More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder
<p><strong>Background:</strong> 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-minute face-to-face sessions , some of which are out of the offi...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Jezik: | English |
| Izdano: |
Cambridge University Press
2022
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| _version_ | 1826310894921973760 |
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| author | Clark, DM Wild, J Warnock-Parkes, E Stott, R Grey, N Thew, G Ehlers, A |
| author_facet | Clark, DM Wild, J Warnock-Parkes, E Stott, R Grey, N Thew, G Ehlers, A |
| author_sort | Clark, DM |
| collection | OXFORD |
| description | <p><strong>Background:</strong> 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-minute face-to-face sessions ,
some of which are out of the office. An internet-based version of the treatment (iCTSAD) with remote therapist support may achieve similar outcomes with less
therapist time.</p>
<p><strong>Methods:</strong> 102 patients with social anxiety disorder were randomized to
iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients
were randomized to the treatments after wait. Assessments were at pretreatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12
months after treatment. The pre-registered (ISRCTN95458747) 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.</p>
<p><strong>Results:</strong> 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 hours. CT-SAD required 15.8
hours 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.</p>
<p><strong>Conclusions:</strong> When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.</p> |
| first_indexed | 2024-03-07T08:00:15Z |
| format | Journal article |
| id | oxford-uuid:46ffcc71-a010-4bf6-be1e-329efc605ad2 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:00:15Z |
| publishDate | 2022 |
| publisher | Cambridge University Press |
| record_format | dspace |
| spelling | oxford-uuid:46ffcc71-a010-4bf6-be1e-329efc605ad22023-09-20T08:59:07ZMore than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorderJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:46ffcc71-a010-4bf6-be1e-329efc605ad2EnglishSymplectic ElementsCambridge University Press2022Clark, DMWild, JWarnock-Parkes, EStott, RGrey, NThew, GEhlers, A<p><strong>Background:</strong> 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-minute face-to-face sessions , some of which are out of the office. An internet-based version of the treatment (iCTSAD) with remote therapist support may achieve similar outcomes with less therapist time.</p> <p><strong>Methods:</strong> 102 patients with social anxiety disorder were randomized to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomized to the treatments after wait. Assessments were at pretreatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN95458747) 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.</p> <p><strong>Results:</strong> 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 hours. CT-SAD required 15.8 hours 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.</p> <p><strong>Conclusions:</strong> When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.</p> |
| spellingShingle | Clark, DM Wild, J Warnock-Parkes, E Stott, R Grey, N Thew, G Ehlers, A More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
| title | More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
| title_full | More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
| title_fullStr | More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
| title_full_unstemmed | More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
| title_short | More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
| title_sort | more than doubling the clinical benefit of each hour of therapist time a randomised controlled trial of internet cognitive therapy for social anxiety disorder |
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