Daydreamer and Night Owl: Comparing Positive and Negative Outcome Cases in an Online, Clinician-Guided, Self-Help Intervention for Social Anxiety Disorder

Abstract

Internet-Based Cognitive-Behavior Treatment (ICBT) has garnered strong empirical support in the last decade. However, despite the growing body of evidence that web-based treatments work, there are still a considerable number of clients who do not benefit sufficiently from such interventions. Recently, research has started to focus on identifying factors that affect treatment outcome and adherence to Internet interventions. To explore the difference between clients who are successful versus unsuccessful in response to ICBT, this article presents two systematic case studies that describe the course of treatment of a positive-outcome client (named "Daydreamer") and a more negative outcome client (named "Night Owl") in clinician-guided ICBT for Social Anxiety Disorder (SAD). We present focal points of therapist communication, as well as the clients' individual gains and obstacles. Lastly, we explore several factors that seem to be crucial in this specific setting, such as therapist support, motivation, and establishing a working alliance via the Internet.

Case Studies of Clinician-Guided, Online Therapy: Towards a Fuller Understanding of How and Under What Conditions Such Therapy Works

“…It is very likely that established alliance measures do not capture specific aspects of Online relationships. This may especially be the case in therapies based on asynchronous written communication (e.g., Schulz et al, 2017), but also in therapies which include real-time video sessions (e.g., Ciuca et al, 2017). There is evidence showing that therapists and clients make adjustments in their behavior when conducting therapy via real-time video.…”

“…Key words: Online therapy; clinician-guided Online therapy; panic disorder; social anxiety disorder; case studies; clinical case studies; randomized controlled trials; therapeutic alliance ________________________________________________________________________ The systematic case studies by Ciuca, Berger, and Miclea (2017) and by Schulz, Vincent, and Berger (2017) are notable contributions to the growing body of literature in the field of Online treatments. While many randomized controlled trials (RCTs) show that Online interventions can work for a number of mental problems and disorders, case studies are still rare.…”

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ABSTRACT Ciuca, Berger, and Miclea (2017) and Schulz, Vincent, & Berger (2017) each present a pair of process-focused, systematic case studies, one with good outcome and one with a poorer outcome. These cases were drawn from a randomized controlled trial (RCT) of an Online self-help therapy for panic disorder and social anxiety disorder, respectively.

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“…In both instances the cases were drawn from the clinician-guided arm of the RCT. This commentary reviews the kind of knowledge emerging from these pairs of case studies from a variety of perspectives, including: the practical advantages of online, clinician-guided treatment; client readiness for treatment; the role of the therapist alliance; the broad reach of online therapy; and the important complementary role that systematic case studies play in enhancing the knowledge that emerges from RCTs.Key words: Online therapy; clinician-guided Online therapy; panic disorder; social anxiety disorder; case studies; clinical case studies; randomized controlled trials; therapeutic alliance ________________________________________________________________________ The systematic case studies by Ciuca, Berger, and Miclea (2017) and by Schulz, Vincent, and Berger (2017) are notable contributions to the growing body of literature in the field of Online treatments. While many randomized controlled trials (RCTs) show that Online interventions can work for a number of mental problems and disorders, case studies are still rare.…”

“…Therapists are actively involved, although to a lesser degree than in traditional therapy. While a client works his or her way through the Online self-help program, a therapist assists and supports the client via real-time video sessions (e.g., Ciuca et al, 2017) or via e-mail (e.g., Schulz et al, 2017).…”