Treating social anxiety disorder remotely with cognitive therapy

Abstract

Remote delivery of evidence-based psychological therapies via video conference has become particularly relevant following the COVID-19 pandemic, and is likely to be an on-going method of treatment delivery post-COVID. Remotely delivered therapy could be of particular benefit for people with social anxiety disorder (SAD), who tend to avoid or delay seeking face-to-face therapy, often due to anxiety about travelling to appointments and meeting mental health professionals in person. Individual cognitive therapy for SAD (CT-SAD), based on the Clark and Wells (1995) model, is a highly effective treatment that is recommended as a first line intervention in NICE Guidance (NICE, 2013). All of the key features of face-to-face CT-SAD; including video feedback, attention training, behavioural experiments, and memory focused techniques can be adapted for remote delivery. In this paper, we provide guidance for clinicians on how to deliver CT-SAD remotely, and suggest novel ways for therapists and patients to overcome the challenges of carrying out a range of behavioural experiments during remote treatment delivery.

Treating social anxiety disorder remotely with cognitive therapy

“…Research suggests that people with social anxiety also experience anxiety and activation of their social cognitions (e.g. people think I am boring or stupid) during online interactions, such as posting or messaging on Facebook (Carruthers et al ., 2019; Warnock-Parkes et al, in preparation). An interview study conducted with patients found that all elements of the cognitive model of SAD were present during interactions without the physical presence of another person, including negative self-images/impressions of patients’ online selves (‘I have the impression I look boring, like I don’t exist’).…”

“…An interview study conducted with patients found that all elements of the cognitive model of SAD were present during interactions without the physical presence of another person, including negative self-images/impressions of patients’ online selves (‘I have the impression I look boring, like I don’t exist’). Patients also described using similar safety behaviours online to their face-to-face interactions (such as censoring posts, avoiding sharing anything about themselves, trying to make a good impression and rehearsing things to post) (Warnock-Parkes et al ., in preparation). This shows that the online social world is not the safe haven some may expect for people with SAD, but it can provide a range of opportunities for behavioural experiments.…”

Delivering Imagery Rescripting via Telehealth: Clinical Concerns, Benefits, and Recommendations

“…There may be different or additional recommendations specific to other clinical populations not treated by the current authors. For instance, Clark’s group provided clinical recommendations in the remote delivery of ImRs of socially traumatic memories [ 41 ]. They recommended that the clinician provide more empathy and encouragement during the rescript (i.e.…”

“…The first and last authors collated this feedback into themes, which was placed into the following sections: (1) implementing ImRs via telehealth: clinical considerations, (2) therapy progress and outcomes, (3) recommendations to clinicians delivering ImRs via telehealth, and (4) limitations and future research. This paper is limited to reflections specific to ImRs, rather than psychological therapy via telehealth more generally (for broader clinical recommendations, see [ 40 , 41 ]). Case illustrations and client quotes are provided where possible.…”

Special Issue commentary: Specific impacts of the COVID-19 pandemic on staff and patients from racialised groups

“…Over the course of the last year, the Cognitive Behaviour Therapist has rapidly published a range of excellent and highly appreciated papers looking at a range of issues such as working with specific disorders during the pandemic such as obsessive compulsive disorder (OCD) (Jassi et al, 2020), eating disorders (Murphy et al, 2020), social anxiety (Warnock-Parkes et al, 2020) and postintensive care unit post-traumatic stress disorder (PTSD) (Murray et al, 2020). There were also papers on how to adapt training and supervision to be delivered remotely (Cromarty et al, 2020) and how to conceptualise uncertainty within the context of the pandemic (Freeston et al, 2020).…”