Evaluating a Web-Based Social Anxiety Intervention Among University Students: Randomized Controlled Trial

Hugh Cameron McCall, Chris G Richardson, Fjola Dogg Helgadottir, Frances S Chen, Hugh Cameron McCall, Chris G Richardson, Fjola Dogg Helgadottir, Frances S Chen

Abstract

Background: Treatment rates for social anxiety, a prevalent and potentially debilitating condition, remain among the lowest of all major mental disorders today. Although computer-delivered interventions are well poised to surmount key barriers to the treatment of social anxiety, most are only marginally effective when delivered as stand-alone treatments. A new, Web-based cognitive behavioral therapy (CBT) intervention called Overcome Social Anxiety was recently created to address the limitations of prior computer-delivered interventions. Users of Overcome Social Anxiety are self-directed through various CBT modules incorporating cognitive restructuring and behavioral experiments. The intervention is personalized to each user's symptoms, and automatic email reminders and time limits are used to encourage adherence.

Objective: The purpose of this study was to conduct a randomized controlled trial to investigate the effectiveness of Overcome Social Anxiety in reducing social anxiety symptoms in a nonclinical sample of university students. As a secondary aim, we also investigated whether Overcome Social Anxiety would increase life satisfaction in this sample.

Methods: Following eligibility screening, participants were randomly assigned to a treatment condition or a wait-list control condition. Only those assigned to the treatment condition were given access to Overcome Social Anxiety; they were asked to complete the program within 4 months. The social interaction anxiety scale (SIAS), the fear of negative evaluation scale (FNE), and the quality of life enjoyment and satisfaction questionnaire-short form (Q-LES-Q-SF) were administered to participants from both conditions during baseline and 4-month follow-up lab visits.

Results: Over the course of the study, participants assigned to the treatment condition experienced a significant reduction in social anxiety (SIAS: P<.001, Cohen d=0.72; FNE: P<.001, Cohen d=0.82), whereas those assigned to the control condition did not (SIAS: P=.13, Cohen d=0.26; FNE: P=.40, Cohen d=0.14). Additionally, a direct comparison of the average change in social anxiety in the 2 conditions over the course of the study showed that those assigned to the treatment condition experienced significantly more improvement than those assigned to the control condition (SIAS: P=.03, Cohen d=0.56; FNE: P=.001, Cohen d=0.97). Although participants assigned to the treatment condition experienced a slight increase in life satisfaction, as measured by Q-LES-Q-SF scores, and those assigned to the control condition experienced a slight decrease, these changes were not statistically significant (treatment: P=.35, Cohen d=-0.18; control: P=.30, Cohen d=0.18).

Conclusions: Our findings indicate that Overcome Social Anxiety is an effective intervention for treating symptoms of social anxiety and that it may have further utility in serving as a model for the development of new interventions. Additionally, our findings provide evidence that contemporary Web-based interventions can be sophisticated enough to benefit users even when delivered as stand-alone treatments, suggesting that further opportunities likely exist for the development of other Web-based mental health interventions.

Trial registration: ClinicalTrials.gov NCT02792127; https://ichgcp.net/clinical-trials-registry/NCT02792127 (Archived by WebCite at http://www.webcitation.org/6xGSRh7MG).

Keywords: clinical trial; cognitive behavior therapy; internet; social anxiety.

Conflict of interest statement

Conflicts of Interest: The third author, FH, is a director of AI-Therapy, the company that created Overcome Social Anxiety. FH, as a registered psychologist, provided critical input for the design of the study. She neither provided funding for the study nor had access to the data. All other authors declare no conflicts of interest.

©Hugh Cameron McCall, Chris G Richardson, Fjola Dogg Helgadottir, Frances S Chen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.03.2018.

Figures

Figure 1
Figure 1
Flowchart of participation.
Figure 2
Figure 2
Mean social interaction anxiety scale (SIAS) scores at baseline and 4 months. Error bars represent 95% CIs.
Figure 3
Figure 3
Mean fear of negative evaluation scale (FNE) scores at baseline and 4 months. Error bars represent 95% CI.

References

    1. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen H-U. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012 Sep;21(3):169–84. doi: 10.1002/mpr.1359.
    1. Dell'Osso L, Rucci P, Ducci F, Ciapparelli A, Vivarelli L, Carlini M, Ramacciotti C, Cassano GB. Social anxiety spectrum. Eur Arch Psychiatry Clin Neurosci. 2003 Dec;253(6):286–91. doi: 10.1007/s00406-003-0442-5.
    1. Reich J, Goldenberg I, Vasile R, Goisman R, Keller M. A prospective follow-along study of the course of social phobia. Psychiatry Res. 1994 Dec;54(3):249–58.
    1. Antony MM, Federici A, Stein MB. Oxford Handbook of Anxiety and Related Disorders. New York, NY, US: Oxford University Press; 2009. Overview and introduction to anxiety disorders; pp. 3–15.
    1. Davidson JR, Hughes DL, George LK, Blazer DG. The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med. 1993 Aug;23(3):709–18.
    1. Schneier FR, Heckelman LR, Garfinkel R, Campeas R, Fallon BA, Gitow A, Street L, Del Bene D, Liebowitz MR. Functional impairment in social phobia. J Clin Psychiatry. 1994 Aug;55(8):322–31.
    1. Stein MB, Torgrud LJ, Walker JR. Social phobia symptoms, subtypes, and severity: findings from a community survey. Arch Gen Psychiatry. 2000 Nov;57(11):1046–52.
    1. Gould RA, Buckminster S, Pollack MH, Otto MW, Massachusetts LY. Cognitive behavioral and pharmacological treatment for social phobia: a meta-analysis. Clinical Psychology: Science and Practice. 1997;4(4):291–306. doi: 10.1111/j.1468-2850.1997.tb00123.x.
    1. Rodebaugh TL, Holaway RM, Heimberg RG. The treatment of social anxiety disorder. Clin Psychol Rev. 2004 Nov;24(7):883–908. doi: 10.1016/j.cpr.2004.07.007.
    1. Olfson M, Guardino M, Struening E, Schneier FR, Hellman F, Klein DF. Barriers to the treatment of social anxiety. Am J Psychiatry. 2000 Apr;157(4):521–7.
    1. Kaltenthaler E, Cavanagh K. Computerised cognitive behavioural therapy and its uses. Prog Neurol Psychiatry. 2010 Jun 09;14(3):22–9. doi: 10.1002/pnp.163.
    1. Davies EB, Morriss R, Glazebrook C. Computer-delivered and web-based interventions to improve depression, anxiety, and psychological well-being of university students: a systematic review and meta-analysis. J Med Internet Res. 2014;16(5):e130. doi: 10.2196/jmir.3142.
    1. Collins ME, Mowbray CT. Higher education and psychiatric disabilities: national survey of campus disability services. Am J Orthopsychiatry. 2005 Apr;75(2):304–15. doi: 10.1037/0002-9432.75.2.304.
    1. Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol. 2008 Aug;43(8):667–72. doi: 10.1007/s00127-008-0345-x.
    1. Helgadóttir FD, Menzies RG, Onslow M, Packman A, O'Brian S. Online CBT I: bridging the gap between Eliza and modern online CBT treatment packages. Behav Change. 2009 Dec 01;26(4):245–53. doi: 10.1375/bech.26.4.245.
    1. Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007 Mar;37(3):319–28. doi: 10.1017/S0033291706008944.
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012 Jun;32(4):329–42. doi: 10.1016/j.cpr.2012.02.004.
    1. Christensen H, Griffiths KM, Farrer L. Adherence in internet interventions for anxiety and depression. J Med Internet Res. 2009;11(2):e13. doi: 10.2196/jmir.1194.
    1. Craske MG, Roy-Byrne P, Stein MB, Sullivan G, Hazlett-Stevens H, Bystritsky A, Sherbourne C. CBT intensity and outcome for panic disorder in a primary care setting. Behav Ther. 2006 Jun;37(2):112–9. doi: 10.1016/j.beth.2005.05.003.
    1. Helgadóttir FD, Menzies RG, Onslow M, Packman A, O'Brian S. Online CBT II: a phase I trial of a standalone, online CBT treatment program for social anxiety in stuttering. Behav Change. 2009;26(4):254–70. doi: 10.1375/bech.26.4.254.
    1. Helgadóttir FD, Menzies RG, Onslow M, Packman A, O'Brian S. A standalone Internet cognitive behavior therapy treatment for social anxiety in adults who stutter: CBTpsych. J Fluency Disord. 2014 Sep;41:47–54. doi: 10.1016/j.jfludis.2014.04.001.
    1. Menzies R, O'Brian S, Lowe R, Packman A, Onslow M. International phase II clinical trial of CBTPsych: a standalone internet social anxiety treatment for adults who stutter. J Fluency Disord. 2016 Jun;48:35–43. doi: 10.1016/j.jfludis.2016.06.002.
    1. Barrera TL, Norton PJ. Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder. J Anxiety Disord. 2009 Dec;23(8):1086–90. doi: 10.1016/j.janxdis.2009.07.011.
    1. Wells A. The attention training technique: theory, effects, and a metacognitive hypothesis on auditory hallucinations. Cogn Behav Pract. 2007 May;14(2):134–8. doi: 10.1016/j.cbpra.2006.01.010.
    1. Holmes EA, Arntz A, Smucker MR. Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and outcomes. J Behav Ther Exp Psychiatry. 2007 Dec;38(4):297–305. doi: 10.1016/j.jbtep.2007.10.007.
    1. Caballo VE, Salazar IC, Irurtia MJ, Arias B, Hofmann SG. Measuring social anxiety in 11 countries. Eur J Psychol Assess. 2010 Jan;26(2):95–107. doi: 10.1027/1015-5759/a000014.
    1. Connor KM, Kobak KA, Churchill LE, Katzelnick D, Davidson JR. Mini-SPIN: a brief screening assessment for generalized social anxiety disorder. Depress Anxiety. 2001;14(2):137–40.
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders (5th ed) Arlington, VA, US: American Psychiatric Publishing; 2013.
    1. Mattick RP, Clarke JC. Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behav Res Ther. 1998 Apr;36(4):455–70.
    1. Watson D, Friend R. Measurement of social-evaluative anxiety. J Consult Clin Psychol. 1969 Aug;33(4):448–57.
    1. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–6.
    1. Phinney JS, Ong AD. Conceptualization and measurement of ethnic identity: current status and future directions. J Couns Psychol. 2007;54(3):271–81. doi: 10.1037/0022-0167.54.3.271.
    1. Heimberg RG, Mueller GP, Holt CS, Hope DA, Liebowitz MR. Assessment of anxiety in social interaction and being observed by others: the social interaction anxiety scale and the social phobia scale. Behav Ther. 1992;23(1):53–73. doi: 10.1016/S0005-7894(05)80308-9.
    1. Stopa L, Clark DM. Social phobia and interpretation of social events. Behav Res Ther. 2000 Mar;38(3):273–83.
    1. Stopa L, Clark DM. Social phobia: comments on the viability and validity of an analogue research strategy and British norms for the Fear of Negative Evaluation Questionnaire. Behav Cogn Psychother. 2001 Oct;29(04):423–30. doi: 10.1017/S1352465801004039.
    1. Brown EJ, Turovsky J, Heimberg RG, Juster HR, Brown TA, Barlow DH. Validation of the Social Interaction Anxiety Scale and the Social Phobia Scale across the anxiety disorders. Psychol Assess. 1997;9(1):21–7. doi: 10.1037/1040-3590.9.1.21.
    1. Stevanovic D. Quality of Life Enjoyment and Satisfaction Questionnaire-short form for quality of life assessments in clinical practice: a psychometric study. J Psychiatr Ment Health Nurs. 2011 Oct;18(8):744–50. doi: 10.1111/j.1365-2850.2011.01735.x.
    1. IBM Corp. Armonk, NY: 2016. IBM SPSS Statistics 24.0 .
    1. Little RJ. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83(404):1198–1202. doi: 10.1080/01621459.1988.10478722.
    1. Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G. Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cogn Behav Ther. 2009;38(2):66–82. doi: 10.1080/16506070802694776.

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