More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder

Abstract

Background 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. Methods 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. Results 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. Conclusions When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.

Internet‐administered, low‐intensity cognitive behavioral therapy for parents of children treated for cancer: A feasibility trial (ENGAGE)

“…Psychology program student e‐therapists did not have time to support caseloads and more experienced licensed psychologists and a CBT‐therapist supported the majority of participants. Further, psychology program student e‐therapists spent a mean time of 2.9 h per participant, per week, which is more therapist time than reported in other studies on guided internet‐administered CBT interventions 74–76 . This finding may be explained by psychology program students only supporting a mean of 2.7 parents.…”

“…Further, psychology program student e‐therapists spent a mean time of 2.9 h per participant, per week, which is more therapist time than reported in other studies on guided internet‐administered CBT interventions. 74 , 75 , 76 This finding may be explained by psychology program students only supporting a mean of 2.7 parents. Consequently, they may not have gained the opportunity to develop competence in using the support protocol and a clear understanding of the intervention structure and content, or how to use the Portal.…”

Therapist‐supported Internet‐based cognitive behaviour therapy yields similar effects as face‐to‐face therapy for psychiatric and somatic disorders: an updated systematic review and meta‐analysis

“…Table 1 provides a description of selected characteristics of all studies included in the review 12‐42 . In the 31 studies, the clinical conditions targeted were depression/depressive symptoms (n=5), social anxiety disorder (n=4), panic disorder (n=3), insomnia (n=3), tinnitus (n=2), animal phobia (n=2), body dissatisfaction (n=2), binge eating disorder (n=1), bulimia nervosa (n=1), health anxiety (n=1), obsessive‐compulsive disorder (n=1), postnatal depression (n=1), post‐traumatic stress disorder (n=1), psychological distress in cancer patients (n=1), serious mental illness (n=1), fibromyalgia (n=1), and male sexual dysfunction (n=1).…”

Internet‐delivered therapist‐assisted cognitive therapy for adolescent social anxiety disorder (OSCA): a randomised controlled trial addressing preliminary efficacy and mechanisms of action

“…An Internet‐delivered therapist‐assisted version of CT‐SAD has been developed for adults and in a recent trial it has been shown to have similar effects to face‐to‐face treatment, but requiring 70% less therapist time (Clark et al., in press ). The question arises as to whether Internet CT‐SAD could be beneficial for adolescents and potentially reduce demand on services, but no studies have examined this yet.…”