In-Clinic and Standalone Internet Cognitive Behavior Therapy Treatment for Social Anxiety in Stuttering: A Randomized Trial of iGlebe

Abstract

Purpose iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores ( Carleton, McCreary, Norton, & Asmundson, 2006 ). Secondary outcomes included speech, psychology, and quality-of-life measures. Results Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings.

Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering

“…However, subclinical VRET may be particularly suited for delivery alongside speech therapy. Some authors have suggested that all PWS receiving speech therapy should also receive psychological treatment (23), given findings that mental health conditions can disrupt the progress made from speech therapy (72). Such is the highly entwined nature of comorbid stuttering and social anxiety, that cognitive and behavioral change are considered necessary for managing stuttering (73).…”

“…As such, treatments should consider the cognitive processes, thoughts, and behaviors associated with social anxiety in stuttering (11), as well as situational factors and practical considerations. Cognitive Behavioral Therapy (CBT) is considered the gold-standard treatment for anxiety disorders (15) and several studies have investigated its use for PWS (16)(17)(18), with some adopting protocols which consider stutteringspecific processes (14,(19)(20)(21)(22)(23)(24). This includes targeting speechrelated fears, and the safety behaviors and expectations that are common amongst PWS.…”

“…In one study, CBT eliminated all SAD diagnoses in the sample and was associated with a decrease in social anxiety (14). Another study adopted a fully automated, online version of CBT, finding it was equally as effective as in vivo CBT at reducing social anxiety levels (23). The third trial also used automated CBT, demonstrating that when integrated into speech restructuring, it can aid the long-term maintenance of speech outcomes (22).…”

Obtaining consensus on core components of stuttering intervention for adults: An e‐Delphi Survey with key stakeholders

“…It is unclear what this discord reflects; however, it may reflect a conflict between stakeholders in the way we manage stuttering, or an evolution in our understanding of what stuttering treatment entails. An increasing efficacy evidence base for affective and cognitive-based interven-tions with adults who stutter is evident, including cognitive behavioural therapy and acceptance and commitment therapy (Beilby et al, 2012;Menzies et al, 2009Menzies et al, , 2019Sønsterud et al, 2020). Such approaches have demonstrated improvements in psychosocial functioning, speech fluency or both when treatments target both aspects of the disorder.…”

Contemporary issues with stuttering: The Fourth Croatia Stuttering Symposium

“…VAL LIM: I definitely refer the patients to my colleagues beyond the discipline who are CBT trained. That said, I have directed patients to an online CBT programme (Menzies et al, 2019). SUE O'BRIAN: I do see a role for SLPs working through a comprehensive online CBT program with their clients.…”