Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-16T23:18:41.982Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of treatment outcomes and adherence in internet-based cognitive behavioral therapy for social anxiety in China

Published online by Cambridge University Press:  13 January 2020

Huijing Chen ,
Marcus A. Rodriguez ,
Mingyi Qian ,
Tomoko Kishimoto Open the ORCID record for Tomoko Kishimoto [Opens in a new window] ,
Muyu Lin  and
Thomas Berger
Huijing Chen
Affiliation:
School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing100871, People’s Republic of China
Marcus A. Rodriguez
Affiliation:
Boston Child Study Center, Los Angeles and Pitzer College, Claremont, CA91711, USA
Mingyi Qian*
Affiliation:
School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing100871, People’s Republic of China
Tomoko Kishimoto
Affiliation:
School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing100871, People’s Republic of China
Muyu Lin
Affiliation:
School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing100871, People’s Republic of China
Thomas Berger
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern3012, Switzerland
*
*Corresponding author. Email: qmy@pku.edu.cn
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes.

Aims:

The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes.

Method:

Participants were assigned to either therapist-guided (N = 183) or self-guided ICBT (N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined.

Results:

No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants (B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, p = .01) and participants who identified as female (B = –0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms.

Conclusions:

Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.

Keywords

adherencecognitive behavioural therapydrop-outinternetsocial anxietytherapist support
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 3 , May 2020 , pp. 291 - 303
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

‡

Present address: Zhou Enlai School of Government, Nankai University, Tianjin 300350, People’s Republic of China.

§

Present address: Berlin School of Mind and Brain, Humboldt Universität zu Berlin, 10117 Berlin, Germany.

References

Ajzen, I. (1985). From intentions to actions: a theory of planned behavior. In Kuhl, J. and Beckman, J. (eds), Action-Control: From Cognition to Behavior (pp. 11–39). Heidelberg, Germany: Springer.CrossRefGoogle Scholar
Ajzen, I., & Fishbein, M. (1980). Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ, USA: Prentice Hall.Google Scholar
Al-Asadi, A. M., Klein, B., & Meyer, D. (2014). Pretreatment attrition and formal withdrawal during treatment and their predictors: an exploratory study of the anxiety online data. Journal of Medical Internet Research, 16, e152. doi: 10.2196/jmir.2989CrossRefGoogle ScholarPubMed
Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175–180. doi: 10.1016/j.brat.2009.01.010CrossRefGoogle ScholarPubMed
Apolinario-Hagen, J. (2019). Internet-delivered psychological treatment options for panic disorder: a review on their efficacy and acceptability. Psychiatry Investigation, 16, 37–49. doi: 10.30773/pi.2018.06.26CrossRefGoogle ScholarPubMed
Arjadi, R., Nauta, M. H., Chowdhary, N., & Bockting, C. L. H. (2015). A systematic review of online interventions for mental health in low and middle income countries: a neglected field. Global Mental Health, 2, e12. doi: 10.1017/gmh.2015.10CrossRefGoogle ScholarPubMed
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17, 327–335.Google ScholarPubMed
Bandura, A. (1986). Social Foundations of Thought and Action. Englewood Cliffs, NJ, USA: Prentice-Hall.Google Scholar
Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York, NY, USA: W.H. Freeman/Times Books/Henry Holt & Co.Google Scholar
Batterham, P. J., Neil, A. L., Bennett, K., Griffiths, K. M., & Christensen, H. (2008). Predictors of adherence among community users of a cognitive behavior therapy website. Patient Preference and Adherence, 2, 97–105.Google ScholarPubMed
Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014). The impact of guidance on Internet-based mental health interventions – a systematic review. Internet Interventions, 1, 205–215. doi: 10.1016/j.invent.2014.08.003CrossRefGoogle Scholar
Beatty, L., & Binnion, C. (2016). A systematic review of predictors of, and reasons for, adherence to online psychological interventions. International Journal of Behavioral Medicine, 23, 776–794. doi: 10.1007/s12529-016-9556-9CrossRefGoogle ScholarPubMed
Berger, T., Caspar, F., Richardson, R., Kneubuhler, B., Sutter, D., & Andersson, G. (2011). Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, 49, 158–169. doi: 10.1016/j.brat.2010.12.007CrossRefGoogle ScholarPubMed
Boettcher, J., Carlbring, P., Renneberg, B., & Berger, T. (2013). Internet-based interventions for social anxiety disorder – an overview. Verhaltenstherapie, 23, 160–168. doi: 10.1159/000354747CrossRefGoogle Scholar
Carpenter, J. K., Curtiss, J., & Hofmann, S. G. (2017). The nature and treatment of social anxiety. In McKay, D., Abramowitz, J. S. & Storch, E. A. (eds), Treatments for Psychological Problems and Syndromes. John Wiley & Sons Ltd.Google Scholar
Christensen, H., Griffiths, K. M., & Farrer, L. (2009). Adherence in internet interventions for anxiety and depression. Journal of Medical Internet Research, 11, e13. doi: 10.2196/jmir.1194CrossRefGoogle ScholarPubMed
de Graaf, L. E., Hollon, S. D., & Huibers, M. J. (2010). Predicting outcome in computerized cognitive behavioral therapy for depression in primary care: a randomized trial. Journal of Consulting and Clinical Psychology, 78, 184–189. doi: 10.1037/a0018324CrossRefGoogle ScholarPubMed
de Graaf, L. E., Huibers, M. J., Riper, H., Gerhards, S. A., & Arntz, A. (2009). Use and acceptability of unsupported online computerized cognitive behavioral therapy for depression and associations with clinical outcome. Journal of Affective Disorders, 116, 227–231. doi: 10.1016/j.jad.2008.12.009CrossRefGoogle ScholarPubMed
Dear, B. F., Staples, L. G., Terides, M. D., Fogliati, V. J., Sheehan, J., Johnston, L., … & Titov, N. (2016). Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for social anxiety disorder and comorbid disorders: a randomized controlled trial. Journal of Anxiety Disorders, 42, 30–44. doi: 10.1016/j.janxdis.2016.05.004CrossRefGoogle ScholarPubMed
Donkin, L., & Glozier, N. (2012). Motivators and motivations to persist with online psychological interventions: a qualitative study of treatment completers. Journal of Medical Internet Research, 14, e91. doi: 10.2196/jmir.2100CrossRefGoogle ScholarPubMed
El Alaoui, S., Ljotsson, B., Hedman, E., Kaldo, V., Andersson, E., Ruck, C., … & Lindefors, N. (2015). Predictors of symptomatic change and adherence in internet-based cognitive behaviour therapy for social anxiety disorder in routine psychiatric care. Plos One, 10, e0124258. doi: 10.1371/journal.pone.0124258CrossRefGoogle ScholarPubMed
Farrer, L. M., Griffiths, K. M., Christensen, H., Mackinnon, A. J., & Batterham, P. J. (2014). Predictors of adherence and outcome in internet-based cognitive behavior therapy delivered in a telephone counseling setting. Cognitive Therapy and Research, 38, 358–367. doi: 10.1007/s10608-013-9589-1CrossRefGoogle Scholar
Fernandez-Alvarez, J., Diaz-Garcia, A., Gonzalez-Robles, A., Banos, R., Garcia-Palacios, A., & Botella, C. (2017). Dropping out of a transdiagnostic online intervention: a qualitative analysis of client’s experiences. Internet Interventions, 10, 29–38. doi: 10.1016/j.invent.2017.09.001CrossRefGoogle ScholarPubMed
Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., … & Andersson, G. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. British Journal of Psychiatry, 195, 440–447. doi: 10.1192/bjp.bp.108.060996CrossRefGoogle ScholarPubMed
Guo, X., Meng, Z., Huang, G., Fan, J., Zhou, W., Ling, W., … & Su, L. (2016). Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015. Scientific Reports, 6, 28033. doi: 10.1038/srep28033CrossRefGoogle ScholarPubMed
Hedman, E., Andersson, E., Ljotsson, B., Andersson, G., Andersson, E., Schalling, M., … & Ruck, C. (2012). Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder. Acta Psychiatrica Scandinavica, 126, 126–136. doi: 10.1111/j.1600-0447.2012.01834.xCrossRefGoogle ScholarPubMed
Hedman, E., Botella, C., & Berger, T. (2016). Internet-based cognitive behavior therapy for social anxiety disorder. In Lindefors, N. and Andersson, G. (eds), Guided Internet-Based Treatments in Psychiatry (pp. 53–78). Switzerland: Springer International Publishing.CrossRefGoogle Scholar
Hilvert-Bruce, Z., Rossouw, P. J., Wong, N., Sunderland, M., & Andrews, G. (2012). Adherence as a determinant of effectiveness of internet cognitive behavioural therapy for anxiety and depressive disorders. Behaviour Research and Therapy, 50, 463–468. doi: 10.1016/j.brat.2012.04.001CrossRefGoogle ScholarPubMed
Kelders, S. M., Kok, R. N., Ossebaard, H. C., & Van Gemert-Pijnen, J. E. (2012). Persuasive system design does matter: a systematic review of adherence to web-based interventions. Journal of Medical Internet Research, 14, e152. doi: 10.2196/jmir.2104CrossRefGoogle ScholarPubMed
Kishimoto, T., Krieger, T., Berger, T., Qian, M., Chen, H., & Yang, Y. (2016). Internet-based cognitive behavioral therapy for social anxiety with and without guidance compared to a wait list in China: a propensity score study. Psychotherapy and Psychosomatics, 85, 317–319. doi: 10.1159/000446584CrossRefGoogle ScholarPubMed
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82, 858–866. doi: /S0042-96862004001100011Google ScholarPubMed
Maddux, J. E., & Rogers, R. W. (1983). Protection motivation and self-efficacy – a revised theory of fear appeals and attitude-change. Journal of Experimental Social Psychology, 19, 469–479. doi: 10.1016/0022-1031(83)90023-9CrossRefGoogle Scholar
March, S., Day, J., Ritchie, G., Rowe, A., Gough, J., Hall, T., … & Ireland, M. (2018). Attitudes toward e-mental health services in a community sample of adults: online survey. Journal of Medical Internet Research, 20, e59. doi: 10.2196/jmir.9109CrossRefGoogle Scholar
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470. doi: 10.1016/s0005-7967(97)10031-6CrossRefGoogle ScholarPubMed
Newby, J. M., Mewton, L., Williams, A. D., & Andrews, G. (2014). Effectiveness of transdiagnostic internet cognitive behavioural treatment for mixed anxiety and depression in primary care. Journal of Affective Disorders, 165, 45–52. doi: 10.1016/j.jad.2014.04.037CrossRefGoogle ScholarPubMed
Newman, M. G., Erickson, T., Przeworski, A., & Dzus, E. (2003). Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? Journal of Clinical Psychology, 59, 251–274. doi: 10.1002/jclp.10128CrossRefGoogle Scholar
Nordgreen, T., Havik, O. E., Ost, L. G., Furmark, T., Carlbring, P., & Andersson, G. (2012). Outcome predictors in guided and unguided self-help for social anxiety disorder. Behaviour Research and Therapy, 50, 13–21. doi: 10.1016/j.brat.2011.10.009CrossRefGoogle ScholarPubMed
Qian, M., Chen, R., Zhang, L., & Zhang, Z. (2010). A prediction for requirement of counselors/psychotherapists in China. Chinese Mental Health Journal, 24, 942–947. doi: 10.3969/j.issn.1000-6729.2010.12.013Google Scholar
Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Review, 32, 329–342. doi: 10.1016/j.cpr.2012.02.004CrossRefGoogle ScholarPubMed
Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems? The Medical Journal of Australia, 187 (7 suppl), S35–39. doi: 10.5694/j.1326-5377.2007.tb01334.xCrossRefGoogle Scholar
Ritterband, L. M., Thorndike, F. P., Cox, D. J., Kovatchev, B. P., & Gonder-Frederick, L. A. (2009). A behavior change model for internet interventions. Annals of Behavioral Medicine, 38, 18–27. doi: 10.1007/s12160-009-9133-4CrossRefGoogle ScholarPubMed
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social-learning theory and the health belief model. Health Education Quarterly, 15, 175–183. doi: 10.1177/109019818801500203CrossRefGoogle ScholarPubMed
Schulz, A., Stolz, T., Vincent, A., Krieger, T., Andersson, G., & Berger, T. (2016). A sorrow shared is a sorrow halved? A three-arm randomized controlled trial comparing internet-based clinician-guided individual versus group treatment for social anxiety disorder. Behaviour Research and Therapy, 84, 14–26. doi: 10.1016/j.brat.2016.07.001CrossRefGoogle ScholarPubMed
Shen, Y. C., Zhang, M. Y., Huang, Y. Q., He, Y. L., Liu, Z. R., Cheng, H., … & Kessler, R. C. (2006). Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychological Medicine, 36, 257–267. doi: 10.1017/S0033291705006367CrossRefGoogle ScholarPubMed
Si, T., Shu, L., Dang, W., Su, Y., Chen, J., Dong, W., … & Zhang, W. (2009). Evaluation of the reliability and validity of Chinese version of the MINI-International Neuropsychiatric Interview in patients with mental disorders. Chinese Mental Health Journal, 23, 493–497 + 503. doi: 10.3969/j.issn.1000-6729.2009.07.011Google Scholar
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37, 319–328. doi: 10.1017/S0033291706008944CrossRefGoogle ScholarPubMed
Spek, V., Nyklicek, I., Cuijpers, P., & Pop, V. (2008). Predictors of outcome of group and internet-based cognitive behavior therapy. Journal of Affective Disorders, 105, 137–145. doi: 10.1016/j.jad.2007.05.001CrossRefGoogle ScholarPubMed
Steketee, G., & Chambless, D. L. (1992). Methodological issues in prediction of treatment outcome. Clinical Psychology Review, 12, 387–400. doi: 10.1016/0272-7358(92)90123-PCrossRefGoogle Scholar
Titov, N., Andrews, G., Schwencke, G., Robinson, E., Peters, L., & Spence, J. (2010). Randomized controlled trial of internet cognitive behavioural treatment for social phobia with and without motivational enhancement strategies. Australian and New Zealand Journal of Psychiatry, 44, 938–945. doi: 10.3109/00048674.2010.493859CrossRefGoogle ScholarPubMed
van Straten, A., Cuijpers, P., & Smits, N. (2008). Effectiveness of a web-based self-help intervention for symptoms of depression, anxiety, and stress: randomized controlled trial. Journal of Medical Internet Research, 10, e7. doi: 10.2196/jmir.954CrossRefGoogle ScholarPubMed
Wilhelmsen, M., Lillevoll, K., Risor, M. B., Hoifodt, R., Johansen, M. L., Waterloo, K., … & Kolstrup, N. (2013). Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study. BMC Psychiatry, 13, 296. doi: 10.1186/1471-244X-13-296CrossRefGoogle ScholarPubMed
Williams, A. D., O’Moore, K., Mason, E., & Andrews, G. (2014). The effectiveness of internet cognitive behaviour therapy (iCBT) for social anxiety disorder across two routine practice pathways. Internet Interventions, 1, 225–229. doi: 10.1016/j.invent.2014.11.001CrossRefGoogle Scholar
Ye, D., Qian, M., Liu, X., & Chen, X. (2007). Revision of Social Interaction Anxiety Scale and Social Phobia Scale. Chinese Journal of Clinical Psychology, 15, 115–117. doi: 10.3969/j.issn.1005-3611.2007.02.002Google Scholar
Submit a response

Comments

No Comments have been published for this article.