Remote video feedback in iCBT for Social Anxiety Disorder

Frequently conceptualised as a single of the most widespread anxiousness issues, Social Anxiety Disorder (SAD) is estimated – by an admittedly outdated study – to have a lifetime prevalence of about 12% of the population (Kessler et al., 2005). SAD is characterised by excessive worry regarding how a single acts, and may perhaps be perceived, in social circumstances.

Clark and Wells’ (1995) influential model understands the disorder to be perpetuated by self-focused focus and adverse self-image. Cognitive Therapy for SAD (CT-SAD), the standardised NHS frontline remedy, combines this model alongside the principles of Cognitive Behavioural Therapy, aiming to boost symptoms by difficult adverse self-perceptions. The 14-week remedy emphasises behavioural experiments. One such experiment centres about video feedback, exactly where individuals are encouraged to challenge their adverse beliefs while viewing a video of themselves in a social encounter.

As healthcare starts to shift towards digitisation, an online-primarily based, remote version of CT-SAD (iCT-SAD) has been created. Requiring notably much less therapist guidance and time, this makes it possible for pros to take on additional individuals. However, this begs the query: in pursuit of effective treatment options, do we danger ignoring the worth of in-individual therapist interactions? And how do behavioural experiments like video feedback translate to remote formats?

Wild, Warnock-Parkes, Stott and colleagues (2023) set forth to answer this query by investigating previously unanalysed video feedback information from two current research investigating iCT-SAD.

Methods

Study 1 compared the effects of CT-SAD and iCT-SAD in a UK sample of 102 adults referred by NHS solutions for SAD remedy (Clark et al., 2022). Patients have been assigned to either CT-SAD or iCT-SAD circumstances and completed a 14-week course of remedy.

Study 2 replicated the remedy and measures of Clark and associates’ study, save the removal of the CT-SAD situation (Thew et al., 2022). Patients have been 44 self-referred Hong Kong-primarily based adults who met criteria for SAD and demonstrated adequate understanding of English.

Video feedback occurred for the duration of the third week. Patients recorded, then viewed a video of themselves in a social interaction. In CT-SAD, reflection was guided by a therapist, whereas in iCT-SAD reflection was guided by digital prompts, with chance to text a therapist afterwards. Patients have been needed to full questionnaires ahead of and right after intervention, rating self-perception statements (pertaining to anxiousness, occurrence of feared beliefs and general functionality) on scales from 1-100, and a self-report SAD symptomology questionnaire (Leibowitz Social Anxiety Scale [LSAS]).

Results

Wild and colleagues opted to analyse video feedback information for each and every study independently, then in comparison. For sake of ease, I will present outcomes in this order.

Study 1 aimed to figure out no matter whether iCT-SAD would be as successful as its face-to-face counterpart, CT-SAD. Interestingly, evaluation of video feedback information showed the exact same general trend in individuals participating in each and every technique of delivery. The trend was an general improvement amongst pre- and post- intervention measures: important decreases in self-perception of anxiousness, occurrence of feared beliefs, LSAS anxiousness ratings and improvement in ratings of general functionality. However, it is significant to note that when compared utilizing Linear Mixed Effect Models, CT-SAD was linked with a higher degree of alter in self-ratings, but not LSAS, when compared to iCT-SAD. Albeit, it is critical to place this into context – while CT-SAD may perhaps be additional successful, the percentages of these experiencing improvement in each interventions are extremely promising. Indeed, 100% of individuals across circumstances reported decreases in degree to which feared beliefs transpired, 98% of CT-SAD and 88% of iCT-SAD individuals reported increases in self-rating of social functionality, and 96% of CT-SAD and 92% of iCT-SAD individuals reported decreases in self-ratings of perception of external anxiousness.

Study 2 aimed to test no matter whether the good effects of video feedback inside iCT-SAD would replicate in a Hong Kong-primarily based sample. Indeed, the information supported the findings of Study 1, with important general improvement following intervention in all measures – self-perception as effectively as LSAS anxiousness score. In reality, upon closer inspection of the information, it will have to be acknowledged that amongst 84-95% – a important majority of participants – demonstrated improvement in each and every measure.

Finally, Linear Mixed Effect Models have been applied to examine the degree of alter amongst the pre- and post-video feedback outcomes amongst iCT-SAD groups in Study 1 and Study 2. Upon examining the extent of alter, no important distinction amongst research was discovered for any measure. In quick, this signifies that the outcomes of Study 2 precisely replicate the iCT-SAD information from Study 1. This additional supports the proof indicating the efficacy of the iCT-SAD video feedback in enhancing SAD symptoms following intervention and adds a cross-cultural element to the proof base.

Conclusions

1. Overall, outcomes recommend that the video feedback intervention inside iCT-SAD may perhaps be an successful signifies to challenge and lower adverse self-perceptions linked with SAD and additional decrease social anxiousness levels. This impact was supported in UK and Hong Kong research.
2. When investigating the effects of video intervention inside iCT-SAD in the Hong Kong and UK-primarily based research, outcomes have been discovered to not substantially differ in regard to the degree of alter of measures. Results are not only comparable, but replicated.
3. However, upon comparison, video feedback inside CT-SAD was linked with higher amounts of alter in adverse self-perceptions amongst pre- and post- intervention scores compared to iCT-SAD. This impact did not extend to LSAS scores.

Strengths and limitations

The researchers acknowledged a notably restricted lack of manage more than timing of measures. Where self-report information was collected straight ahead of and right after feedback, LSAS anxiousness scores have been collected weekly. Additionally, individuals in iCT-SAD have been capable to proceed with further modules straight following feedback, so may perhaps be additional along the course of remedy. Unfortunately, this signifies that effects will have to be interpreted with caution as modifications may perhaps not necessarily be linked strictly with the intervention. The authors have been unable to manage for the quantity of therapist guidance offered – in each CT-SAD and iCT-SAD circumstances, which may perhaps influence the findings of this study.

This author draws focus to additional limitations:

• Effects of video feedback have been measured only in the quick-term, inside the week it was carried out. Hence, inquiries will have to be raised concerning longevity of good effects linked with the video intervention.
• Conclusions are more than-reliant on self-report information. Whilst it may perhaps be the most effective way of understanding self-perceptions, self-reports inherently rely upon introspection and interpretation that may be unreliable.
• The participant pools of each and every study have been reasonably little and restricted to English speakers. Further study is needed to greater recognize the generalisability of findings.
• There is a lack of details in regard to patient retention, which may perhaps be important in regard to cross-cultural effects, as UK individuals have been referred by the NHS whereas Hong Kong individuals have been self-referred and they paid an upfront expense for remedy.

However, the strengths of this novel study should be acknowledged. The study builds upon and adds to an current base of understanding, effectively furthering our understanding of particular components inside SAD remedy. Further, understanding is applicable in a clinical setting considering that each versions of CT-SAD are at present in use, or becoming trialed inside the NHS. A multifaceted strategy permitted for a thorough investigation of effects, by analysing common effects, comparative effects, and cross-cultural proof. Lastly, the use of self-report questionnaires permitted for measures of self-perception, a targeted outcome. Further, scores have been quantitative which permitted for statistical evaluation.

Implications

In order to contextualise Wild and associates’ findings, it is significant to appear at the each the particular and broader implications.

Firstly, particular. Upon searching at the general effectiveness in enhancing quick post-video outcomes, outcomes look to recommend that video feedback can be effectively carried out remotely. The replication of this impact in Hong Kong adds robustness to this conclusion. From a clinical standpoint, this is promising proof that this particular adapted element of CT-SAD translates effectively to a digitised format. However right here it will have to be noted that CT-SAD was discovered to outcome in a higher degree of alter in adverse self-evaluations, seemingly indicating video feedback carried out beneath direct therapist guidance to be additional important.

At this point we will have to ‘zoom out’ to recognize broader implications. In quick, the study does assistance the use of digitised therapy for video feedback, even if it is not fairly as successful. Remotely delivered therapies may perhaps certainly represent the future of remedy. We face a healthcare conundrum, with restricted mental well being pros offered to assistance increasing numbers of these in want. Remotely delivered, digitised therapy makes it possible for for wider distribution of remedy as therapists are needed to invest much less speak to time, and as such can take on additional individuals. Accordingly, individuals may perhaps access remedy and recover quicker. Indeed as we stand, we face complications in SAD remedy. Alongside higher prevalence, low remedy-looking for and low prices of all-natural recovery are also observed (Waumans et al., 2022, Bruce et al., 2005). Is the shift to remote therapy a single that will advantage each patient and therapist? Well… possibly, and possibly not. A digitised therapy may perhaps be additional accessible – maybe in particular to these with social phobia – however, in looking for efficiency, we may perhaps drop sight of the worth of in-individual therapeutic relationships.

However, this query is currently becoming investigated. As of May 2023, Good started assessment, with iCT-SAD at present becoming trialed in an Oxford NHS Talking Therapies service. This trial makes it possible for individuals to opt-in to iCT-SAD and will measure outcomes more than 7 months, which includes satisfaction with remedy (see Clark, 2023). We are now at the fascinating forefront of discovering exactly where remotely delivered CT-SAD fits inside our healthcare technique. The present study contributed an significant understanding of video feedback, and while not as successful as face-to-face, the effective adaptation and good implications need to not be ignored.

Now, to leave you with some meals for believed (or inspiration?). To construct upon the foundation, this author believes we want additional study into the longevity of video feedback effects, additional cross-cultural research, and lastly an understanding of each patient and therapist opinions of accessibility and effectiveness in remotely delivered therapy for SAD.

Statement of interests

The author has no conflicts of interest to declare.

King’s MSc in Mental Health Studies

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Links

Primary paper

Wild, J., Warnock-Parkes, E., Stott, R., Kwok, A. P., Chan, M. H. L., Powell, C. L., … &amp Thew, G. R. (2023). Video feedback to update adverse self-perceptions in social anxiousness disorder: A comparison of online-delivered vs face-to-face cognitive therapy formats. Journal of Affective Disorders, 331, 139-144.

Other references

Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., … &amp Keller, M. B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiousness disorder, social phobia, and panic disorder: a 12-year potential study. American Journal of psychiatry, 162(6), 1179-1187.

Clark, D. M., Wild, J., Warnock-Parkes, E., Stott, R., Grey, N., Thew, G., &amp Ehlers, A. (2023). More than doubling the clinical advantage of each and every hour of therapist time: a randomised controlled trial of online cognitive therapy for social anxiousness disorder. Psychological Medicine, 53(11), 5022-5032.

Clark, D. M., &amp Wells, A. (1995). A cognitive model of social phobia.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., &amp Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV issues in the National Comorbidity Survey Replication. Archives of common psychiatry, 62(6), 593-602.

Thew, G. R., Kwok, A. P., Chan, M. H. L., Powell, C. L., Wild, J., Leung, P. W., &amp Clark, D. M. (2022). Internet-delivered cognitive therapy for social anxiousness disorder in Hong Kong: A randomized controlled trial. Internet Interventions, 28, 100539.

Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., … &amp Clark, D. M. (2020). Treating social anxiousness disorder remotely with cognitive therapy. The Cognitive Behaviour Therapist, 13, e30.

Waumans, R. C., Muntingh, A. D., Draisma, S., Huijbregts, K. M., van Balkom, A. J., &amp Batelaan, N. M. (2022). Barriers and facilitators for remedy-looking for in adults with a depressive or anxiousness disorder in a Western-European well being care setting: a qualitative study. BMC psychiatry, 22(1), 165.

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