Cognitive behavioural therapy augmented with virtual reality exposure for treatment of social anxiety: A randomised clinical trial

2019 ◽  
Author(s):  
Benjamin Arnfred ◽  
Peter Bang ◽  
Carsten Hjorthøj ◽  
Clas Winding ◽  
Kirsten Møller ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Virtual Reality ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Cognitive Behavioural Therapy ◽  
Social Anxiety Disorder ◽  
Behavioural Therapy ◽  
Secondary Outcome ◽  
Cognitive Behavioural ◽  
Virtual Reality Exposure

Abstract Background Social Anxiety Disorder (SAD) has high lifetime prevalence, early onset and long duration or chronicity. Cognitive Behavioural Therapy (CBT) has best evidence for treatment effect and planned exposure is considered one of the most effective elements of CBT in SAD. However, in vivo exposure can be difficult to access and control and is sometimes rejected by patients because they expect it to be too aversive. The use of virtual reality allows exposure to challenging situations in an immersive, but also protected, flexible and controlled environment. Methods The design is an investigator initiated randomized, assessor-blinded, parallel group and superiority designed clinical trial. 302 patients diagnosed with social anxiety disorder, will be included from two psychotherapeutic outpatient clinics at Mental Health Center Copenhagen. All patients will be offered a manual-based 14-week CBT group program, including eight sessions of exposure therapy. Patients will be randomised with concealed allocation sequence to CBT augmented with virtual reality exposure or CBT. Patients will be assessed at baseline, post treatment and at one-year follow-up by researchers blinded for treatment condition. The primary outcome will be social anxiety measured with Liebowitz Social Anxiety Scale. Secondary outcome measures will be depression, social functioning, and patient satisfaction. Exploratory outcomes will be substance and alcohol use, working alliance and quality of life. Discussion The SO REAL trial will be the hitherto largest trial investigating the use of virtual reality as augmentation of CBT and the results may guide future clinical treatments. Trials registration The project was registered at clinicaltrials.gov on 02/19/2019 as NCT03845101. Can be found online at: https://clinicaltrials.gov/ct2/show/NCT03845101

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

2017 ◽  
Vol 10 (2) ◽  
pp. 236-246 ◽  
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.

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

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.

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

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018345 ◽  
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.

scholarly journals Internet-based psychodynamic therapy vs cognitive behavioural therapy for social anxiety disorder: A preference study

2020 ◽  
Vol 20 ◽  
pp. 100316 ◽  
Author(s):  
Tomas Lindegaard ◽  
Thomas Hesslow ◽  
Maja Nilsson ◽  
Robert Johansson ◽  
Per Carlbring ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Cognitive Behavioural Therapy ◽  
Social Anxiety Disorder ◽  
Behavioural Therapy ◽  
Psychodynamic Therapy ◽  
Cognitive Behavioural ◽  
Preference Study

scholarly journals Virtual reality compared within vivoexposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial

2017 ◽  
Vol 210 (4) ◽  
pp. 276-283 ◽  
Author(s):  
Stéphane Bouchard ◽  
Stéphanie Dumoulin ◽  
Geneviève Robillard ◽  
Tanya Guitard ◽  
Évelyne Klinger ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Waiting List ◽  
Secondary Outcome

BackgroundPeople with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive–behavioural therapy (CBT), could be an answer.AimsTo show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposurein vivo.MethodParticipants were randomly assigned to either VR exposure (n= 17),in vivoexposure (n= 22) or waiting list (n= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069.)ResultsImprovements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment thanin vivoon the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists thanin vivoexposure.ConclusionsUsing VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.

scholarly journals A pilot study of intensive 7-day internet-based cognitive behavioural therapy for social anxiety disorder

2021 ◽  
pp. 102473
Author(s):  
Natasha Jain ◽  
Eileen Stech ◽  
Ashlee B. Grierson ◽  
Maria J. Sharrock ◽  
Ian Li ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Pilot Study ◽  
Social Anxiety ◽  
Cognitive Behavioural Therapy ◽  
Social Anxiety Disorder ◽  
Behavioural Therapy ◽  
Cognitive Behavioural

scholarly journals Treating co-morbid insomnia and social anxiety disorder with sequential CBT protocols: a single-case experimental study

2021 ◽  
pp. 1-17
Author(s):  
Daniel Wallsten ◽  
Annika Norell-Clarke ◽  
Sven Alfonsson ◽  
David Gryphon ◽  
Hanna Eriksson ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Single Case ◽  
Behavioural Therapy ◽  
Secondary Outcome ◽  
Treatment Protocols ◽  
Insomnia Disorder ◽  
Cognitive Behavioural ◽  
Sequential Treatments

Abstract Background: Although insomnia disorder and social anxiety disorder are among the most prevalent psychiatric disorders, no studies have yet evaluated the use of sequential evidence-based treatment protocols in the population with co-morbid social anxiety disorder and insomnia disorder. Aims: This study aimed to investigate the effects of sequential treatments on co-morbid insomnia disorder and social anxiety disorder. As depression is a common co-morbid syndrome for both insomnia and social anxiety, a secondary aim was to examine depressive symptoms. Method: A single-case repeated crossover AB design was used. Ten participants between 18 and 59 years of age with co-morbid DSM-5 diagnoses of insomnia disorder and social anxiety disorder received sequential treatments with cognitive behavioural therapy (CBT). Seven participants completed the treatment course. The primary outcomes were symptoms of insomnia and social anxiety, and the secondary outcome was symptoms of depression. Results: The effects of CBT on people with co-morbid social anxiety disorder and insomnia disorder were mixed. The majority of participants improved their sleep quality and lessened symptoms of social anxiety and depression. However, participants differed in their degree of improvement concerning all three disorders. Conclusions: Sequential CBT treatments are potentially effective at decreasing symptoms of social anxiety and insomnia for people with co-morbid social anxiety disorder and insomnia disorder. The variation in outcome across participants makes firm conclusions about the treatment efficacy difficult to draw.

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