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Does a Pre-Treatment Diagnostic Interview Affect the Outcome of Internet-Based Self-Help for Social Anxiety Disorder? A Randomized Controlled Trial

Published online by Cambridge University Press:  17 July 2012

Johanna Boettcher ,
Thomas Berger  and
Babette Renneberg
Johanna Boettcher*
Affiliation:
Freie Universitaet Berlin, Germany
Thomas Berger
Affiliation:
University of Bern, Switzerland
Babette Renneberg
Affiliation:
Freie Universitaet Berlin, Germany
*
Reprint requests to Johanna Boettcher, Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany. E-mail: johanna.boettcher@fu-berlin.de
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Abstract

Background: Numerous studies suggest that Internet-based self-help treatments are effective in treating anxiety disorders. Trials evaluating such interventions differ in their screening procedures and in the amount of clinician contact in the diagnostic assessment phase. The present study evaluates the impact of a pre-treatment diagnostic interview on the outcome of an Internet-based treatment for Social Anxiety Disorder (SAD). Method: One hundred and nine participants seeking treatment for SAD were randomized to either an interview-group (IG, N = 53) or to a non-interview group (NIG, N = 56). All participants took part in the same 10-week cognitive-behavioural unguided self-help programme. Before receiving access to the programme, participants of the IG underwent a structured diagnostic interview. Participants of the NIG started directly with the programme. Results: Participants in both groups showed significant and substantial improvement on social anxiety measures from pre- to post-assessment (dIG = 1.30–1.63; dNIG = 1.00–1.28) and from pre- to 4-month follow-up assessment (dIG = 1.38–1.87; dNIG = 1.10–1.21). Significant between-groups effects in favour of the IG were found on secondary outcome measures of depression and general distress (d = 0.18–0.42). Conclusions: These findings suggest that Internet-based self-help is effective in treating SAD, whether or not a diagnostic interview is involved. However, the pre-treatment interview seems to facilitate change on secondary outcomes such as depression and general distress.

Keywords

Social anxiety disorderInternet-based self-helpstructured diagnostic interviewrandomized controlled trial
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 40 , Issue 5 , October 2012 , pp. 513 - 528
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

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References

Abramson, L. Y., Metalsky, G. I. and Alloy, L. B. (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358–372. doi: 10.1037/0033-295x.96.2.358CrossRefGoogle Scholar
Andersson, G., Bergström, J., Holländare, F., Carlbring, P., Kaldo, V. and Ekselius, L. (2005). Internet-based self-help for depression: randomised controlled trial. British Journal of Psychiatry, 187, 456–461. doi: 10.1192/bjp.187.5.456CrossRefGoogle ScholarPubMed
Andersson, G., Carlbring, P. and Cuijpers, P. (2009). Internet interventions: moving from efficacy to effectiveness. E-Journal of Applied Psychology, 5, 18–24.Google Scholar
Andersson, G., Carlbring, P., Holmström, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E., et al. (2006). Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 677–686. doi: 10.1037/0022-006X.74.4.677Google Scholar
Andersson, G. and Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behaviour Therapy, 38, 196–205. doi: 10.1080/16506070903318960Google Scholar
Attkisson, C. C. and Zwick, R. (1982). The Client Satisfaction Questionnaire: psychometric properties and correlations with service utilisation and psychotherapy outcome. Evaluation and Program Planning, 5, 233–237.Google Scholar
Baker, S. L., Heinrichs, N., Kim, H.-J. and Hofmann, S. G. (2002). The Liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis. Behaviour Research and Therapy, 40, 701–715. doi: 10.1016/S0005-7967(01)00060-2Google Scholar
Barak, A., Hen, L., Boniel-Nissim, M. and Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109–160. doi: 10.1080/15228830802094429Google Scholar
Beck, A., Steer, R. and Brown, G. (1996). Beck Depression Inventory-II (BDI-II). San Antonio: TX: Psychological Corporation.Google Scholar
Berger, T., Caspar, F., Richardson, R., Kneubuhler, B., Sutter, D. and Andersson, G. (2011). Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, 49, 158–169. doi: 10.1016/j.brat.2010.12.007CrossRefGoogle ScholarPubMed
Berger, T., Hohl, E. O. and Caspar, F. (2009). Internet-based treatment for social phobia: a randomized controlled trial. Journal of Clinical Psychology, 65, 1021–1035. doi: 10.1002/jclp.20603CrossRefGoogle ScholarPubMed
Berger, T., Hohl, E. and Caspar, F. (2010). Internetbasierte therapie der sozialen phobie: Ergebnisse einer 6-monate-katamnese. Zeitschrift für Klinische Psychologie und Psychotherapie: Forschung und Praxis, 39, 217–221. doi: 10.1026/1616-3443/a000050CrossRefGoogle Scholar
Botella, C., Gallego, M. J., Garcia-Palacios, A., Guillen, V., Banos, R. M., Quero, S., et al. (2010). An Internet-based self-help treatment for fear of public speaking: a controlled trial. Cyberpsychology, Behavior, and Social Networking, 13, 407–421. doi: 10.1089/cyber.2009.0224Google Scholar
Carlbring, P., Furmark, T., Steczkó, J., Ekselius, L. and Andersson, G. (2006). An open study of internet-based bibliotherapy with minimal therapist contact via email for social phobia. Clinical Psychologist, 10, 30–38. doi: 10.1080/13284200500378662Google Scholar
Carlbring, P., Gunnarsdóttir, M., Hedensjö, L., Andersson, G., Ekselius, L. and Furmark, T. (2007). Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry, 190, 123–128. doi: 10.1192/bjp.bp.105.020107CrossRefGoogle ScholarPubMed
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. (2005). Treatment of panic disorder: live therapy vs. self-help via the Internet. Behaviour Research and Therapy, 43, 1321–1333. doi: 10.1016/j.brat.2004.10.002Google Scholar
Carlbring, P., Nordgren, L. B., Furmark, T. and Andersson, G. (2009). Long-term outcome of internet-delivered cognitive-behavioural therapy for social phobia: a 30-month follow-up. Behaviour Research and Therapy, 47, 848–850. doi: 10.1016/j.brat.2009.06.012CrossRefGoogle ScholarPubMed
Carlbring, P., Westling, B. E., Ljungstrand, P., Ekselius, L. and Andersson, G. (2001). Treatment of panic disorder via the Internet: a randomized trial of a self-help program. Behavior Therapy, 32, 751–764. doi: 10.1016/S0005-7894(01)80019-8CrossRefGoogle Scholar
Chan, Y. H. (2004). Biostatistics 301A: repeated measurement analysis (mixed models). Singapore Medical Journal, 45, 456–462.Google Scholar
Christensen, H., Griffiths, K. M. and Jorm, A. F. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. British Medical Journal, 328, 265–269. doi: 10.1136/bmj.37945.566632.EEGoogle Scholar
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578. doi: 10.1037/0022-006X.74.3.568CrossRefGoogle ScholarPubMed
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A. and Schneier, F. R. (Eds.), Social Phobia: diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford Press.Google Scholar
Clarke, G., Eubanks, D., Kelleher, C., O'Connor, E., DeBar, L. L., Lynch, F., et al. (2005). Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders. Journal of Medical Internet Research, 7, e16. doi: 10.2196/jmir.7.2.e16Google Scholar
Clarke, G., Reid, E., Eubanks, D., O'Connor, E., DeBar, L. L., Kelleher, C., et al. (2002). Overcoming Depression on the Internet (ODIN): a randomised controlled trial of an internet depression skills intervention program. Journal of Medical Internet Research, 4, e14. doi: 10.2196/jmir.4.3.e14CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Derogatis, L. R. and Melisaratos, N. (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 13, 595–605. doi: 10.1017/S0033291700048017CrossRefGoogle ScholarPubMed
Franke, G. (2000). Brief Symptom Inventory von LR Derogatis; BSI;(kurzform der SCL-90-R); deutsche Version: Beltz Test.Google Scholar
Furmark, T., Carlbring, P., Hedman, E., Sonnenstein, A., Clevberger, P., Bohman, B., et al. (2009). Guided and unguided self-help for social anxiety disorder: randomised controlled trial. British Journal of Psychiatry, 195, 440–447. doi: 10.1192/bjp.bp.108.060996Google Scholar
Fydrich, T., Renneberg, B., Schmitz, B. and Wittchen, H. U. (1997). SKID-II: Strukturiertes klinisches Interview für DSM-IV: Achse II: Persönlichkeitsstörungen: Interviewheft. Göttingen: Hogrefe.Google Scholar
Gibbons, M. B. C., Crits-Christoph, P., Barber, J. P., Wiltsey Stirman, S., Gallop, R., Goldstein, L. A., et al. (2009). Unique and common mechanisms of change across cognitive and dynamic psychotherapies. Journal of Consulting and Clinical Psychology, 77, 801–813. doi: 10.1037/a0016596Google Scholar
Hautzinger, M., Keller, F. and Kühner, C. (2006). Das Beck Depressions-Inventar II. Revision. Frankfurt/Main: Harcourt Test Services.Google Scholar
Hedman, E., Ljotsson, B., Rück, C., Furmark, T., Carlbring, P., Lindefors, N., et al. (2010). Internet administration of self-report measures commonly used in research on social anxiety disorder: a psychometric evaluation. Computers in Human Behavior, 26, 736–740. doi: 10.1016/j.chb.2010.01.010Google Scholar
Henkel, V., Bussfeld, P., Möller, H. J. and Hegerl, U. (2002). Cognitive-behavioural theories of helplessness/hopelessness: valid models of depression? European Archives of Psychiatry and Clinical Neuroscience, 252, 240–249. doi: 10.1007/s00406-002-0389-yGoogle ScholarPubMed
Houck, P. R., Mazumdar, S., Koru-Sengul, T., Tang, G., Mulsant, B. H., Pollock, B. G., et al. (2004). Estimating treatment effects from longitudinal clinical trial data with missing values: comparative analyses using different methods. Psychiatry Research, 129, 209–215. doi: 10.1016/j.psychres.2004.08.001Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. doi: 10.1037/0022-006X.59.1.12Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602. doi: 10.1001/archpsyc.62.6.593Google Scholar
Klein, B., Richards, J. C. and Austin, D. W. (2006). Efficacy of internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 37, 213–238. doi: 10.1016/j.jbtep.2005.07.001CrossRefGoogle ScholarPubMed
Lincoln, T. M., Rief, W., Hahlweg, K., Frank, M., von Witzleben, I., Schroeder, B., et al. (2003). Effectiveness of an empirically supported treatment for social phobia in the field. Behaviour Research and Therapy, 41, 1251–1269. doi: 10.1016/S0005-7967(03)00038-XCrossRefGoogle ScholarPubMed
Marks, I. and Cavanagh, K. (2009). Computer-aided psychological treatments: evolving issues. Annual Review of Clinical Psychology, 5, 121–141. doi: 10.1146/annurev.clinpsy.032408.153538Google Scholar
Mattick, R. P. and Clarke, J. C. (1989). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Unpublished manuscript.Google Scholar
Minero, K. I. (1999). The effect of using the structured clinical interview for the DSM-IV as an assessment tool in clinical trials. Dissertation Abstracts International: Section B: The Sciences and Engineering, 60.Google Scholar
Olfson, M., Guardino, M., Struening, E., Schneier, F. R., Hellman, F. and Klein, D. F. (2000). Barriers to the treatment of social anxiety. The American Journal of Psychiatry, 157, 521–527. doi: 10.1176/appi.ajp.157.4.521Google Scholar
Preacher, K. J. and Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. doi: 10.3758/BRM.40.3.879Google Scholar
Rapee, R. M., Abbott, M. J., Baillie, A. J. and Gaston, J. E. (2007). Treatment of social phobia through pure self-help and therapist-augmented self-help. British Journal of Psychiatry, 191, 246–252. doi: 10.1192/bjp.bp.106.028167Google Scholar
Rosnow, R. L. and Rosenthal, R. (1991). If you're looking at the cell means, you're not looking at only the interaction (unless all main effects are zero). Psychological Bulletin, 110, 574–576. doi: 10.1037/0033–2909.110.3.574Google Scholar
Schmidt, J., Lamprecht, F. and Wittmann, W. (1989). Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. Psychotherapie, Psychosomatik, Medizinische Psychologie, 39, 248–255.Google Scholar
Spek, V., Cuijpers, P., Nyklícek, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37, 319–328. doi: 10.1017/S0033291706008944Google Scholar
Stangier, U. and Heidenreich, T. (1995). Die deutsche Bearbeitung des Social Phobia Scale (SPS) und Social Interaction Axiety Scale (SIAS) von Mattick und Clarke. Unpublished manuscript.Google Scholar
Stangier, U. and Heidenreich, T. (2003). Die Liebowitz Soziale Angst-Skala (LSAS). Internationale Skalen für Psychiatrie. Göttingen: Hogrefe.Google Scholar
Stangier, U., Heidenreich, T., Berardi, A., Golbs, U. and Hoyer, J. (1999). Die Erfassung sozialer Phobie durch Social Interaction Anxiety Scale (SIAS) und die Social Phobia Scale (SPS). Zeitschrift für Klinische Psychologie, 28, 28–36. doi: 10.1026//0084-5345.28.1.28CrossRefGoogle Scholar
Suppiger, A., In-Albon, T., Hendriksen, S., Hermann, E., Margraf, J. R. and Schneider, S. (2009). Acceptance of structured diagnostic interviews for mental disorders in clinical practice and research settings. Behavior Therapy, 40, 272–279. doi: 10.1016/j.beth.2008.07.002Google Scholar
Titov, N., Andrews, G., Choi, I., Schwencke, G. and Johnston, L. (2009). Randomized controlled trial of web-based treatment of social phobia without clinician guidance. Australian and New Zealand Journal of Psychiatry, 43, 913–919. doi: 10.1080/00048670903179160Google Scholar
Titov, N., Andrews, G., Choi, I., Schwencke, G. and Mahoney, A. (2008). Shyness 3: randomized controlled trial of guided versus unguided Internet-based CBT for social phobia. Australian and New Zealand Journal of Psychiatry, 42, 1030–1040. doi: 10.1080/00048670802512107Google Scholar
Titov, N., Andrews, G., Johnston, L., Schwencke, G. and Choi, I. (2009). Shyness programme: longer term benefits, cost-effectiveness, and acceptability. Australian and New Zealand Journal of Psychiatry, 43, 36–44. doi: 10.1080/00048670802534424Google Scholar
Titov, N., Andrews, G. and Schwencke, G. (2008). Shyness 2: Treating social phobia online: replication and extension. Australian and New Zealand Journal of Psychiatry, 42, 595–605. doi: 10.1080/00048670802119820CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Schwencke, G., Drobny, J. and Einstein, D. (2008). Shyness 1: distance treatment of social phobia over the internet. Australian and New Zealand Journal of Psychiatry, 42, 585–594. doi: 10.1080/00048670802119762Google Scholar
Titov, N., Andrews, G., Schwencke, G., Robinson, E., Peters, L. and Spence, J. (2010). Randomized controlled trial of internet cognitive behavioural treatment for social phobia with and without motivational enhancement strategies. Australian and New Zealand Journal of Psychiatry, 44, 938–945. doi: 10.3109/00048674.2010.493859CrossRefGoogle ScholarPubMed
Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B. and Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 603–613. doi: 10.1001/archpsyc.62.6.603Google Scholar
Wittchen, H., Wunderlich, U., Gruschwitz, S. and Zaudig, M. (1997). Strukturiertes klinisches Interview für DSM-IV. Göttingen: Hogrefe.Google Scholar
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