The effectiveness of guided internet-based cognitive behavioral therapy for social anxiety disorder in a routine care setting

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Abstract

Social anxiety disorder (SAD) is a common mental disorder with high persistence when untreated. As access to effective treatment is limited, guided internet-based cognitive behavioral therapy (ICBT) has been proposed as an effective alternative to face-to-face treatment. In this study, we examined the effectiveness of a 14-week therapist-guided ICBT program for patients with SAD undergoing routine care. From 2014 to 2017, 169 patients were included in the study, of which 145 started the treatment. The sample was all general practitioner-referred and had a lower educational level and higher rate of work absence compared to similar effectiveness studies. Regarding social anxiety symptoms, we identified significant within-group effect sizes (post-treatment: d = 1.00–1.10; six-month follow-up: d = 1.03–1.55). We also found significant effects on secondary depression symptoms ( d = 0.67). Clinically significant improvement was reported by 66.2% of the participants, and 16.6% had a significant deterioration. Clinical implications of the current study are that guided ICBT for SAD is an effective treatment for the majority of the patients undergoing routine care. Future studies should explore interventions targeting non-responders and deteriorated patients.

Highlights

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The effectiveness of guided ICBT for 169 patients with social anxiety disorder was studied in routine care.
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All patients were GP- referred and had a low educational level and high rate of work absence compared to other studies.
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Significant within-group effect sizes were identified at post treatment and follow-up for primary and secondary symptoms.
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Clinically significant improvement (66.2%) and deterioration (16.6%) are reported.
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Non-responding and deteriorated patients needs to be addressed in future studies.

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Most cited references 24

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Credibility of analogue therapy rationales

Thomas D Borkovec, Sidney D. Nau (1972)

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The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative

Dan J. Stein, Carmen C W Lim, Annelieke M Roest … (2017)

Background There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis. Methods Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates. Results SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries. Conclusions While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.

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Gender differences in social anxiety disorder: A review.

Idan M Aderka, Maya Asher, Anu Asnaani (2017)

Gender differences in social anxiety disorder (SAD) have not received much empirical attention despite the large body of research on the disorder, and in contrast to significant literature about gender differences in other disorders such as depression or posttraumatic stress disorder. To address this gap, we comprehensively reviewed the literature regarding gender differences in eight domains of SAD: prevalence, clinical presentation, functioning and impairment, comorbidity, course, treatment seeking, physiological arousal, and the oxytocin system. Findings from the present review indicate that women are more likely to have SAD and report greater clinical severity. Notwithstanding, men with the disorder may seek treatment to a greater extent. According to the present review, the course of SAD seems to be similar for men and women, and findings regarding gender differences in functional impairment and comorbidity are inconclusive. We highlight areas requiring future research and discuss the findings in the context of a number of theoretical perspectives. We believe that further research and integration of scientific findings with existing theories is essential in order to increase our understanding and awareness of gender differences in SAD, thus facilitating gender-sensitive and specifically-tailored interventions for both men and women with the disorder.

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Author and article information

Contributors

Tine Nordgreen

Journal

Journal ID (nlm-ta): Internet Interv

Journal ID (iso-abbrev): Internet Interv

Title: Internet Interventions

Publisher: Elsevier

ISSN (Electronic): 2214-7829

Publication date PMC-release: 31 May 2018

Publication date Collection: September 2018

Publication date (Electronic): 31 May 2018

Volume: 13

Pages: 24-29

Affiliations

[a ]eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway

[b ]Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway

[c ]Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway

[d ]Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway

[e ]Department of Behavioural Sciences and Learning, Linköping University, Sweden

[f ]Department of Clinical Neuroscience, Karolinska Institutet, Sweden

[g ]Department of Psychology, Stockholm University, Sweden

[h ]Department of Psychology, University of Southern Denmark, Denmark

Author notes

[* ]Corresponding author at: eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. tine.nordgreen@ 123456helse-bergen.no

Article

Publisher ID: S2214-7829(18)30020-4

DOI: 10.1016/j.invent.2018.05.003

PMC ID: 6112093

PubMed ID: 30206515

SO-VID: e70da8f9-727e-4056-ad8f-bca6101b38b7

License:

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

History

Date received : 23 March 2018

Date revision received : 28 May 2018

Date accepted : 29 May 2018

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The effectiveness of guided internet-based cognitive behavioral therapy for social anxiety disorder in a routine care setting

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Sex and gender-sensitive medicine

Most cited references 24

Credibility of analogue therapy rationales

The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative

Gender differences in social anxiety disorder: A review.

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