Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
PLoS One. 2012;7(5):e37411. doi: 10.1371/journal.pone.0037411. Epub 2012 May 23.
Guided internet-delivered cognitive behavior therapy (ICBT) has been tested in several trials on social anxiety disorder (SAD) with moderate to large effects. The aims of this study were threefold. First, to compare the effects of ICBT including online discussion forum with a moderated online discussion forum only. Second, to investigate if knowledge about SAD increased following treatment and third to compare the effects of inexperienced versus experienced therapists on patient outcomes.
A total of 204 participants with a primary diagnosis of SAD were included and randomized to either guided ICBT or the control condition. ICBT consisted of a 9-week treatment program which was guided by either psychology students at MSc level (n = 6) or by licensed psychologists with previous experience of ICBT (n = 7). A knowledge test dealing with social anxiety was administered before and after treatment. Measures of social anxiety and secondary outcomes dealing with general anxiety, depression, and quality of life were administered before and after treatment. In addition, a 1-year follow-up was conducted on the treated individuals.
Immediately following treatment, the ICBT group showed superior outcome on the Liebowitz Social Anxiety Scale self-report version with a between group posttreatment Hedges g effect size of g = 0.75. In addition, significant differences on all the secondary outcomes were observed. Gains were well maintained one year later. Knowledge, as assessed by the knowledge test, increased following treatment with little gain in the control group. Therapist experience did not result in different outcomes, but experienced therapists logged in less frequently compared to the inexperienced therapists, suggesting that they needed less time to support patients.
We conclude that guided ICBT reduce symptoms of SAD, increase knowledge about SAD and that therapist experience does not make a difference apart from the finding that experienced therapist may require less time to guide patients.
UMIN.ac.jp UMIN000001383.
已在几项社交焦虑障碍（SAD）试验中测试了指导互联网提供的认知行为疗法（ICBT），其疗效为中等到较大。本研究的目的有三。首先，比较包括在线讨论论坛的 ICBT 与仅包含moderated 在线讨论论坛的效果。其次，调查治疗后对 SAD 的了解是否增加。第三，比较无经验治疗师和有经验治疗师对患者结局的影响。
共纳入 204 名 SAD 初诊患者，并随机分为接受指导的 ICBT 或对照组。ICBT 包含一个为期 9 周的治疗计划，由硕士水平的心理学学生（n=6）或有过 ICBT 经验的持照心理学家（n=7）进行指导。在治疗前后进行社交焦虑知识测试。在治疗前后，还进行了社交焦虑和涉及一般焦虑、抑郁和生活质量的次要结局测量。此外，对接受治疗的个体进行了为期 1 年的随访。
治疗后即刻，ICBT 组在 Liebowitz 社交焦虑量表自评版本上的结果更好，组间治疗后 Hedges g 效应大小为 g=0.75。此外，还观察到所有次要结局的显著差异。一年后，获益得以很好地维持。治疗后，知识测试评估的知识有所增加，而对照组的知识增长较少。治疗师经验并未导致不同的结局，但经验丰富的治疗师登录频率低于无经验治疗师，这表明他们需要较少的时间来支持患者。
我们的结论是，指导的 ICBT 可减轻 SAD 的症状，增加对 SAD 的了解，且治疗师经验除了经验丰富的治疗师可能需要较少的时间来指导患者外，并无差异。
UMIN.ac.jp UMIN000001383。
