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      Leveraging the social network for treatment of social anxiety: Pilot study of a youth-specific digital intervention with a focus on engagement of young men


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          The primary objective was to determine the acceptability, feasibility and safety of a novel digital intervention (Entourage) for young people with prominent social anxiety symptoms, with a particular focus on the engagement of young men. The secondary aim was to explore whether the intervention was associated with clinically significant improvements to clinical and social variables known to co-occur with social anxiety.


          A multidisciplinary team comprising of mental health clinicians, researchers, young adult fiction writers, a comic artist and young people with a lived experience of social anxiety developed the Entourage platform in collaboration. Entourage combines evidence-based therapeutic techniques for social anxiety with an engaging, social-media-based interface that allows users to build social connections, while also receiving expert clinical moderation and support from peer workers. Acceptability, feasibility and safety outcomes of Entourage were tested in a 12-week pilot study with 89 young people (48.3% male; age M = 19.8 years, SD = 3.3 years). Eligible participants were recruited via liaison with four headspace early-intervention centres in north-western Melbourne.


          56.8% of the sample reported social anxiety symptoms in the severe or very severe range at baseline. Results demonstrated the Entourage intervention was feasible, safe, and potentially acceptable, with 98.6% of participants reporting they would recommend Entourage to another young person experiencing social anxiety. Usage results were also comparable across male and non-male participants. Results showed that young people reliably and significantly improved on clinical and social variables. In particular, young males showed a clinically significant improvement on social anxiety symptoms ( d = 0.79, p < .001), depression ( d = 0.71, p < .001), belongingness ( d = 0.58, p = .001), increased feelings of social connectedness ( d = 0.46, p = .004) and decreased loneliness ( d =  0.46, p = .006). Non-male participants also experienced a significant increase in social connectedness ( d = 0.76, p < .001), alongside reduced social anxiety ( d = 0.78, p < .001) and experiential avoidance ( d = 0.81, p < .001).


          Entourage is a highly engaging and potentially effective intervention that represents a novel combination of features designed both to reduce social anxiety symptoms and improve social connection among young people. Entourage demonstrated some acceptability, feasibility and safety, with encouraging benefits to clinical and social variables. Entourage also showed favorable results for the engagement and support of young men with social anxiety symptoms.


          • Entourage is a novel digital intervention for social anxiety.

          • Clinical and peer moderators help to boost engagement with the intervention.

          • Entourage was trialled with 89 young people experiencing social anxiety.

          • Entourage was acceptable, feasible and safe, with clinical and social benefit.

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          Most cited references60

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          Construction and factorial validation of a short form of the Self-Compassion Scale.

          The objective of the present study was to construct and validate a short-form version of the Self-Compassion Scale (SCS). Two Dutch samples were used to construct and cross-validate the factorial structure of a 12-item Self-Compassion Scale-Short Form (SCS-SF). The SCS-SF was then validated in a third, English sample. The SCS-SF demonstrated adequate internal consistency (Cronbach's alpha ≥ 0.86 in all samples) and a near-perfect correlation with the long form SCS (r ≥ 0.97 all samples). Confirmatory factor analysis on the SCS-SF supported the same six-factor structure as found in the long form, as well as a single higher-order factor of self-compassion. The SCS-SF thus represents a reliable and valid alternative to the long-form SCS, especially when looking at overall self-compassion scores. Copyright © 2010 John Wiley & Sons, Ltd.
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            The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health

            In February 2020, Duan and Zhu (2020) stressed the need for a solid Chinese evidence-based mental health care system in times of public health emergencies such as the outbreak of the Coronavirus disease-2019 (COVID-19). That would enable treatment of people who suffer from mental health problems in relation to the epidemic. The WHO has meanwhile labelled the Coronavirus a pandemic, and it is now hitting Europe, the USA, and Australia hard as well. In an attempt to reduce the risk of infections, many mental health care providers in afflicted countries are currently closing their doors for patients who need ambulatory face-to-face therapy. They are simultaneously trying to replace some of these contacts with digital therapies. Most probably, European mental health care institutions have yet to experience the full impact of the coronavirus crisis. At the same time, the demand for mental health care among infected patients and their relatives is expected to rise (Blumenstyk, 2020). Levels of anxiety will increase, both through direct causes including fears of contamination, stress, grief, and depression triggered by exposure to the virus, and through influences from the consequences of the social and economic mayhem that is occurring on individual and societal levels. We expect that this “black swan” moment (Blumenstyk, 2020) - an unforeseen event that changes everything - will lead to a partly, though robust, shift in mental health care provision towards online prevention, treatment, and care in the near future. We also need to consider the role of psychological processes and fear that may cause further harm on top of the pandemic (Asmundson and Taylor, 2020). The obvious solution to continue mental health care within a pandemic is to provide mental health care at a ‘warm’ distance by video-conferencing psychotherapy and internet interventions. A systematic review showed that videoconferencing psychotherapy show promising results for anxiety and mood disorders (Berryhill et al., 2019), and the evidence-base for therapist-guided internet interventions is even stronger (Andersson, 2016). Yet, despite two decades of evidence-based e-mental health services, numerous barriers have stalled the overall implementation in routine care thus far (Vis et al., 2018; Tuerk et al., 2019). One of the most important barriers highlighted, however, has been that e-mental health has not been integrated as a normal part of routine care practice due to the lack of acceptance by health professionals themselves (Topooco et al., 2017). Myths on telehealth such as “the therapeutic alliance can only be established face-to-face” have dominated the field, in spite of research showing the opposite (Berger, 2017). In that sense, learning curves in the adoption of new e-mental health technologies by both patients and psychologists have progressed far more slowly than initially expected, thus tallying with the estimate that it takes on average16 years for a health care innovation to be implemented (Rogers et al., 2017). There are however exceptions in the world but progress is still slow. In the Netherlands and elsewhere, we are now witnessing a phenomenon whereby the outbreak of COVID-19 is hastening managers, ICT-staff, and clinicians to overcome all such barriers overnight, from a pragmatic standpoint seldom seen before. The virus seems a greater catalyst for the implementation of online therapy and e-health tools in routine practice than two decades of many brilliant, but failed, attempts in this domain (Mohr et al., 2018). After all, since predictions about COVID-19 are largely unclear as of yet, it is now time to create a longer-term solution to the problem of heterogeneous patient populations, such as those still active in the community and those that are house-bound or isolated in hospitals. Videoconferencing and internet interventions could therefore be very helpful in mental health care, as well as in physical care and can be easily upscaled to serve isolated regions and reach across borders. Thus, the “black swan virus” has already enabled wide-scale acceptance of videoconferencing by health professionals and patients alike – creating a win-win situation for both. We should stress that e-mental health applications hold value far beyond the provision of videoconferencing psychotherapy in the current situation of crisis. Countries hit by the Corona virus may also consider adopting a wider public e-mental health approach, which would focus additionally on prevention and on reaching people at risk for mental health disorders. In this respect, not only guided but also fully self-guided interventions, such as self-help apps or online therapeutic modules, could also be applied in settings and countries with scarce mental health resources (Christiani and Setiawan, 2018). We should also consider the need for treatment development (for the psychological problems caused by corona virus isolation), which is by far more rapid in the field of internet interventions than in traditional psychotherapy (Andersson et al., 2018). It is likely that the response to this emergency will be more than a temporary increase in online work (Blumenstyk, 2020). Once mental health care institutions have developed the capabilities of serving their patients via videoconferencing and other digital technologies, there is little reason for them to give these up, in view of the many advantages (Blumenstyk, 2020; Tuerk et al., 2019). This black swan should be a call for action by encouraging providers to move more rapidly towards blended care models (van der Vaart et al., 2014; Kooistra et al., 2019). Agility, flexibility, and resilience are essential skills for 21-st-century institutions, particularly when unforeseen disruptive viruses and devastating events driven by climate change are likely to be increasingly common (Blumenstyk, 2020). We urge practitioners to promptly start adopting e-mental health care applications, both as methods to continue their care to current patients in need and as interventions to cope with the imminent upsurge in mental health symptoms due to the coronavirus. Uncited reference Karyotaki et al., 2018
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              The role of masculinity in men's help-seeking for depression: A systematic review.

              Conformity to traditional masculine gender norms may deter men's help-seeking and/or impact the services men engage. Despite proliferating research, current evidence has not been evaluated systematically. This review summarises findings related to the role of masculinity on men's help-seeking for depression.

                Author and article information

                Internet Interv
                Internet Interv
                Internet Interventions
                08 May 2020
                April 2020
                08 May 2020
                : 20
                [a ]Orygen, Parkville, Victoria, Australia
                [b ]Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
                [c ]Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
                [d ]Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
                [e ]School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
                [f ]School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
                Author notes
                [* ]Corresponding author at: 35 Poplar Rd, Parkville, Victoria 3052, Australia. simon.rice@ 123456orygen.org.au

                These authors contributed equally to this work.

                S2214-7829(19)30120-4 100323
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                social anxiety,young people,digital intervention,peer support


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