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

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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Combining escitalopram and cognitive–behavioural therapy for social anxiety disorder: Randomised controlled fMRI trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.115.175794 ◽

2016 ◽

Vol 209 (3) ◽

pp. 229-235 ◽

Cited By ~ 19

Author(s):

Malin Gingnell ◽

Andreas Frick ◽

Jonas Engman ◽

Iman Alaie ◽

Johannes Björkstrand ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Selective Serotonin Reuptake Inhibitors ◽

Behavioural Therapy ◽

Post Treatment ◽

Cognitive Behavioural ◽

Amygdala Reactivity

BackgroundSelective serotonin reuptake inhibitors (SSRIs) and cognitive–behavioural therapy (CBT) are often used concomitantly to treat social anxiety disorder (SAD), but few studies have examined the effect of this combination.AimsTo evaluate whether adding escitalopram to internet-delivered CBT (ICBT) improves clinical outcome and alters brain reactivity and connectivity in SAD.MethodDouble-blind, randomised, placebo-controlled neuroimaging trial of ICBT combined either with escitalopram (n = 24) or placebo (n = 24), including a 15-month clinical follow-up (trial registration: ISRCTN24929928).ResultsEscitalopram+ICBT, relative to placebo+ICBT, resulted in significantly more clinical responders, larger reductions in anticipatory speech state anxiety at post-treatment and larger reductions in social anxiety symptom severity at 15-month follow-up and at a trend-level (P = 0.09) at post-treatment. Right amygdala reactivity to emotional faces also decreased more in the escitalopram+ICBT combination relative to placebo+ICBT, and in treatment responders relative to non-responders.ConclusionsAdding escitalopram improves the outcome of ICBT for SAD and decreased amygdala reactivity is important for anxiolytic treatment response.

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Accelerated Outpatient Individual Cognitive Behavioural Therapy for Social Anxiety Disorder: A Preliminary Pilot Study

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465818000267 ◽

2018 ◽

Vol 46 (6) ◽

pp. 690-705 ◽

Cited By ~ 2

Author(s):

Bethany M. Wootton ◽

Alexandra Hunn ◽

Annabelle Moody ◽

Bethany R. Lusk ◽

Valerie A. Ranson ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Group Treatment ◽

Preliminary Investigation ◽

Behavioural Therapy ◽

Post Treatment ◽

Cognitive Behavioural

Background: Social anxiety disorder (SAD) is a common and chronic mental health condition. Given the significant prevalence and impairment caused by SAD, it is important to investigate novel ways to improve the efficacy of cognitive behavioural therapy (CBT) for SAD. One approach may be to provide CBT in an accelerated fashion, which involves multiple sessions per week. Such accelerated treatments have been shown to be effective in other anxiety disorders, but in SAD this accelerated treatment has only been studied in a group treatment format. Aims: The aim of this study was to provide a preliminary investigation of the efficacy of individual accelerated CBT (aCBT) in the treatment of SAD. Method: The studied utilized an open trial design. Seventeen participants commenced the treatment, which consisted of 12 sessions delivered over 4 weeks. Results: The results indicated that participants obtained moderate to large effect sizes on measures of SAD at post-treatment (range d = 0.76–0.92) and 3-month follow-up (range d = 1.31–1.79). In addition, at post-treatment, 59% of participants no longer met criteria for SAD, and this number increased to 71% at 3-month follow-up. Conclusions: The results provide preliminary evidence to suggest that individual aCBT may be an important treatment option for individuals with SAD.

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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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Performance anxiety disorder: Developing a proposal for an inventory, according to the cognitive-behavioural therapy rationale

Psychological Thought ◽

10.5964/psyct.v10i2.232 ◽

2017 ◽

Vol 10 (2) ◽

pp. 236-246 ◽

Cited By ~ 1

Author(s):

George Varvatsoulias

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Performance Anxiety ◽

Behavioural Therapy ◽

External Shame ◽

Cognitive Behavioural ◽

The Future

This editorial aims at the presentation of a proposal regarding an inventory about performance anxiety disorder in a cognitive-behavioural therapy (CBT) framework. It provides some initial understanding as to that condition and how CBT could assist in the consideration of it counter to social anxiety disorder. At first, there is an introduction to performance anxiety in line to social anxiety/phobia and some questionnaires that have been developed which include performance anxiety as an element of social anxiety/phobia. Then, I am presenting the proposal, both in view to the rationale for that and the construction of an inventory with items drawn from elements that performance anxiety is related with, such as uneasiness about worry, self-focus issues of perfectionism and internal/external shame ideas. The statements in the inventory refer to hypothetical examples in life so inventory to be easily responded to, when administered to participants. This proposal closes with the conclusion that the questionnaire will be pilot-studied in the future by the author so the feasibility of it and/or possible changes to be considered when empirically studied.

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