A Randomized Trial of Brief Online Interventions to Facilitate Treatment Seeking for Social Anxiety

Abstract

This study developed and evaluated a brief, single-session online intervention designed to facilitate treatment seeking among adults with clinically significant social anxiety (SA) symptoms, who generally seek treatment at exceptionally low rates. Adults (N = 267) reporting significant SA symptoms were recruited online and randomized to a brief, single-session online intervention: Education consisted of brief psychoeducation and treatment resources, or Education+Motivation which added treatment seeking-focused motivational content adapted from Motivational Interviewing and Acceptance and Commitment Therapy. Attitudes, intentions, perceived control, and treatment seeking were assessed at Pre, Post, and 1-month follow-up (FU). Both interventions were feasible (90% completion) and improved all outcomes. At FU, 70% reported engaging in one or more SA treatment-seeking behaviors. Education+Motivation was more effective than Education at improving treatment-seeking attitudes and behaviors. A brief online intervention with educational and motivational content is a promising direction for promoting treatment seeking for adults with SA symptoms.

Keywords

social anxiety disorder internet values motivation acceptance and commitment therapy motivational interviewing

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References

Ajzen

(1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.

Arch

J. J.

Twohig

M. P.

Deacon

B. J.

Landy

L. N.

Bluett

E. J.

(2015). The credibility of exposure therapy: Does the theoretical rationale matter? Behaviour Research and Therapy, 72, 81–92.

Assessing attrition bias. (2013). Retrieved from https://ies.ed.gov/ncee/wwc/Docs/ReferenceResources/wwc_attrition_v2.1.pdf.

Attkisson

C. C.

Zwick

(1982). The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5(3), 233–237.

Becker

K. D.

Boustani

Gellatly

Chorpita

B. F.

(2018). Forty years of engagement research in children’s mental health services: Multidimensional measurement and practice elements. Journal of Clinical Child & Adolescent Psychology, 47(1), 1–23.

Brijnath

Protheroe

Mahtani

K. R.

Antoniades

(2016). Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. Journal of Medical Internet Research, 18(6), e165.

Brown

T. A.

Barlow

D. H.

(2014). Anxiety and related disorders interview schedule for DSM-5 (ADIS-5L): Lifetime version. Client interview schedule. Oxford University Press.

Bruce

S. E.

Yonkers

K. A.

Otto

M. W.

Eisen

J. L.

Weisberg

R. B.

Pagano

Shea

M. T.

Keller

M. B.

(2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162(6), 1179–1187.

Buckner

J. D.

Bonn-Miller

M. O.

Zvolensky

M. J.

Schmidt

N. B.

(2007). Marijuana use motives and social anxiety among marijuana-using young adults. Addictive Behaviors, 32(10), 2238–2252.

10.

Buckner

J. D.

Schmidt

N. B.

(2009). A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive-behavioral therapy for social anxiety. Behaviour Research and Therapy, 47(8), 710–715.

11.

Caplan

S. E.

(2007). Relations among loneliness, social anxiety, and problematic Internet use. CyberPsychology & Behavior, 10(2), 234–242.

12.

Chandler

Shapiro

(2016). Conducting clinical research using crowdsourced convenience samples. Annual Review of Clinical Psychology, 12, 53–81.

13.

Chartier-Otis

Perreault

Bélanger

(2010). Determinants of barriers to treatment for anxiety disorders. Psychiatric Quarterly, 81(2), 127–138.

14.

Coles

M. E.

Schubert

J. R.

Heimberg

R. G.

Weiss

B. D.

(2014). Disseminating treatment for anxiety disorders: Step 1: Recognizing the problem as a precursor to seeking help. Journal of Anxiety Disorders, 28(8), 737–740.

15.

Coles

M. E.

Turk

C. L.

Jindra

Heimberg

R. G.

(2004). The path from initial inquiry to initiation of treatment for social anxiety disorder in an anxiety disorders specialty clinic. Journal of Anxiety Disorders, 18(3), 371–383.

16.

Connor

K. M.

Davidson

J. R.

Churchill

L. E.

Sherwood

Foa

Weisler

R. H.

(2000). Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. The British Journal of Psychiatry, 176(4), 379–386.

17.

Craske

M. G.

Niles

A. N.

Burklund

L. J.

Wolitzky-Taylor

K. B.

Vilardaga

J. C.

Arch

J. J.

Saxbe

D. E.

Lieberman

M. D.

(2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators. Journal of Consulting and Clinical Psychology, 82(6), 1034–1048.

18.

Faul

Erdfelder

Lang

A. G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

19.

Fehm

Beesdo

Jacobi

Fiedler

(2008). Social anxiety disorder above and below the diagnostic threshold: Prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257–265.

20.

Feingold

(2009). Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods, 14(1), 43–53.

21.

Fishbein

Ajzen

(2011). Predicting and changing behavior: The reasoned action approach. Taylor & Francis.

22.

Gallo

K. P.

Comer

J. S.

Barlow

D. H.

(2013). Direct-to-consumer marketing of psychological treatments for anxiety disorders. Journal of Anxiety Disorders, 27(8), 793–801.

23.

Glenn

Golinelli

Rose

R. D.

Roy-Byrne

Stein

M. B.

Sullivan

Bystritksy

Sherbourne

Craske

M. G.

(2013). Who gets the most out of cognitive behavioral therapy for anxiety disorders? The role of treatment dose and patient engagement. Journal of Consulting and Clinical Psychology, 81(4), 639–649.

24.

Grant

B. F.

Hasin

D. S.

Blanco

Stinson

F. S.

Chou

S. P.

Goldstein

R. B.

Dawson

D. A.

Smith

Saha

T. D.

Huang

(2005). The epidemiology of social anxiety disorder in the United States: Results from the National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66(11), 1351–1361.

25.

Green

MacLeod

C. J.

(2016). SIMR : An R package for power analysis of generalized linear mixed models by simulation. Methods in Ecology and Evolution, 7(4), 493–498.

26.

Griffiths

K. M.

(2013). Towards a framework for increasing help-seeking for social anxiety disorder. Australian and New Zealand Journal of Psychiatry, 47(10), 899–903.

27.

Griffiths

K. M.

Walker

Batterham

P. J.

(2017). Help seeking for social anxiety: A pilot randomised controlled trial. Digital Health, 3, 1–12.

28.

Gulliver

Griffiths

K. M.

Christensen

Brewer

J. L.

(2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry, 12(1), 81.

29.

Hansen

R. A.

Gaynes

B. N.

Gartlehner

Moore

C. G.

Tiwari

Lohr

K. N.

(2008). Efficacy and tolerability of second-generation antidepressants in social anxiety disorder. International Clinical Psychopharmacology, 23(3), 170–179.

30.

Hayes

S. C.

Strosahl

K. D.

Wilson

K. G.

(1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.

31.

Hofmann

S. G.

Smits

J. A.

(2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621–632.

32.

Hox

(2010). Sample sizes and power analysis in multilevel regression. In Multilevel analysis: Techniques and applications (2nd ed., pp. 233–256). Taylor & Francis Group.

33.

Iza

Olfson

Vermes

Hoffer

Wang

Blanco

(2013). Probability and predictors of first treatment contact for anxiety disorders in the United States: Analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 74(11), 1093–1100.

34.

Jorm

A. F.

(2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243.

35.

Jorm

A. F.

Korten

A. E.

Jacomb

P. A.

Christensen

Rodgers

Pollitt

(1997). Mental health literacy": A survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Australia, 166(4), 182–186.

36.

Kazdin

A. E.

Blase

S. L.

(2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6(1), 21–37.

37.

Keller

M. B.

(2006). Social anxiety disorder clinical course and outcome: Review of Harvard/Brown Anxiety Research Project (HARP) findings. Journal of Clinical Psychiatry, 67(Suppl 12), 14–19.

38.

Kessler

R. C.

Berglund

Demler

Jin

Merikangas

K. R.

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(6), 593–602.

39.

Kroenke

Spitzer

R. L.

Williams

J. B.

(2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

40.

Kuznetsova

Brockhoff

P. B.

Christensen

R. H. B.

(2017). LmerTest package: Tests in linear mixed effects models. Journal of Statistical Software, 82(13), 1–26.

41.

Kwan

B. M.

Bryan

A. D.

(2010). Affective response to exercise as a component of exercise motivation: Attitudes, norms, self-efficacy, and temporal stability of intentions. Psychology of Sport and Exercise, 11(1), 71–79.

42.

Lannin

D. G.

Vogel

D. L.

Heath

P. J.

(2017). Can reflecting on personal values online increase positive beliefs about counseling? Journal of Counseling Psychology, 64(3), 261–268.

43.

Littell

J. H.

Girvin

(2002). Stages of change: A critique. Behavior Modification, 26(2), 223–273.

44.

Lundahl

Burke

B. L.

(2009). The effectiveness and applicability of motivational interviewing: A practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65(11), 1232–1245.

45.

Maltby

Tolin

D. F.

(2005). A brief motivational intervention for treatment-refusing OCD patients. Cognitive Behaviour Therapy, 34(3), 176–184.

46.

Mayo-Wilson

Dias

Mavranezouli

Kew

Clark

D. M.

Ades

A. E.

Pilling

(2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368–376.

47.

McHugh

R. K.

Whitton

S. W.

Peckham

A. D.

Welge

J. A.

Otto

M. W.

(2013). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: A meta-analytic review. Journal of Clinical Psychiatry, 74(6), 595–602.

48.

Miller

W. R.

Rollnick

(2002). Motivational interviewing: Preparing people for change. Guilford Press.

49.

Miller

W. R.

Zweben

DiClemente

C. C.

Rychtarik

R. G.

(1992). Motivational enhancement therapy manual: A clinical tool for therapists treating individuals with alcohol abuse and dependence. National Institute on Alcohol Abuse and Alcoholism.

50.

Moscovitch

D. A.

(2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioral Practice, 16(2), 123–134.

51.

Moscovitch

D. A.

Rodebaugh

T. L.

Hesch

B. D.

(2012). How awkward! Social anxiety and the perceived consequences of social blunders. Behaviour Research and Therapy, 50(2), 142–149.

52.

Moser

J. S.

Hajcak

Huppert

J. D.

Foa

E. B.

Simons

R. F.

(2008). Interpretation bias in social anxiety as detected by event-related brain potentials. Emotion, 8(5), 693–700.

53.

Nelson

C. J.

Saracino

R. M.

Napolitano

Pessin

Narus

J. B.

Mulhall

J. P.

(2019). Acceptance and commitment therapy to increase adherence to penile injection therapy-based rehabilitation after radical prostatectomy: Pilot randomized controlled trial. Journal of Sexual Medicine, 16(9), 1398–1408.

54.

Norman

S. B.

Cissell

S. H.

Means-Christensen

A. J.

Stein

M. B.

(2006). Development and validation of an overall anxiety severity and impairment scale (OASIS). Depression and Anxiety, 23(4), 245–249.

55.

Olfson

Guardino

Struening

Schneier

F. R.

Hellman

Klein

D. F.

(2000). Barriers to the treatment of social anxiety. American Journal of Psychiatry, 157(4), 521–527.

56.

Peters

Romano

Byrow

Gregory

McLellan

L. F.

Brockveld

Baillie

Gaston

Rapee

R. M.

(2019). Motivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial. Journal of Affective Disorders, 256, 70–78.

57.

Prochaska

J. O.

DiClemente

C. C.

(1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.

58.

Ruscio

A. M.

Brown

T. A.

Chiu

W. T.

Sareen

Stein

M. B.

Kessler

R. C.

(2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey replication. Psychological Medicine, 38(1), 15–28.

59.

Seidman

A. J.

Wade

N. G.

Lannin

D. G.

Heath

P. J.

Brenner

R. E.

Vogel

D. L.

(2018). Self-affirming values to increase student veterans’ intentions to seek counseling. Journal of Counseling Psychology, 65(5), 653–660.

60.

Shapiro

D. N.

Chandler

Mueller

P. A.

(2013). Using mechanical turk to study clinical populations. Clinical Psychological Science, 1(2), 213–220.

61.

Stein

M. B.

Fuetsch

Müller

Höfler

Lieb

Wittchen

H. U.

(2001). Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry, 58(3), 251–256.

62.

Stein

M. B.

Stein

D. J.

(2008). Social anxiety disorder. Lancet, 371, 1115–1125.

63.

van der Linden

G. J.

Stein

D. J.

van Balkom

A. J

. (2000). The efficacy of the selective serotonin reuptake inhibitors for social anxiety disorder (social phobia): A meta-analysis of randomized controlled trials. International Clinical Psychopharmacology, 15(Suppl2), S15–S23.

64.

Wang

P. S.

Berglund

Olfson

Pincus

H. A.

Wells

K. B.

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(6), 603–613.

65.

Wang

P. S.

Lane

Olfson

Pincus

H. A.

Wells

K. B.

Kessler

R. C.

(2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey replication. Archives of General Psychiatry, 62(6), 629–640.

66.

Westra

H. A.

Arkowitz

Dozois

D. J.

(2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders, 23(8), 1106–1117.

67.

Westra

H. A.

Dozois

D. J. A.

(2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30(4), 481–498.

68.

Wolitzky-Taylor

Zimmermann

Arch

J. J.

De Guzman

Lagomasino

(2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9–17.

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