Reductions in social anxiety during treatment predict lower levels of loneliness during follow-up among individuals with social anxiety disorder

BACKGROUND Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. OBJECTIVE The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. METHODS Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire–9 (PHQ-9), General Anxiety Disorder–7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. RESULTS Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was −4.1 (F1=4.45, P=.04), the change in PDSS was −4.4 (F1=6.83, P=.001), and the change in LSAS was −30.9 (F1=6.73, P=.01). The change in the PHQ-9 at 12 months was −2.7 (F1=7.72, P=.007), and the change in the GAD-7 was −3.0 (F1=7.09, P=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (P=.01). Total costs to provide the VCBT were ¥60,800 to ¥81,960 per patient. The set threshold was ¥189,500 ($1723, €1579, and £1354) calculated based on willingness to pay in Japan. CONCLUSIONS VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030495

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Targeting fear of positive evaluation in patients with social anxiety disorder via a brief cognitive behavioural therapy protocol: a proof-of-principle study

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465820000491 ◽

2020 ◽

Vol 48 (6) ◽

pp. 745-750

Author(s):

Justin W. Weeks ◽

M. Taylor Wilmer ◽

Carrie M. Potter ◽

Elizabeth M. Waldron ◽

Mark Versella ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Behavioural Therapy ◽

Cognitive Behavioural ◽

Proof Of Principle ◽

Fear Of Positive Evaluation ◽

Positive Evaluation

AbstractBackground:Our aim was to develop a brief cognitive behavioural therapy (CBT) protocol to augment treatment for social anxiety disorder (SAD). This protocol focused specifically upon fear of positive evaluation (FPE). To our knowledge, this is the first protocol that has been designed to systematically target FPE.Aims:To test the feasibility of a brief (two-session) CBT protocol for FPE and report proof-of-principle data in the form of effect sizes.Method:Seven patients with a principal diagnosis of SAD were recruited to participate. Following a pre-treatment assessment, patients were randomized to either (a) an immediate CBT condition (n = 3), or (b) a comparable wait-list (WL) period (2 weeks; n = 4). Two WL patients also completed the CBT protocol following the WL period (delayed CBT condition). Patients completed follow-up assessments 1 week after completing the protocol.Results:A total of five patients completed the brief, FPE-specific CBT protocol (two of the seven patients were wait-listed only and did not complete delayed CBT). All five patients completed the protocol and provided 1-week follow-up data. CBT patients demonstrated large reductions in FPE-related concerns as well as overall social anxiety symptoms, whereas WL patients demonstrated an increase in FPE-related concerns.Conclusions:Our brief FPE-specific CBT protocol is feasible to use and was associated with large FPE-specific and social anxiety symptom reductions. To our knowledge, this is the first treatment report that has focused on systematic treatment of FPE in patients with SAD. Our protocol warrants further controlled evaluation.

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Therapist-guided internet-delivered cognitive–behavioural therapy supplemented with group exposure sessions for adolescents with social anxiety disorder: a feasibility trial

BMJ Open ◽

10.1136/bmjopen-2017-018345 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018345 ◽

Cited By ~ 13

Author(s):

Martina Nordh ◽

Sarah Vigerland ◽

Lars-Göran Öst ◽

Brjánn Ljótsson ◽

David Mataix-Cols ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Behavioural Therapy ◽

Post Treatment ◽

Feasibility Trial ◽

Cognitive Behavioural ◽

Exposure Sessions

ObjectivesSocial anxiety disorder (SAD) is one of the most common psychiatric disorders in youth, with a prevalence of about 3%–4% and increased risk of adverse long-term outcomes, such as depression. Cognitive–behavioural therapy (CBT) is considered the first-line treatment for youth with SAD, but many adolescents remain untreated due to limited accessibility to CBT. The aim of this study was to develop and evaluate the feasibility and preliminary efficacy of a therapist-guided internet-delivered CBT treatment, supplemented with clinic-based group exposure sessions (BIP SOFT).DesignA proof-of-concept, open clinical trial with 6-month follow-up.ParticipantsThe trial was conducted at a child and adolescent psychiatric research clinic, and participants (n=30) were 13–17 years old (83% girls) with a principal diagnosis of SAD.Intervention12 weeks of intervention, consisting of nine remote therapist-guided internet-delivered CBT sessions and three group exposure sessions at the clinic for the adolescents and five internet-delivered sessions for the parents.ResultsAdolescents were generally satisfied with the treatment, and the completion rate of internet modules, as well as attendance at group sessions, was high. Post-treatment assessment showed a significant decrease in clinician-rated, adolescent-rated and parent-rated social anxiety (d=1.17, 0.85 and 0.79, respectively), as well as in general self-rated and parent-rated anxiety and depression (d=0.76 and 0.51), compared with pretreatment levels. Furthermore, 47% of participants no longer met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD at post-treatment. At a 6-month follow-up, symptom reductions were maintained, or further improved, and 57% of participants no longer met criteria for SAD.ConclusionTherapist-guided and parent-guided internet-delivered CBT, supplemented with a limited number of group exposure sessions, is a feasible and promising intervention for adolescents with SAD.Trial registration numberNCT02576171; Results.

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A 5-Year Follow-up of Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder

Journal of Medical Internet Research ◽

10.2196/jmir.1776 ◽

2011 ◽

Vol 13 (2) ◽

pp. e39 ◽

Cited By ~ 66

Author(s):

Erik Hedman ◽

Tomas Furmark ◽

Per Carlbring ◽

Brjánn Ljótsson ◽

Christian Rück ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Cognitive Behavior

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Long-Term Effectiveness of Cognitive Therapy for Refractory Social Anxiety Disorder: One-Year Follow-Up of a Randomized Controlled Trial

Psychotherapy and Psychosomatics ◽

10.1159/000500108 ◽

2019 ◽

Vol 88 (4) ◽

pp. 244-246 ◽

Cited By ~ 3

Author(s):

Naoki Yoshinaga ◽

Kazumi Kubota ◽

Kensuke Yoshimura ◽

Rieko Takanashi ◽

Yasushi Ishida ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Therapy ◽

Social Anxiety Disorder ◽

Controlled Trial ◽

Randomized Controlled ◽

One Year

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Attentional Heterogeneity in Social Anxiety Disorder: Evidence from Hidden Markov Models

10.31219/osf.io/8tf7g ◽

2021 ◽

Author(s):

Mikael Rubin ◽

Karl Muller ◽

Mary Hayhoe ◽

Michael Telch

Keyword(s):

Virtual Reality ◽

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Public Speaking ◽

Hidden Markov ◽

Attention Control ◽

Attentional Processes ◽

Pre Treatment

There is some evidence for heterogeneity in attentional processes among individuals with social anxiety. However, there is limited work considering how attentional processes may differ in a naturalistic task-based context (e.g., public speaking). In this secondary analysis we tested attentional heterogeneity among individuals (N = 21) with social anxiety disorder in the context of a virtual reality exposure treatment study. Participants completed a public speaking challenge in an immersive 360º-video virtual reality environment with eye tracking at pre-treatment, post-treatment, and at 1-week follow-up. Using a Hidden Markov Model (HMM) approach with clustering we tested whether there were distinct profiles of attention pre-treatment and whether there were changes following the intervention. As a secondary aim we tested whether the distinct attentional profiles at pre-treatment predicted differential treatment outcomes. We found two distinct attentional profiles pre-treatment that we characterized as vigilant/diffuse attention control and avoidant/high attention control. By the 1-week follow-up the two profiles were no longer meaningfully different. We found a difference between HMM groups for fear at public speaking at post-treatment b = -8.54, 95% Highest Density Interval (HDI) [-16.00, -0.90], Bayes Factor (BF) = 8.31 but not at one-week follow-up b = -5.83, 95% HDI [-13.25, 1.81], BF = 2.28. These findings provide support for heterogeneity in attentional processes among socially anxious individuals is likely, but that this may change following treatment. Moreover, our results provide evidence that attentional avoidance may be related to poorer treatment outcomes.

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Long-term follow-up of cognitive behavior therapy for social anxiety disorder

10.17918/etd-542 ◽

2021 ◽

Author(s):

Elizabeth Mintzer Nolan

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Cognitive Behavior ◽

Long Term Follow Up

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Do Social Threat Cognitions Decrease With School-Based CBT and Predict Treatment Outcome in Adolescents With Social Anxiety Disorder?

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.33.4.331 ◽

2019 ◽

Vol 33 (4) ◽

pp. 331-342

Author(s):

Julie L. Ryan ◽

Jeremy K. Fox ◽

Sarah R. Lowe ◽

Carrie Masia Warner

Keyword(s):

High School Students ◽

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Behavioral Treatment ◽

Negative Evaluation ◽

Social Threat ◽

Counseling Intervention ◽

School Based

Evidence suggests that Social Anxiety Disorder (SAD) is less responsive to cognitive behavioral treatment (CBT) compared to other anxiety disorders. Therefore, exploring what might facilitate clinical benefit is essential. Social threat cognitions, characterized by exaggerated perceptions of negative evaluation by others, may be one important avenue to examine. The current study investigated whether youths' social threat cognitions decreased with Skills for Academic and Social Success (SASS), a group, school-based CBT designed for SAD, and whether decreases predicted SAD severity and treatment response. Participants included 138 high school students with SAD randomly assigned to SASS, or a nonspecific school counseling intervention. SASS participants showed significantly decreased social threat cognitions at 5-month follow-up. Treatment responders had significantly greater reductions in social threat cognitions compared to nonresponders at post-intervention and follow-up. These findings suggest that social threat cognitions may be important to assess and monitor when treating youth with SAD.

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