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      Combining Attention Training with Internet-Based Cognitive-Behavioural Self-Help for Social Anxiety: A Randomised Controlled Trial

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          Abstract

          Guided Internet-based cognitive-behavioural self-help (ICBT) has been proven to be effective for social anxiety disorder (SAD) by several independent research groups. However, as the proportion of clinical significant change has room for improvement, new treatments should be developed and investigated. A novel treatment is attention bias modification (ABM). This study aimed at evaluating the combination of ABM and ICBT. We compared two groups, one group receiving ICBT and ABM targeting attentional avoidance and the other group receiving ICBT and control training. ABM and control training tasks were both based on the dot-probe paradigm. A total of 133 participants, diagnosed with SAD, were randomised to these two groups. The attention training group ( N = 66) received 2 weeks of daily attention training followed by 9 weeks of ICBT. The control group ( N = 67) received 2 weeks of daily control training, also followed by 9 weeks of ICBT. Social anxiety measures as well as the attention bias were assessed at pre-assessment, at week 2, and at post-treatment. Results showed no significant differences between the attention training group and the control group. Both groups improved substantially on social anxiety symptoms from pre- to post-assessment ( d within = 1.39–1.41), but showed no change in attention processes ( d within = 0.10–0.17). In this trial, the attention modification training failed to induce differential change in attention bias. Results demonstrate that the applied ABM procedure with its focus on the reduction of attentional avoidance was ineffective in the Internet-based setting. The results do not suggest that adding ABM targeting attentional avoidance to ICBT results in better outcomes than ICBT alone.

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          Most cited references77

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          Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication.

          An understudied crucial step in the help-seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder. To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey carried out between February 2001 and April 2003. A total of 9282 respondents aged 18 years and older. Lifetime DSM-IV disorders were assessed with the World Mental Health (WMH) Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured interview designed to be administered by trained lay interviewers. Information about age of first professional treatment contact for each lifetime DSM-IV/WMH-CIDI disorder assessed in the survey was collected and compared with age at onset of the disorder to study typical duration of delay. Cumulative lifetime probability curves show that the vast majority of people with lifetime disorders eventually make treatment contact, although more so for mood (88.1%-94.2%) disorders than for anxiety (27.3%-95.3%), impulse control (33.9%-51.8%), or substance (52.7%-76.9%) disorders. Delay among those who eventually make treatment contact ranges from 6 to 8 years for mood disorders and 9 to 23 years for anxiety disorders. Failure to make initial treatment contact and delay among those who eventually make treatment contact are both associated with early age of onset, being in an older cohort, and a number of socio-demographic characteristics (male, married, poorly educated, racial/ethnic minority). Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.
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            R: A language and environmental for statistical computing

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              Using the Internet to provide cognitive behaviour therapy.

              A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By delivering treatment components, mainly in the form of texts presented via web pages, and provide ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of treatment has grown rapidly over recent years with several controlled trials in the field of anxiety disorders, mood disorders and behavioural medicine. For some of the conditions for which Internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example in the treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efficacy trials. This article provides a brief summary of the evidence, comments on the role of the therapist and for which patient and therapist this is suitable. Areas of future research and exploration are identified.
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                Author and article information

                Journal
                Cogn Behav Ther
                Cogn Behav Ther
                sbeh
                Cognitive Behaviour Therapy
                Taylor & Francis
                1650-6073
                1651-2316
                30 July 2013
                January 2014
                : 43
                : 1
                : 34-48
                Affiliations
                [1 ] Department of Psychology, Stockholm University, Stockholm, Sweden
                [2 ] Department of Clinical Psychology, Freie Universitaet Berlin, Berlin, Germany
                [3 ] Department of Psychology, Umeå University, Umeå, Sweden
                [4 ] Department of Behavioural Sciences and Learning, Psychology, Linköping University, Linköping, Sweden
                [5 ] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
                Author notes
                Correspondence address: Johanna Boettcher, Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany. Tel: +49 (0) 30 838 56 569. Fax: +49 (0) 30 838 51 233. E-mail: johanna.boettcher@ 123456fu-berlin.de

                This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed and cited is permitted. The moral rights of the named author(s) have been asserted.

                Article
                10.1080/16506073.2013.809141
                3869050
                23898817
                8a8b15cc-ad62-489b-9ead-09e19fb7c03e
                © 2013 The Authors. Published by Routledge.

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 March 2013
                : 23 May 2013
                Categories
                Research Article

                Clinical Psychology & Psychiatry
                web,social anxiety disorder,cognitive bias modification,psychotherapy

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