.1080/00048670802119820
Titov N., Andrews G., Schwencke G., Drobny J. and Einstein D. (2008). Shyness 1: distance treatment of social phobia over the Internet. Australian and New Zealand Journal of Psychiatry, 42, 585594. doi: 794820327 [pii] 10.1080/00048670802119762
Titov N., Andrews G., Johnston L., Robinson E. and Spence J. (2010). Transdiagnostic Internet treatment for anxiety disorders: a randomized controlled trial. Behaviour Research and Therapy, 48, 890899. doi: S0005-7967(10)00110-5 [pii] 10.1016/j.brat.2010.05.014
Weidman A. C., Fernandez K. C., Levinson C. A., Augustine A. A., Larsen R. J. and Rodebaugh T. L. (2012). Compensatory internet use among individuals higher in social anxiety and its implications for well-being. Personality and Individual Differences, 53, 191195. doi: 10.1016/j.paid.2012.03.003
Wild J. and Clark D. M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioral Practice, 18, 433443. doi: 10.1016/j.cbpra.2011.03.002
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Behavioural and Cognitive Psychotherapy
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