1. More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder.
- Author
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Clark, David M., Wild, Jennifer, Warnock-Parkes, Emma, Stott, Richard, Grey, Nick, Thew, Graham, and Ehlers, Anke
- Subjects
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ANXIETY treatment , *MEDICAL consultation , *INTERNET , *TIME , *CLIENT relations , *MEDICAL care , *COGNITION , *SOCIAL anxiety , *TREATMENT effectiveness , *RANDOMIZED controlled trials , *PRE-tests & post-tests , *MENTAL depression , *FACTOR analysis , *QUALITY assurance , *DESCRIPTIVE statistics , *RESEARCH funding , *STATISTICAL sampling , *COGNITIVE therapy , *TELEMEDICINE - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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