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More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder
Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may achieve similar outcomes with less therapist time.
102 patients with social anxiety disorder were randomised to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomised to the treatments after wait. Assessments were at pre-treatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN 95 458 747) primary outcome was the social anxiety disorder composite, which combines 6 independent assessor and patient self-report scales of social anxiety. Secondary outcomes included disability, general anxiety, depression and a behaviour test.
CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or follow-up. Total therapist time in iCT-SAD was 6.45 h. CT-SAD required 15.8 h for the same reduction in social anxiety. Mediation analysis indicated that change in process variables specified in cognitive models accounted for 60% of the improvements associated with either treatment. Unlike the primary outcome, there was a significant but small difference in favour of CT-SAD on the behaviour test.
When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.
Journal Article
Social phobia : an interpersonal approach
\"Social phobia is a disorder involving an intense fear of being judged by others and it affects the lives of many people. This book takes a critical stance towards the received view of social phobia as a disease of sorts, characterized by abnormal anxiety and caused by an inner mental or physical defective mechanism. Ariel Stravynski adopts an alternative approach to social phobia - as a purposeful interpersonal pattern protective against public humiliation or private rebuff. In this conception, fearfulness is the emotional facet of the socially phobic interpersonal pattern, rather than its driving force. This theoretical framework emphasizing dynamic transactions is articulated in terms of an anthropological psychology and Stravynski argues that social phobia can only be formulated and understood in interpersonal terms. He integrates all available knowledge on social phobia into his proposed framework and exemplifies its application by extending it to the assessment and treatment of the disorder\"-- Provided by publisher.
Book
Efficacy of CBT, intensified tDCS and their combination for reducing clinical symptoms and improving quality of life in social anxiety disorder with comorbid depression: a randomized controlled trial
Background/aim
Social anxiety disorder (SAD) is a common and disabling psychiatric disorder. It is generally treated with medication and psychotherapy such as cognitive-behavioral therapy (CBT). Due to the involvement of cortical and subcortical areas in the pathophysiology of SAD, non-invasive brain stimulation techniques such as transcranial Direct Current Stimulation (tDCS) are potential adjunctive treatment options for SAD. This study aims to assess comparable efficacy of CBT, intensified tDCS, and combined CBT/tDCS on clinical symptoms and quality of life of patients with SAD and comorbid depression.
Methods
In this randomized controlled trial, 37 adults with SAD and comorbid depressive disorder were assigned into three groups: (1) CBT + active tDCS (
n
= 13), (2) active tDCS alone (
n
= 12), and (3) CBT + sham tDCS (
n
= 12). SAD symptoms, depressive states, quality of life and trait worry were assessed with the Liebowitz Social Anxiety Scale, Beck’s Depression Inventory, QOL questionnaire (WHOQOL-BREF), and the Penn State Worry Questionnaire respectively. The active tDCS was an intensified stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) and was applied over the left dorsolateral prefrontal cortex (F3) and medial prefrontal cortex (Fpz). The CBT was provided individually based on the exposure technique at 12–20 sessions, twice a week. All clinical measures were assessed at baseline, after the intervention, and at 3-month follow-up.
Results
SAD symptoms significantly decreased after intervention and follow-up in all groups, with no significant differences between them. However, CBT + tDCS resulted in a numerically larger symptom reduction, significantly exceeding CBT + sham tDCS on the fear scale. Depressive states and trait worry significantly improved in all groups post-intervention and at the 3-month follow-up, with no between-group differences. Quality of life (total scores, physical, and psychological domains) significantly improved after the and at the 3-month follow-up only in the CBT + tDCS and tDCS-alone groups with no between-group differences.
Conclusion
Psychotherapeutic interventions with CBT, intensified tDCS targeting the prefrontal cortex, and the combined CBT-tDCS are effective for alleviating primary and secondary clinical symptoms in individuals with SAD. The combined CBT-tDCS intervention showed superior efficacy in reducing the primary symptoms of SAD.
Trial registration ID
IRCT20220421054607N1, registration date: 19/05/2022, available at:
https://irct.behdasht.gov.ir/trial/63119
.
Journal Article
Social Anxiety
Affecting millions of people in the United States, social anxiety, according to DSM-5-TR, refers to the condition of persisting intense fear or anxiety about being severely embarrassed or humiliated in social situations where such fear is out of proportion to any actual threat. This compelling new guide calls for an expanded definition, one that involves the persistent fears and shame of individuals related to what others might think of them if certain actions or thoughts in their past or present were ever to become known—even when there may be no actual interaction with those other people. At the heart of the case made by Social Anxiety: Hidden Fears and Shame in Teens and Adults are 22 case examples featuring individuals from age 14 to age 52. These revealing vignettes underscore that • Social anxiety does not correspond merely to transient fears such as meeting new people or public speaking but can be chronic and persistent• Social anxiety does not involve only fears of potentially challenging behaviors; for many it also manifests as fears or shame about past or present wishes or thoughts considered unacceptable• A significant percentage—as many as half—of individuals struggling with social anxiety avoid seeking help Opening with a description of what the research has to say about the nature, causes, and effects of social anxiety, this book also examines the wide variety of treatment interventions, including psychotherapy, medications, and family interventions. With a depth of information that will prove clinically useful to medical and mental health professionals, Social Anxiety is also written in an engaging style that will be easily accessible to laypeople—including those suffering from social anxiety themselves, as well as their family and community.
eBook
Be yourself : overcoming social anxiety
\"Social anxiety is more than feeling nervous from time to time. For people with social anxiety, everyday social interactions can cause significant anxiety. Without treatment, social anxiety can disrupt a person's life\"-- Provided by publisher.
BOOK
Unraveling the neurophysiological underpinnings of social anxiety through body language: An ERP study
Body language plays a vital role in emotion perception, yet the involuntary neural mechanisms through which individuals with social anxiety process these signals remain unclear. This research investigates these mechanisms by analyzing visual components such as P3a, P1, and N190 within a three-stimulus oddball paradigm.
Participants were classified into high social anxiety (HSA, n = 31) and low social anxiety (LSA, n = 26) groups using the Liebowitz Social Anxiety Scale (LSAS). The paradigm employed custom-designed distractors depicting positive, negative, and neutral body expressions to examine the involuntary processing of these stimuli.
The findings indicate that individuals with high social anxiety (HSA) showed significantly higher P3a amplitudes than those with low social anxiety (LSA), especially for positive body expressions. In contrast, negative expressions elicited the weakest amplitudes. The N190 component responded most strongly to positive expressions and least to negative ones, while the P1 component showed uniform responses across all types.
HSA individuals process body expressions more intensely and are highly sensitive to them, regardless of valence. This insight can inform interventions targeting their cognitive and emotional biases.
•Investigates involuntary processing of body expressions in social anxiety using ERPs.•High social anxiety group shows heightened P3a amplitudes for positive body expressions.•N190 component reveals sensitivity to emotional valence, with highest response to positive expressions.•Findings suggest biased cognitive resource allocation in high social anxiety individuals.
Journal Article
No fear networking : a guide to building connections for the socially anxious professional
\"Transform your networking experience with No Fear Networking Embark on a transformative journey with No Fear Networking: A Guide to Building Connections for the Socially Anxious Professional, tailored for anyone who's ever felt overwhelmed by traditional networking. Crafted by a formerly agoraphobic LinkedIn guru who became a viral sensation at 30, this guide is an essential toolkit for fostering genuine connections and opening doors to new opportunities. No Fear Networking offers a compassionate approach to networking, addressing the challenges faced by socially anxious professionals through practical, actionable strategies. From understanding the nuances of social anxiety to mastering the art of small talk, this book provides everything you need to network with confidence and still feel like yourself.\"-- Provided by publisher.
BOOK
Brain activity during reappraisal and associations with psychotherapy response in social anxiety and major depression: a randomized trial
Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm.
Participants were 75 treatment-seeking patients with SAD (
= 34) or MDD (
= 41) randomized to CBT (
= 40) or ST (
= 35). Before randomization, patients completed a cognitive reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment.
Results indicated that pre-treatment neural activity during reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported reappraisal improvement, regardless of treatment arm.
If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.
Journal Article