Efficacy of Transdiagnostic Cognitive-Behavioral Therapy for Assertiveness: A Randomized Controlled Trial

Hagberg, Tobias; Manhem, Patrik; Oscarsson, Martin; Michel, Fiona; Andersson, Gerhard; Carlbring, Per

doi:10.2139/ssrn.4331995

Cited by 1 publication

(1 citation statement)

References 43 publications

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“…It could be hypothesized that the guided treatment led to faster improvements, but that those improvements made in the unguided group still led to positive cycles, facilitating further positive change. Interestingly, a recent study by Hagberg et al 62 on internet-delivered assertiveness training also found no significant differences between guided and unguided interventions in their impact on participants at follow-up, further corroborating the findings of this study. However, it should be noted that there was no control group during the follow up-period, meaning that there is no way to control for spontaneous remission.…”

Section: Discussionsupporting

confidence: 90%

Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder: A randomized controlled trial

Mechler,

Lindqvist,

Magnusson

et al. 2024

npj Mental Health Res

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Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD. In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively. Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT. In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD. The study was prospectively registered at ClinicalTrials (NCT05015166).

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Section: Discussionsupporting

confidence: 90%