%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66210 %T A Rent Subsidy and Identity Capital Intervention for Youth Exiting Homelessness: Protocol for the Transitioning Youth Out of Homelessness 2.0 Pilot Randomized Controlled Trial %A Thulien,Naomi S %A Stark,Rowen K %A Amiri,Alexandra %A Abramovich,Alex %A Akdikmen,Alex %A Carasco,Alexandra %A Daley,Mardi %A Downey,Bernice %A Fambegbe,Oluwapelumi (Pukky) %A Frederick,Tyler %A Hwang,Stephen W %A Kozloff,Nicole %A Noble,Amanda %A Pedersen,Cheryl %A Rampersaud,Marsha %A Rodney,Ruth %A Tibebu,Tadios %A Nisenbaum,Rosane %+ MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, 209 Victoria St., Toronto, ON, M5B 1T8, Canada, 1 647 460 0781, naomi.thulien@unityhealth.to %K youth homelessness %K socioeconomic inclusion %K transition %K critical qualitative methodology %K community-based research %K identity capital %K youth %K homeless %K rent %K community %K feasibility %K acceptability %K novel intervention %K socioeconomic %K participatory action research %K pilot study %K protocol %K RCT %K randomized controlled trial %D 2025 %7 25.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: For young people who have experienced homelessness, relative housing stability alone is insufficient to achieve socioeconomic inclusion. There is little peer-reviewed research investigating interventions targeting socioeconomic inclusion outcomes for youth who have experienced homelessness. Our previous community-engaged work signaled that identity capital (purpose, control, self-efficacy, and self-esteem) may mediate socioeconomic inclusion outcomes for youth exiting homelessness. This 12-month pilot randomized controlled trial (RCT) explores whether portable rent subsidies and an intervention targeting identity capital hold promise as a way to facilitate socioeconomic inclusion for youth exiting homelessness and living in market rent housing in Ontario, Canada. Objective: The objectives of this study were (1) to examine the feasibility and acceptability of an RCT of targeted economic and identity-based supports to foster socioeconomic inclusion (primary objective), (2) to estimate the effect of adding identity-based supports to economic supports (intervention group) compared with economic supports alone (control group) at the 12-month end point with respect to self-reported proxy indicators of socioeconomic inclusion (secondary objective), and (3) to explore, among the intervention group, whether the estimated effect of the intervention differs by baseline variables or level of engagement with the intervention (exploratory objective). Methods: This study is a convergent mixed methods, 2-arm parallel RCT, open-label design with 1:1 allocation. All youth participants (n=40) received rent subsidies; half were randomly assigned an identity capital intervention (co-designed leadership guide+coach). The overall study was guided by community-based participatory action research axiology. The qualitative component used a qualitative descriptive design underpinned by critical social theory. The measures used were (1) recruitment, enrolment, and dropout metrics; self-report composite checklists regarding intervention engagement; coaching session attendance; and qualitative focus groups (primary measures); (2) education, employment, and training; housing security; and identity capital (secondary measures); and (3) impact of baseline variables (eg, participant demographics such as gender or mental health symptoms as measured by the Global Appraisal of Individual Needs–Short Screener) or level of engagement with intervention (coaching session attendance) on secondary measures (exploratory measures). Results: Recruitment and enrolment began March 1, 2023, and ended June 19, 2023. Data collection began March 7, 2023, and ended June 17, 2024. Qualitative and quantitative data analyses concluded on August 20, 2024. Conclusions: Findings from this RCT will help inform the way we conceptualize the types of supports that are necessary to sustain successful exits from homelessness. The intervention was co-designed with youth who have experienced homelessness, and their voices will continue to inform the next iteration of this work. Trial Registration: ClinicalTrials.gov NCT05781503; https://clinicaltrials.gov/study/NCT05781503 International Registered Report Identifier (IRRID): DERR1-10.2196/66210 %M 40279147 %R 10.2196/66210 %U https://www.researchprotocols.org/2025/1/e66210 %U https://doi.org/10.2196/66210 %U http://www.ncbi.nlm.nih.gov/pubmed/40279147 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60957 %T Blended Mobile-Based Interventions With Integrated Virtual Reality Exposure Therapy for Anxiety Disorders: Thematic Analysis of Patient Perspectives %A Planert,Jari %A Hildebrand,Anne-Sophie %A Machulska,Alla %A Roesmann,Kati %A Neubert,Marie %A Pilgramm,Sebastian %A Pilgramm,Juliane %A Klucken,Tim %+ Department of Psychology, Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 21, Siegen, 57072, Germany, 49 271 740 ext 3887, jari.planert@uni-siegen.de %K virtual reality exposure therapy %K anxiety disorders %K internet- and mobile-based interventions %K blended therapy %K eHealth %D 2025 %7 24.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Guided mobile-based interventions may mitigate symptoms of anxiety disorders such as panic disorder, agoraphobia, or social anxiety disorder. With exposure therapy being efficacious in traditional treatments for these disorders, recent advancements have introduced 360° videos to deliver virtual reality exposure therapy (VRET) within mobile-based interventions. Objective: Despite ongoing trials evaluating the treatment’s efficacy, research examining patient perceptions of this innovative approach is still scarce. Therefore, this study aimed to explore patient opinions on specific treatment aspects of mobile-based interventions using mobile VRET and psychotherapeutic guidance for anxiety disorders. Methods: A total of 11 patients diagnosed with panic disorder, agoraphobia, or social anxiety disorder who had previously taken part in the experimental conditions of 2 randomized controlled trials for a mobile intervention including mobile VRET participated in cross-sectional, retrospective interviews. Using a semistructured interview format, patients were asked to reflect on their treatment experiences; personal changes; helpful and hindering aspects; their motivation levels; and their encounters with the mobile-based intervention, manualized treatment sessions, and the mobile VRET. Results: Thematic analysis led to the formation of 14 themes in four superordinate categories: (1) perceived treatment outcomes, (2) aspects of the mobile intervention, (3) experiences with mobile VRET, and (4) contextual considerations. Patients offered their insights into factors contributing to treatment success or failure, delineated perceived treatment outcomes, and highlighted favorable aspects of the treatment while pointing out shortcomings and suggesting potential enhancements. Most strikingly, while using a blended app-based intervention, patients highlighted the role of psychotherapeutic guidance as a central contributing factor to their symptom improvement. Conclusions: The findings of the thematic analysis and its diverse patient perspectives hold the potential to guide future research to improve mobile-based treatment options for anxiety disorders. Insights from these patient experiences can contribute to refining mobile-based interventions and optimizing the integration of VRET in accordance with patients’ preferences, needs, and expectations. %M 40273440 %R 10.2196/60957 %U https://humanfactors.jmir.org/2025/1/e60957 %U https://doi.org/10.2196/60957 %U http://www.ncbi.nlm.nih.gov/pubmed/40273440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64138 %T Safety and Efficacy of Modular Digital Psychotherapy for Social Anxiety: Randomized Controlled Trial %A Garvert,Mona M %A McFadyen,Jessica %A Linke,Stuart %A McCloud,Tayla %A Meyer,Sofie S %A Sobanska,Sandra %A Sharp,Paul B %A Long,Alex %A Huys,Quentin J M %A Ahmadi,Mandana %+ Alena, 25 Wilton Rd, Pimlico, London, SW1V 1LW, United Kingdom, 44 09313185834, mona.garvert@gmail.com %K social anxiety disorder %K randomized controlled trial %K digital mental health %K cognitive behavioral therapy %K internet-delivered CBT %D 2025 %7 10.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Social anxiety disorder is a common mental health condition characterized by an intense fear of social situations that can lead to significant impairment in daily life. Cognitive behavioral therapy (CBT) has been recognized as an effective treatment; however, access to therapists is limited, and the fear of interacting with therapists can delay treatment seeking. Furthermore, not all individuals respond. Tailoring modular treatments to individual cognitive profiles may improve efficacy. We developed a novel digital adaptation of CBT for social anxiety that is both modular and fully digital without a therapist in the loop and implemented it in the smartphone app Alena. Objective: This study aimed to evaluate the safety, acceptability, and efficacy of the new treatment in online participants with symptoms of social anxiety. Methods: In total, 2 web-based randomized controlled trials (RCTs) comparing individuals with access to the treatment through the app to a waitlist control group were conducted. Participants were recruited on the web and reported Social Phobia Inventory (SPIN) total scores of ≥30. Primary outcomes were safety and efficacy over 6 weeks in 102 women aged 18 to 35 years (RCT 1) and symptom reduction (SPIN scores) after 8 weeks in 248 men and women aged 18 to 75 years (RCT 2). Results: In RCT 1, active and control arm adverse event frequency and severity were not distinguishable (intervention: 7/52, 13%; waitlist control: 8/50, 16%; χ21=0.007; P=.93). App acceptability was high, with a median completion rate of 90.91% (IQR 54.55%-100%). Secondary outcomes suggested greater symptom reduction in the active arm (mean SPIN score reduction −9.83, SD 12.80) than in the control arm (mean SPIN score reduction −4.13, SD 11.59; t90=−2.23; false discovery rate P=.04; Cohen d=0.47). RCT 2 replicated these findings. Adverse event frequency was comparable across the 2 groups (intervention: 20/124, 16.1%; waitlist control: 21/124, 16.8%; χ21<0.001; P>.99). Despite a longer treatment program, median completion remained high (84.85%, IQR 51.52%-96.97%). SPIN score reduction was greater in the active arm (mean −12.89, SD 13.87) than in the control arm (mean −7.48, SD 12.24; t227=−3.13; false discovery rate P=.008; Cohen d=0.42). Conclusions: The web-only, modular social anxiety CBT program appeared safe, acceptable, and efficacious in 2 independent RCTs on online patient groups with self-reported symptoms of social anxiety. Trial Registration: ClinicalTrials.gov NCT05858294; https://clinicaltrials.gov/study/NCT05858294 (RCT 1) and ClinicalTrials.gov NCT05987969; https://clinicaltrials.gov/study/NCT05987969 (RCT 2) %M 40208666 %R 10.2196/64138 %U https://www.jmir.org/2025/1/e64138 %U https://doi.org/10.2196/64138 %U http://www.ncbi.nlm.nih.gov/pubmed/40208666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65589 %T Therapeutic Potential of Social Chatbots in Alleviating Loneliness and Social Anxiety: Quasi-Experimental Mixed Methods Study %A Kim,Myungsung %A Lee,Seonmi %A Kim,Sieun %A Heo,Jeong-in %A Lee,Sangil %A Shin,Yu-Bin %A Cho,Chul-Hyun %A Jung,Dooyoung %+ Department of Psychiatry, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 029205505, david0203@gmail.com %K artificial intelligence %K AI %K social chatbot %K loneliness %K social anxiety %K exploratory research %K mixed methods study %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) social chatbots represent a major advancement in merging technology with mental health, offering benefits through natural and emotional communication. Unlike task-oriented chatbots, social chatbots build relationships and provide social support, which can positively impact mental health outcomes like loneliness and social anxiety. However, the specific effects and mechanisms through which these chatbots influence mental health remain underexplored. Objective: This study explores the mental health potential of AI social chatbots, focusing on their impact on loneliness and social anxiety among university students. The study seeks to (i) assess the impact of engaging with an AI social chatbot in South Korea, "Luda Lee," on these mental health outcomes over a 4-week period and (ii) analyze user experiences to identify perceived strengths and weaknesses, as well as the applicability of social chatbots in therapeutic contexts. Methods: A single-group pre-post study was conducted with university students who interacted with the chatbot for 4 weeks. Measures included loneliness, social anxiety, and mood-related symptoms such as depression, assessed at baseline, week 2, and week 4. Quantitative measures were analyzed using analysis of variance and stepwise linear regression to identify the factors affecting change. Thematic analysis was used to analyze user experiences and assess the perceived benefits and challenges of chatbots. Results: A total of 176 participants (88 males, average age=22.6 (SD 2.92)) took part in the study. Baseline measures indicated slightly elevated levels of loneliness (UCLA Loneliness Scale, mean 27.97, SD (11.07)) and social anxiety (Liebowitz Social Anxiety Scale, mean 25.3, SD (14.19)) compared to typical university students. Significant reductions were observed as loneliness decreasing by week 2 (t175=2.55, P=.02) and social anxiety decreasing by week 4 (t175=2.67, P=.01). Stepwise linear regression identified baseline loneliness (β=0.78, 95% CI 0.67 to 0.89), self-disclosure (β=–0.65, 95% CI –1.07 to –0.23) and resilience (β=0.07, 95% CI 0.01 to 0.13) as significant predictors of week 4 loneliness (R2=0.64). Baseline social anxiety (β=0.92, 95% CI 0.81 to 1.03) significantly predicted week 4 anxiety (R2=0.65). These findings indicate higher baseline loneliness, lower self-disclosure to the chatbot, and higher resilience significantly predicted higher loneliness at week 4. Additionally, higher baseline social anxiety significantly predicted higher social anxiety at week 4. Qualitative analysis highlighted the chatbot's empathy and support as features for reliability, though issues such as inconsistent responses and excessive enthusiasm occasionally disrupted user immersion. Conclusions: Social chatbots may have the potential to mitigate feelings of loneliness and social anxiety, indicating their possible utility as complementary resources in mental health interventions. User insights emphasize the importance of empathy, accessibility, and structured conversations in achieving therapeutic goals. Trial Registration: Clinical Research Information Service (CRIS) KCT0009288; https://tinyurl.com/hxrznt3t %M 39808786 %R 10.2196/65589 %U https://www.jmir.org/2025/1/e65589 %U https://doi.org/10.2196/65589 %U http://www.ncbi.nlm.nih.gov/pubmed/39808786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59540 %T Effectiveness of a Videoconference-Based Cognitive Behavioral Therapy Program for Patients with Schizophrenia: Pilot Randomized Controlled Trial %A Katsushima,Masayuki %A Nakamura,Hideki %A Shiko,Yuki %A Hanaoka,Hideki %A Shimizu,Eiji %+ Department of Rehabilitation, Faculty of Health Care and Medical Sports, Teikyo Heisei University, 4-1 UruidoMinami, Ichihara, 290-0193, Japan, 81 436 74 6915, m.katsushima@thu.ac.jp %K schizophrenia %K randomized controlled trial %K cognitive behavioral therapy %K videoconference %K remote therapy %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy for psychosis (CBTp) is not sufficiently widespread in clinical practice, although evidence has been presented. Objective: The purpose of this study was to explore whether one-on-one videoconference-based CBTp (vCBTp) is more effective than usual care (UC) alone for improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. Methods: In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp program was conducted once a week, with each session lasting for 50 minutes, for a total of 7 sessions conducted in real-time and in a one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline (week 0) to posttest (week 8). Results: The study included 24 participants. There were no significant differences between the 2 groups at baseline. With regard to significant differences between the 2 groups in terms of the primary outcome, the mean change in the PANSS total score from baseline to week 8 in the vCBTp plus UC group was –9.5 (95% CI –12.09 to –6.91) and the mean change in the UC alone group was 6.9 (95% CI 1.54-12.30). The difference between the 2 groups was significant (P<.001). In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder-7 (GAD-7; P=.04) and EQ-5D-5L (P=.005). There were no dropouts and no serious adverse events in this study. Conclusions: A total of 7 remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life. However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the 2 groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety regarding transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069734 %M 39610049 %R 10.2196/59540 %U https://formative.jmir.org/2025/1/e59540 %U https://doi.org/10.2196/59540 %U http://www.ncbi.nlm.nih.gov/pubmed/39610049 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56235 %T Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study %A Beele,Gesa %A Liesong,Paula %A Bojanowski,Sabine %A Hildebrand,Kristian %A Weingart,Malte %A Asbrand,Julia %A Correll,Christoph U %A Morina,Nexhmedin %A Uhlhaas,Peter J %+ Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, Berlin, 13353, Germany, 49 30450 ext 516193, peter.uhlhaas@charite.de %K virtual reality exposure therapy %K VRET %K school anxiety %K social anxiety %K adolescents %K virtual reality %K VR %K autonomic arousal %K exposure therapy %K posttreatment %K digital health %K simulation %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking. Objective: A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of “being there,” during VR exposure with anxiety measures and treatment response was examined. Methods: In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured. Results: The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response. Conclusions: Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents. %M 39499549 %R 10.2196/56235 %U https://mental.jmir.org/2024/1/e56235 %U https://doi.org/10.2196/56235 %U http://www.ncbi.nlm.nih.gov/pubmed/39499549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55679 %T Virtual Reality–Based Exposure With 360° Environments for Social Anxiety Disorder: Usability and Feasibility Study %A Ernst,Mathias %A Bouchard,Stéphane %A Andersen,Tonny %A Orskov,Per Trads %A Tarp,Kristine %A Lichtenstein,Mia Beck %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 26218846, mlichtenstein@health.sdu.dk %K anxiety %K exposure therapy %K social anxiety disorder %K virtual reality %K 360° %K mixed methods %K interactive %D 2024 %7 21.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social anxiety disorder (SAD) is a long-term and overwhelming fear of social situations that can affect work, school, and other daily activities. Although cognitive behavioral therapy is effective, few seek treatment, and many who do start often drop out. This may be due to the component of exposure inherent to cognitive behavioral therapy, where the patient confronts feared stimuli outside the therapist’s office, which they otherwise try to avoid. As an alternative, research has explored the effectiveness of virtual reality (VR)–based exposure therapy with promising results. However, few studies have investigated the feasibility of VR tools using mixed methodologies before assessing their efficacy. Objective: This study aims to assess the usability, feasibility, and presence of four 360° virtual environments and whether these were able to evoke anxiety in patients with SAD. Methods: A total of 10 adult participants with SAD and 10 healthy controls were recruited for 1 experimental session (age range 21-32 y; 12/20, 60% male participants). Questionnaire and interview data were collected and analyzed. A mixed methods triangulation design was applied to analyze and compare the data. Results: Participants with SAD experienced increased anxiety when exposed to VR, and environments were considered relevant and useful as an exposure tool. Participants with SAD reported significantly higher average anxiety levels (P=.01) and peak anxiety levels (P=.01) compared with controls during exposure; however, significant differences in anxiety when accounting for baseline anxiety levels were only found in 2 of 4 environments (P=.01, P=.01, P=.07, and P=.06). While presence scores were acceptable in both groups, participants with SAD scored significantly lower than controls. Qualitative analyses highlight this finding within the SAD group, where some participants experienced presence reduction due to being observed while in VR and in situations with reduced interaction in VR. Conclusions: VR exposure with 360° videos seems to be useful as a first step of exposure therapy for patients with SAD. Future exploration in the clinical application of VR-based exposure for SAD, as well as means of increasing presence within the virtual environments, may be useful. %M 39432344 %R 10.2196/55679 %U https://formative.jmir.org/2024/1/e55679 %U https://doi.org/10.2196/55679 %U http://www.ncbi.nlm.nih.gov/pubmed/39432344 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55786 %T Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Subthreshold Social Anxiety Disorder in Adolescents and Young Adults: Multicenter Randomized Controlled Trial %A Matsumoto,Kazuki %A Hamatani,Sayo %A Shiga,Kiko %A Iiboshi,Kiyoko %A Kasai,Makiko %A Kimura,Yasuhiro %A Yokota,Satoshi %A Watanabe,Katsunori %A Kubo,Yoko %A Nakamura,Masayuki %+ Division of Clinical Psychology, Kagoshima University Hospital, Research and Education Assembly Medical and Dental Sciences Area, Kagoshima University, 1-8-35 Sakuragaoka, Kagoshima, 8908520, Japan, 81 0992655707, k2782199@kadai.jp %K adolescent %K social anxiety disorder %K general anxiety %K adolescents %K teens %K social anxiety %K teenagers %K internet-based cognitive behavioral therapy %K self-help %K randomized controlled trials %K young adults %K cognitive behavioral therapy %K anxiety %K mental health %K students %K colleges %K universities %K social socialize %K anxious %K fear %K mobile phone %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. Objective: This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. Methods: A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. Results: In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. Conclusions: The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. Trial Registration: UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035 %M 39037759 %R 10.2196/55786 %U https://pediatrics.jmir.org/2024/1/e55786 %U https://doi.org/10.2196/55786 %U http://www.ncbi.nlm.nih.gov/pubmed/39037759 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52212 %T Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking %A Banakou,Domna %A Johnston,Tania %A Beacco,Alejandro %A Senel,Gizem %A Slater,Mel %+ Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Campus de Mundet Edifici CAVE, Passeig de la Vall d'Hebron 171, Barcelona, 08035, Spain, 34 93 403 ext 9618, melslater@ub.edu %K exposure therapy %K virtual reality %K gradual exposure %K fear of public speaking %K anxiety %K change blindness %K public speaking %K desensitization %K anxiety disorder %K feasibility study %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. Objective: This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. Methods: We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. Results: Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. Conclusions: Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients. %M 39037760 %R 10.2196/52212 %U https://formative.jmir.org/2024/1/e52212 %U https://doi.org/10.2196/52212 %U http://www.ncbi.nlm.nih.gov/pubmed/39037760 %0 Journal Article %@ 2368-7959 %I JMIR Mental Health %V 11 %N %P e50535 %T The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial %A Wen,Xu %A Gou,Mengke %A Chen,Huijing %A Kishimoto,Tomoko %A Qian,Mingyi %A Margraf,Jürgen %A Berger,Thomas %K social anxiety disorder %K web-based cognitive behavioral therapy %K shame intervention %K mediating effects %K shame experience %D 2024 %7 27.6.2024 %9 %J JMIR Ment Health %G English %X Background: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. Objective: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. Methods: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Results: Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation −12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation −9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. Conclusions: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300072184; https://www.chictr.org.cn/showproj.html?proj=152757 %R 10.2196/50535 %U https://mental.jmir.org/2024/1/e50535 %U https://doi.org/10.2196/50535 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46593 %T Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review %A Fernández-Álvarez,Javier %A Colombo,Desirée %A Gómez Penedo,Juan Martín %A Pierantonelli,Maitena %A Baños,Rosa María %A Botella,Cristina %+ Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, Castellon de la Plana, 12071, Spain, 34 964 72 80 0, javferalvarez@gmail.com %K social anxiety disorder %K ambulatory assessment %K ecological momentary assessment %K intensive longitudinal methods %K systematic review %K social anxiety %K use %K qualitative synthesis %K emotional %K cognitive %K behavioral %K development %K mental disorder %K anxiety %K mental health %K mobile health %K mHealth %K monitoring %K review %K assessment %K mobile phone %D 2024 %7 4.4.2024 %9 Review %J JMIR Ment Health %G English %X Background: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. Objective: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. Results: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. Conclusions: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder. %M 38574359 %R 10.2196/46593 %U https://mental.jmir.org/2024/1/e46593 %U https://doi.org/10.2196/46593 %U http://www.ncbi.nlm.nih.gov/pubmed/38574359 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53353 %T Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study %A Zhang,Yanan %A Zhang,Xinwen %A Jiang,Jinzhuo %A Xie,Wanhua %A Xiang,Daoman %+ Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, 9 Jinsui Road, Guangzhou, 510623, China, 1 13725370379, xiewanhua1@126.com %K stigma %K social anxiety %K depression %K parents of children with cleft lip and palate %K cleft lip %K cleft palate %K cross-sectional study %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples. Objective: This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P. Methods: A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants’ demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma. Results: The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404). Conclusions: Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents’ education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents’ social anxiety, reducing perceived stigma, and preventing depression. %M 38437002 %R 10.2196/53353 %U https://formative.jmir.org/2024/1/e53353 %U https://doi.org/10.2196/53353 %U http://www.ncbi.nlm.nih.gov/pubmed/38437002 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53659 %T Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial %A Shinno,Seina %A Matsumoto,Kazuki %A Hamatani,Sayo %A Inaba,Yosuke %A Ozawa,Yoshihito %A Kawasaki,Yohei %A Ikai,Tomoki %A Sutoh,Chihiro %A Hayashi,Hiroyuki %A Shimizu,Eiji %+ Division of Clinical Psychology, Kagoshima University Medical and Dental Hospital, 1-35-8 Sakuragaoka, Kagoshima, 8908520, Japan, 81 099 275 5707, k2782199@kadai.jp %K cognitive behavioral therapy %K internet intervention %K panic disorder %K social anxiety %K feasibility trail %K adult %K adults %K anxiety disorder %K internet-based %K e-learning %K Japan %K statistical analyses %K therapist %K therapists %K intervention %K severity %K symptoms %K therapeutic alliance %K mobile phone %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. Objective: The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. Methods: In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire–9, Generalized Anxiety Disorder–7, and Working Alliance Inventory–Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire–9, and Generalized Anxiety Disorder–7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. Results: Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI –22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI –28.4 to –3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI –50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI –59.7 to –4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. Conclusions: Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439 %M 38421717 %R 10.2196/53659 %U https://formative.jmir.org/2024/1/e53659 %U https://doi.org/10.2196/53659 %U http://www.ncbi.nlm.nih.gov/pubmed/38421717 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e48916 %T Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review %A Shahid,Simon %A Kelson,Joshua %A Saliba,Anthony %+ Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Panorama Ave, Bathurst, 2795, Australia, 61 2 6338 4570, jkelson@csu.edu.au %K social anxiety disorder %K social phobia %K virtual reality %K VR %K VR exposure therapy %K effectiveness %K user experience %K safety %K usability %K acceptability %K anxiety %K phobia %K exposure %K systematic %K review methods %K review methodology %K social %K psychiatric %K mental health %K mobile phone %D 2024 %7 8.2.2024 %9 Review %J JMIR Ment Health %G English %X Background: Social anxiety disorder (SAD) is a debilitating psychiatric disorder that affects occupational and social functioning. Virtual reality (VR) therapies can provide effective treatment for people with SAD. However, with rapid innovations in immersive VR technology, more contemporary research is required to examine the effectiveness and concomitant user experience outcomes (ie, safety, usability, acceptability, and attrition) of emerging VR interventions for SAD. Objective: The aim of this systematic review was to examine the effectiveness and user experience of contemporary VR interventions among people with SAD. Methods: The Cochrane Library, Emcare, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science databases were searched between January 1, 2012, and April 26, 2022. Deduplicated search results were screened based on title and abstract information. Full-text examination was conducted on 71 articles. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience outcomes of any immersive VR intervention among people with SAD. A standardized coding sheet was used to extract data on key participant, intervention, comparator, outcome, and study design items. Results: The findings were tabulated and discussed using a narrative synthesis. A total of 18 studies met the inclusion criteria. Conclusions: The findings showed that VR exposure therapy–based interventions can generally provide effective, safe, usable, and acceptable treatments for adults with SAD. The average attrition rate from VR treatment was low (11.36%) despite some reported user experience difficulties, including potential simulator sickness, exposure-based emotional distress, and problems with managing treatment delivered in a synchronous group setting. This review also revealed several research gaps, including a lack of VR treatment studies on children and adolescents with SAD as well as a paucity of standardized assessments of VR user experience interactions. More studies are required to address these issues. Trial Registration: PROSPERO CRD42022353891; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353891 %M 38329804 %R 10.2196/48916 %U https://mental.jmir.org/2024/1/e48916 %U https://doi.org/10.2196/48916 %U http://www.ncbi.nlm.nih.gov/pubmed/38329804 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48926 %T A Digital Single-Session Intervention (Project Engage) to Address Fear of Negative Evaluation Among College Students: Pilot Randomized Controlled Trial %A Ghosh,Arka %A Cohen,Katherine A %A Jans,Laura %A Busch,Carly A %A McDanal,Riley %A Yang,Yuanyuan %A Cooper,Katelyn M %A Schleider,Jessica L %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, 21st Fl, Chicago, IL, 60611, United States, 1 3125033403, arka.ghosh@northwestern.edu %K single-session intervention %K fear of negative evaluation %K active learning course %K pilot randomized controlled trial %K intervention %K college student %K science course %K active learning %K negative evaluation %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Increasingly, college science courses are transitioning from a traditional lecture format to active learning because students learn more and fail less frequently when they engage in their learning through activities and discussions in class. Fear of negative evaluation (FNE), defined as a student’s sense of dread associated with being unfavorably evaluated while participating in a social situation, discourages undergraduates from participating in small group discussions, whole class discussions, and conversing one-on-one with instructors. Objective: This study aims to evaluate the acceptability of a novel digital single-session intervention and to assess the feasibility of implementing it in a large enrollment college science course taught in an active learning way. Methods: To equip undergraduates with skills to cope with FNE and bolster their confidence, clinical psychologists and biology education researchers developed Project Engage, a digital, self-guided single-session intervention for college students. It teaches students strategies for coping with FNE to bolster their confidence. Project Engage provides biologically informed psychoeducation, uses interactive elements for engagement, and helps generate a personalized action plan. We conducted a 2-armed randomized controlled trial to evaluate the acceptability and the preliminary effectiveness of Project Engage compared with an active control condition that provides information on available resources on the college campus. Results: In a study of 282 upper-level physiology students, participants randomized to complete Project Engage reported a greater increase in overall confidence in engaging in small group discussions (P=.01) and whole class discussions (P<.001), but not in one-on-one interactions with instructors (P=.05), from baseline to immediately after intervention outcomes, compared with participants in an active control condition. Project Engage received a good acceptability rating (1.22 on a scale of –2 to +2) and had a high completion rate (>97%). Conclusions: This study provides a foundation for a freely available, easily accessible intervention to bolster student confidence for contributing in class. Trial Registration: OSF Registries osf.io/4ca68 http://osf.io/4ca68 %M 37995114 %R 10.2196/48926 %U https://mental.jmir.org/2023/1/e48926 %U https://doi.org/10.2196/48926 %U http://www.ncbi.nlm.nih.gov/pubmed/37995114 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46008 %T Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study %A Prior,Katrina %A Salemink,Elske %A Piggott,Monique %A Manning,Victoria %A Wiers,Reinout W %A Teachman,Bethany A %A Teesson,Maree %A Baillie,Andrew J %A Mahoney,Alison %A McLellan,Lauren %A Newton,Nicola C %A Stapinski,Lexine A %+ Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 286279032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K young adult %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. Objective: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU). Methods: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. Results: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. Conclusions: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): RR2-10.2196/28667 %M 37878363 %R 10.2196/46008 %U https://formative.jmir.org/2023/1/e46008 %U https://doi.org/10.2196/46008 %U http://www.ncbi.nlm.nih.gov/pubmed/37878363 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48437 %T Internet-Based Cognitive Behavioral Therapy and Virtual Reality Exposure Therapy for Social Anxiety Disorder: Protocol for a Randomized Controlled Trial in Hong Kong %A Pan,Jia-Yan %+ Department of Social Work, Hong Kong Baptist University, 10/F, Academic and Administration Building, 15 Baptist University Road, Baptist University Road Campus, Hong Kong, China (Hong Kong), 852 34116415, jiayan@hkbu.edu.hk %K internet-based cognitive behavioral therapy %K virtual reality exposure therapy %K social anxiety disorder %K Chinese %K CBT %K iCBT %K internet %K virtual reality %K anxiety %K social phobia %K mental disorder %K mental health %K quality of life %K treatment %K cognitive behavioral therapy %K psychological intervention %D 2023 %7 14.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social anxiety disorder (SAD), also known as social phobia, is one of the most common mental disorders worldwide. In Hong Kong, the prevalence of SAD is high, but its treatment rate is low. SAD has immense impact on academic or work performance, social life, career development, and quality of life. One of the most effective treatments for SAD is cognitive behavioral therapy (CBT), with internet-based CBT (iCBT) and virtual reality exposure therapy (VRET) showing promise in treating SAD. However, internet interventions are underdeveloped in Chinese communities including Hong Kong. Objective: This study aims to develop an iCBT program that includes VRET, called “Ease Anxiety in Social Event Online” (Ease Online), for Hong Kong adults with SAD in a randomized controlled trial. Methods: The 14-week Ease Online program is a guided self-help iCBT program with a blended mode of service delivery. The program comprises 9 web-based modules and 5 individual counseling sessions (including 2 VRET sessions) conducted remotely or face-to-face with a therapist to provide therapist support, as guided iCBT shows superior effects than unguided iCBT. Other program components include therapist feedback on assignments, internal messages, forums, client portfolios, web-based questionnaires, reminders, and web-based bookings. The program can be accessed either through a mobile app or program website through a PC with an internet connection. The participants are openly recruited and screened using a questionnaire and through an intake interview. Eligible participants are randomized by placing them into a web-based iCBT group, app-based iCBT group, or a waitlist control (WLC) group. Participants in the WLC group are assigned to the app-based program upon completion of the service of the 2 experimental groups. Measurements of social anxiety, depression and anxiety symptoms, psychological distress, automatic thoughts, and quality of life are administered at pretest, posttest, and 3- and 6-month follow-ups. Multivariate ANOVA with repeated measures will be performed to determine the intervention effectiveness on the continuous variables over time. Results: Participant recruitment commenced in January 2021. As of February 2023, a total of 1811 individuals applied for the Ease Online program. In total, 401 intake interviews have been completed, and 329 eligible participants have joined the program, among whom 166 have completed the service. Data collection is still ongoing, which is expected to be completed in March 2024. Conclusions: This study is the first of its kind in combining iCBT and VRET for the treatment of SAD in Hong Kong. At a theoretical level, this study contributes to the development and evaluation of internet-based psychological interventions in Hong Kong. At a practical level, the Ease Online program may serve as an alternative service option for SAD clients in Hong Kong if proven effective. Trial Registration: ClinicalTrials.gov NCT04995913; https://clinicaltrials.gov/study/NCT04995913 International Registered Report Identifier (IRRID): DERR1-10.2196/48437 %M 37707944 %R 10.2196/48437 %U https://www.researchprotocols.org/2023/1/e48437 %U https://doi.org/10.2196/48437 %U http://www.ncbi.nlm.nih.gov/pubmed/37707944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44888 %T Changes in Learning From Social Feedback After Web-Based Interpretation Bias Modification: Secondary Analysis of a Digital Mental Health Intervention Among Individuals With High Social Anxiety Symptoms %A Beltzer,Miranda L %A Daniel,Katharine E %A Daros,Alexander R %A Teachman,Bethany A %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, United States, 1 9144622962, miranda.beltzer@northwestern.edu %K social anxiety %K reinforcement learning %K cognitive bias modification %K interpretation bias %K reward learning %K probabilistic learning %K Q-learning %K digital intervention %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Biases in social reinforcement learning, or the process of learning to predict and optimize behavior based on rewards and punishments in the social environment, may underlie and maintain some negative cognitive biases that are characteristic of social anxiety. However, little is known about how cognitive and behavioral interventions may change social reinforcement learning in individuals who are anxious. Objective: This study assessed whether a scalable, web-based cognitive bias modification for interpretations (CBM-I) intervention changed social reinforcement learning biases in participants with high social anxiety symptoms. This study focused on 2 types of social reinforcement learning relevant to social anxiety: learning about other people and learning about one’s own social performance. Methods: Participants (N=106) completed 2 laboratory sessions, separated by 5 weeks of ecological momentary assessment tracking emotion regulation strategy use and affect. Approximately half (n=51, 48.1%) of the participants completed up to 6 brief daily sessions of CBM-I in week 3. Participants completed a task that assessed social reinforcement learning about other people in both laboratory sessions and a task that assessed social reinforcement learning about one’s own social performance in the second session. Behavioral data from these tasks were computationally modeled using Q-learning and analyzed using mixed effects models. Results: After the CBM-I intervention, participants updated their beliefs about others more slowly (P=.04; Cohen d=−0.29) but used what they learned to make more accurate decisions (P=.005; Cohen d=0.20), choosing rewarding faces more frequently. These effects were not observed among participants who did not complete the CBM-I intervention. Participants who completed the CBM-I intervention also showed less-biased updating about their social performance than participants who did not complete the CBM-I intervention, learning similarly from positive and negative feedback and from feedback on items related to poor versus good social performance. Regardless of the intervention condition, participants at session 2 versus session 1 updated their expectancies about others more from rewarding (P=.003; Cohen d=0.43) and less from punishing outcomes (P=.001; Cohen d=−0.47), and they became more accurate at learning to avoid punishing faces (P=.001; Cohen d=0.20). Conclusions: Taken together, our results provide initial evidence that there may be some beneficial effects of both the CBM-I intervention and self-tracking of emotion regulation on social reinforcement learning in individuals who are socially anxious, although replication will be important. %M 37556186 %R 10.2196/44888 %U https://formative.jmir.org/2023/1/e44888 %U https://doi.org/10.2196/44888 %U http://www.ncbi.nlm.nih.gov/pubmed/37556186 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45136 %T Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan %A Yoshinaga,Naoki %A Thew,Graham R %A Hayashi,Yuta %A Matsuoka,Jun %A Tanoue,Hiroki %A Takanashi,Rieko %A Araki,Mutsumi %A Kanai,Yoshihiro %A Smith,Alisha %A Grant,Sophie H L %A Clark,David M %+ School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan, 81 985 85 9784, naoki-y@med.miyazaki-u.ac.jp %K benchmarking %K anxiety %K social anxiety %K social phobia %K cognitive behavioral therapy %K cognitive therapy %K cross-cultural comparison %K Japan %K mental disorders %K internet-based intervention %K mobile phone %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. Objective: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. Methods: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety–related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants’ feedback about their experience with the iCT-SAD. Results: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. Conclusions: Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly. %M 37145850 %R 10.2196/45136 %U https://formative.jmir.org/2023/1/e45136 %U https://doi.org/10.2196/45136 %U http://www.ncbi.nlm.nih.gov/pubmed/37145850 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44325 %T Predicting Generalized Anxiety Disorder From Impromptu Speech Transcripts Using Context-Aware Transformer-Based Neural Networks: Model Evaluation Study %A Teferra,Bazen Gashaw %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, 10 King’s College Road, Toronto, ON, M5S3G4, Canada, 1 4169786992, bazen.teferra@mail.utoronto.ca %K mental health %K generalized anxiety disorder %K impromptu speech %K linguistic features %K anxiety prediction %K neural networks %K natural language processing %K transformer models %K mobile phone %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The ability to automatically detect anxiety disorders from speech could be useful as a screening tool for an anxiety disorder. Prior studies have shown that individual words in textual transcripts of speech have an association with anxiety severity. Transformer-based neural networks are models that have been recently shown to have powerful predictive capabilities based on the context of more than one input word. Transformers detect linguistic patterns and can be separately trained to make specific predictions based on these patterns. Objective: This study aimed to determine whether a transformer-based language model can be used to screen for generalized anxiety disorder from impromptu speech transcripts. Methods: A total of 2000 participants provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test (TSST). They also completed the Generalized Anxiety Disorder 7-item (GAD-7) scale. A transformer-based neural network model (pretrained on large textual corpora) was fine-tuned on the speech transcripts and the GAD-7 to predict whether a participant was above or below a screening threshold of the GAD-7. We reported the area under the receiver operating characteristic curve (AUROC) on the test data and compared the results with a baseline logistic regression model using the Linguistic Inquiry and Word Count (LIWC) features as input. Using the integrated gradient method to determine specific words that strongly affect the predictions, we inferred specific linguistic patterns that influence the predictions. Results: The baseline LIWC-based logistic regression model had an AUROC value of 0.58. The fine-tuned transformer model achieved an AUROC value of 0.64. Specific words that were often implicated in the predictions were also dependent on the context. For example, the first-person singular pronoun “I” influenced toward an anxious prediction 88% of the time and a nonanxious prediction 12% of the time, depending on the context. Silent pauses in speech, also often implicated in predictions, influenced toward an anxious prediction 20% of the time and a nonanxious prediction 80% of the time. Conclusions: There is evidence that a transformer-based neural network model has increased predictive power compared with the single word–based LIWC model. We also showed that the use of specific words in a specific context—a linguistic pattern—is part of the reason for the better prediction. This suggests that such transformer-based models could play a useful role in anxiety screening systems. %M 36976636 %R 10.2196/44325 %U https://mental.jmir.org/2023/1/e44325 %U https://doi.org/10.2196/44325 %U http://www.ncbi.nlm.nih.gov/pubmed/36976636 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e38284 %T Prediction of Specific Anxiety Symptoms and Virtual Reality Sickness Using In Situ Autonomic Physiological Signals During Virtual Reality Treatment in Patients With Social Anxiety Disorder: Mixed Methods Study %A Chun,Joo Young %A Kim,Hyun-Jin %A Hur,Ji-Won %A Jung,Dooyoung %A Lee,Heon-Jeong %A Pack,Seung Pil %A Lee,Sungkil %A Kim,Gerard %A Cho,Chung-Yean %A Lee,Seung-Moo %A Lee,Hyeri %A Choi,Seungmoon %A Cheong,Taesu %A Cho,Chul-Hyun %+ Department of Psychiatry, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 029205505, david0203@gmail.com %K social anxiety %K virtual reality %K autonomic physiological signals %K machine learning %K virtual reality sickness %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Social anxiety disorder (SAD) is the fear of social situations where a person anticipates being evaluated negatively. Changes in autonomic response patterns are related to the expression of anxiety symptoms. Virtual reality (VR) sickness can inhibit VR experiences. Objective: This study aimed to predict the severity of specific anxiety symptoms and VR sickness in patients with SAD, using machine learning based on in situ autonomic physiological signals (heart rate and galvanic skin response) during VR treatment sessions. Methods: This study included 32 participants with SAD taking part in 6 VR sessions. During each VR session, the heart rate and galvanic skin response of all participants were measured in real time. We assessed specific anxiety symptoms using the Internalized Shame Scale (ISS) and the Post-Event Rumination Scale (PERS), and VR sickness using the Simulator Sickness Questionnaire (SSQ) during 4 VR sessions (#1, #2, #4, and #6). Logistic regression, random forest, and naïve Bayes classification classified and predicted the severity groups in the ISS, PERS, and SSQ subdomains based on in situ autonomic physiological signal data. Results: The severity of SAD was predicted with 3 machine learning models. According to the F1 score, the highest prediction performance among each domain for severity was determined. The F1 score of the ISS mistake anxiety subdomain was 0.8421 using the logistic regression model, that of the PERS positive subdomain was 0.7619 using the naïve Bayes classifier, and that of total VR sickness was 0.7059 using the random forest model. Conclusions: This study could predict specific anxiety symptoms and VR sickness during VR intervention by autonomic physiological signals alone in real time. Machine learning models can predict the severe and nonsevere psychological states of individuals based on in situ physiological signal data during VR interventions for real-time interactive services. These models can support the diagnosis of specific anxiety symptoms and VR sickness with minimal participant bias. Trial Registration: Clinical Research Information Service KCT0003854; https://cris.nih.go.kr/cris/search/detailSearch.do/13508 %M 36112407 %R 10.2196/38284 %U https://games.jmir.org/2022/3/e38284 %U https://doi.org/10.2196/38284 %U http://www.ncbi.nlm.nih.gov/pubmed/36112407 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31844 %T The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study %A Lee,Hojun %A Choi,JongKwan %A Jung,Dooyoung %A Hur,Ji-Won %A Cho,Chul-Hyun %+ Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 044 995 4775, david0203@gmail.com %K anxiety %K social anxiety disorder %K virtual reality %K fNIRS %K brain activity %K prefrontal cortex %K effectiveness %D 2021 %7 17.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. Objective: The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). Methods: Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant’s self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant’s self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). Results: We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=–2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=–2.93, P<.001; left: t=–2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=–2.10, P=.045; left: t=–2.21, P=.04) while watching video 2. Conclusions: Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. Trial Registration: Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp %M 34801979 %R 10.2196/31844 %U https://www.jmir.org/2021/12/e31844 %U https://doi.org/10.2196/31844 %U http://www.ncbi.nlm.nih.gov/pubmed/34801979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29873 %T Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland %A Thorarinsdottir,Kristjana %A Holmes,Emily A %A Hardarson,Johann %A Hedinsdottir,Unnur %A Kanstrup,Marie %A Singh,Laura %A Hauksdottir,Arna %A Halldorsdottir,Thorhildur %A Gudmundsdottir,Berglind %A Valdimarsdottir,Unnur %A Thordardottir,Edda Bjork %A Gamble,Beau %A Bjornsson,Andri %+ Department of Psychology, University of Iceland, Sæmundargata 12, Reykjavik, 101, Iceland, 354 6942001, kth35@hi.is %K psychological trauma %K intrusive memories %K case report %K visuospatial interference task %K Tetris gameplay %K mental imagery %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event. Objective: This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session. Methods: This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms. Results: The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing. Conclusions: This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention. %M 34734830 %R 10.2196/29873 %U https://formative.jmir.org/2021/11/e29873 %U https://doi.org/10.2196/29873 %U http://www.ncbi.nlm.nih.gov/pubmed/34734830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32656 %T Detecting Subclinical Social Anxiety Using Physiological Data From a Wrist-Worn Wearable: Small-Scale Feasibility Study %A Shaukat-Jali,Ruksana %A van Zalk,Nejra %A Boyle,David Edward %+ Dyson School of Design Engineering, Imperial College London, 25 Exhibition Road, London, SW7 2AZ, United Kingdom, 44 2083318091, n.van-zalk@imperial.ac.uk %K social anxiety %K wearable sensors %K physiological measurement %K machine learning %K young adults %K mental health %K mHealth %K new methods %K anxiety %K wearable %K sensor %K digital phenotyping %K digital biomarkers %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Subclinical (ie, threshold) social anxiety can greatly affect young people’s lives, but existing solutions appear inadequate considering its rising prevalence. Wearable sensors may provide a novel way to detect social anxiety and result in new opportunities for monitoring and treatment, which would be greatly beneficial for persons with social anxiety, society, and health care services. Nevertheless, indicators such as skin temperature measured by wrist-worn sensors have not been used in prior work on physiological social anxiety detection. Objective: This study aimed to investigate whether subclinical social anxiety in young adults can be detected using physiological data obtained from wearable sensors, including heart rate, skin temperature, and electrodermal activity (EDA). Methods: Young adults (N=12) with self-reported subclinical social anxiety (measured using the widely used self-reported version of the Liebowitz Social Anxiety Scale) participated in an impromptu speech task. Physiological data were collected using an E4 Empatica wearable device. Using the preprocessed data and following a supervised machine learning approach, various classification algorithms such as Support Vector Machine, Decision Tree, Random Forest, and K-Nearest Neighbours (KNN) were used to develop models for 3 different contexts. Models were trained to differentiate (1) between baseline and socially anxious states, (2) among baseline, anticipation anxiety, and reactive anxiety states, and (3) social anxiety among individuals with social anxiety of differing severity. The predictive capability of the singular modalities was also explored in each of the 3 supervised learning experiments. The generalizability of the developed models was evaluated using 10-fold cross-validation as a performance index. Results: With modalities combined, the developed models yielded accuracies between 97.54% and 99.48% when differentiating between baseline and socially anxious states. Models trained to differentiate among baseline, anticipation anxiety, and reactive anxiety states yielded accuracies between 95.18% and 98.10%. Furthermore, the models developed to differentiate between social anxiety experienced by individuals with anxiety of differing severity scores successfully classified with accuracies between 98.86% and 99.52%. Surprisingly, EDA was identified as the most effective singular modality when differentiating between baseline and social anxiety states, whereas ST was the most effective modality when differentiating anxiety among individuals with social anxiety of differing severity. Conclusions: The results indicate that it is possible to accurately detect social anxiety as well as distinguish between levels of severity in young adults by leveraging physiological data collected from wearable sensors. %M 34617905 %R 10.2196/32656 %U https://formative.jmir.org/2021/10/e32656 %U https://doi.org/10.2196/32656 %U http://www.ncbi.nlm.nih.gov/pubmed/34617905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27570 %T Evaluation of a Commercial Mobile Health App for Depression and Anxiety (AbleTo Digital+): Retrospective Cohort Study %A Anton,Margaret T %A Greenberger,Heidi Mochari %A Andreopoulos,Evie %A Pande,Reena L %+ AbleTo, Inc, 320 W, 37th Street, 5th floor, New York, NY, 10018, United States, 1 (347) 926 5527, margaret.anton@ableto.com %K digital mental health %K mHealth %K iCBT %K coaching %K depression %K generalized anxiety %K social anxiety %K mobile phone %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although a growing number of randomized trials have established the efficacy of digital interventions for common mental health problems, less is known about the real-world impact of these tools. AbleTo Digital+, a commercially available mental health app for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in a real-world context. Objective: The primary aim of this study is to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs. The secondary aim is to evaluate Digital+ module completion, including the use of 1:1 coaching. Methods: In this retrospective cohort study, we analyzed previously collected and permanently deidentified data from a consecutive cohort of 1896 adults who initiated using one of the three Digital+ eight-module programs (depression, generalized anxiety, or social anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Social Phobia Inventory, respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging, was also evaluated. Results: Significant effects were observed among depression (Cohen d=1.5), generalized anxiety (Cohen d=1.2), and social anxiety (Cohen d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (β=−1.2; P<.001), generalized anxiety (β=−1.1; P<.001), and social anxiety (β=−2.4; P<.001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD 2.7) modules. The average total length of app use was 52.2 (SD 83.5) days. Approximately two-thirds of the users engaged in at least 1 coaching call (66.82%, 1267/1896) or in-app text messaging (66.09%, 1253/1896). Participants who completed at least four modules participated in significantly more coaching calls per module (mean 1.1, SD 0.7) than users who completed fewer than four modules (mean 1.0, SD 1.2; t1407=−2.1; P=.03). Conclusions: This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms throughout the program. %M 34546170 %R 10.2196/27570 %U https://formative.jmir.org/2021/9/e27570 %U https://doi.org/10.2196/27570 %U http://www.ncbi.nlm.nih.gov/pubmed/34546170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e26603 %T Psychoeducational Social Anxiety Mobile Apps: Systematic Search in App Stores, Content Analysis, and Evaluation %A Hammond,Trent Ernest %A Lampe,Lisa %A Campbell,Andrew %A Perisic,Steve %A Brakoulias,Vlasios %+ Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, 62 Derby Street, Kingswood, New South Wales, 2747, Australia, 61 431931448, trent.hammond@sydney.edu.au %K anxiety %K app %K cell phone %K mobile app %K mobile phone %K SAD %K smartphone %K social anxiety %K social phobia %K tablet %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets. Objective: This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety. Methods: This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps. Results: In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus $3.99) and US $3.69 (Aus $5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E). Conclusions: The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps. %M 34546179 %R 10.2196/26603 %U https://mhealth.jmir.org/2021/9/e26603 %U https://doi.org/10.2196/26603 %U http://www.ncbi.nlm.nih.gov/pubmed/34546179 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28667 %T A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial %A Prior,Katrina %A Salemink,Elske %A Wiers,Reinout W %A Teachman,Bethany A %A Piggott,Monique %A Newton,Nicola C %A Teesson,Maree %A Baillie,Andrew J %A Manning,Victoria %A McLellan,Lauren F %A Mahoney,Alison %A Stapinski,Lexine A %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 02 8627 9032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K emerging adults %D 2021 %7 7.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious. Objective: This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention—an adjunct web-based ApBM+IBM program—among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. Methods: The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes. Results: This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. Conclusions: This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): PRR1-10.2196/28667 %M 34255726 %R 10.2196/28667 %U https://www.researchprotocols.org/2021/7/e28667 %U https://doi.org/10.2196/28667 %U http://www.ncbi.nlm.nih.gov/pubmed/34255726 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e27981 %T Trajectories of Change in an Open-access Internet-Based Cognitive Behavior Program for Childhood and Adolescent Anxiety: Open Trial %A March,Sonja %A Batterham,Philip J %A Rowe,Arlen %A Donovan,Caroline %A Calear,Alison L %A Spence,Susan H %+ Centre for Health Research and School of Psychology and Counselling, University of Southern Queensland, Sinnathamby Blvd, Springfield, 4300, Australia, 61 734704434, sonja.march@usq.edu.au %K iCBT %K child %K adolescent %K anxiety %K online %K trajectories of change %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although evidence bolstering the efficacy of internet-based cognitive behavioral therapy (iCBT) for treating childhood anxiety has been growing continuously, there is scant empirical research investigating the timing of benefits made in iCBT programs (eg, early or delayed). Objective: This study aims to examine the patterns of symptom trajectories (changes in anxiety) across an iCBT program for anxiety (BRAVE Self-Help). Methods: This study’s participants included 10,366 Australian youth aged 7 to 17 years (4140 children aged 7-12 years; 6226 adolescents aged 12-17 years) with elevated anxiety who registered for the BRAVE Self-Help program. Participants self-reported their anxiety symptoms at baseline or session 1 and then at the commencement of each subsequent session. Results: The results show that young people completing the BRAVE Self-Help program tend to fall into two trajectory classes that can be reliably identified in terms of high versus moderate baseline levels of anxiety and subsequent reduction in symptoms. Both high and moderate anxiety severity trajectory classes showed significant reductions in anxiety, with the greatest level of change being achieved within the first six sessions for both classes. However, those in the moderate anxiety severity class tended to show reductions in anxiety symptoms to levels below the elevated range, whereas those in the high symptom group tended to remain in the elevated range despite improvements. Conclusions: These findings suggest that those in the high severity group who do not respond well to iCBT on a self-help basis may benefit from the additional support provided alongside the program or a stepped-care approach where progress is monitored and support can be provided as necessary. %M 34142971 %R 10.2196/27981 %U https://mental.jmir.org/2021/6/e27981 %U https://doi.org/10.2196/27981 %U http://www.ncbi.nlm.nih.gov/pubmed/34142971 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25731 %T Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task %A Hur,Ji-Won %A Shin,Hyemin %A Jung,Dooyoung %A Lee,Heon-Jeong %A Lee,Sungkil %A Kim,Gerard J %A Cho,Chung-Yean %A Choi,Seungmoon %A Lee,Seung-Moo %A Cho,Chul-Hyun %+ Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 44 995 4775, david0203@gmail.com %K virtual reality %K VR %K social anxiety %K social phobia %K exposure therapy %K fMRI %K unctional magnetic resonance imaging %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. Objective: We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. Methods: We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality–based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. Results: Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality–based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. Conclusions: These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation. %M 33851931 %R 10.2196/25731 %U https://mental.jmir.org/2021/4/e25731 %U https://doi.org/10.2196/25731 %U http://www.ncbi.nlm.nih.gov/pubmed/33851931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22723 %T Smartphone-Detected Ambient Speech and Self-Reported Measures of Anxiety and Depression: Exploratory Observational Study %A Di Matteo,Daniel %A Wang,Wendy %A Fotinos,Kathryn %A Lokuge,Sachinthya %A Yu,Julia %A Sternat,Tia %A Katzman,Martin A %A Rose,Jonathan %+ The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, DL Pratt Building, 6 King's College Road, Toronto, ON, M5S 3H5, Canada, 1 416 978 6992, dandm@ece.utoronto.ca %K mobile sensing %K passive sensing %K psychiatric assessment %K mood and anxiety disorders %K mobile apps %K linguistics %K speech recognition %K speech content %K lexical choice %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to objectively measure the severity of depression and anxiety disorders in a passive manner could have a profound impact on the way in which these disorders are diagnosed, assessed, and treated. Existing studies have demonstrated links between both depression and anxiety and the linguistic properties of words that people use to communicate. Smartphones offer the ability to passively and continuously detect spoken words to monitor and analyze the linguistic properties of speech produced by the speaker and other sources of ambient speech in their environment. The linguistic properties of automatically detected and recognized speech may be used to build objective severity measures of depression and anxiety. Objective: The aim of this study was to determine if the linguistic properties of words passively detected from environmental audio recorded using a participant’s smartphone can be used to find correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods: An Android app was designed to collect periodic audiorecordings of participants’ environments and to detect English words using automatic speech recognition. Participants were recruited into a 2-week observational study. The app was installed on the participants’ personal smartphones to record and analyze audio. The participants also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Words detected from audiorecordings were categorized, and correlations were measured between words counts in each category and the 4 self-report measures to determine if any categories could serve as correlates of social anxiety disorder, generalized anxiety disorder, depression, or general impairment. Results: The participants were 112 adults who resided in Canada from a nonclinical population; 86 participants yielded sufficient data for analysis. Correlations between word counts in 67 word categories and each of the 4 self-report measures revealed a strong relationship between the usage rates of death-related words and depressive symptoms (r=0.41, P<.001). There were also interesting correlations between rates of word usage in the categories of reward-related words with depression (r=–0.22, P=.04) and generalized anxiety (r=–0.29, P=.007), and vision-related words with social anxiety (r=0.31, P=.003). Conclusions: In this study, words automatically recognized from environmental audio were shown to contain a number of potential associations with severity of depression and anxiety. This work suggests that sparsely sampled audio could provide relevant insight into individuals’ mental health. %M 33512325 %R 10.2196/22723 %U http://formative.jmir.org/2021/1/e22723/ %U https://doi.org/10.2196/22723 %U http://www.ncbi.nlm.nih.gov/pubmed/33512325 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e23024 %T Effectiveness of a Participatory and Interactive Virtual Reality Intervention in Patients With Social Anxiety Disorder: Longitudinal Questionnaire Study %A Kim,Hyun-Jin %A Lee,Seulki %A Jung,Dooyoung %A Hur,Ji-Won %A Lee,Heon-Jeong %A Lee,Sungkil %A Kim,Gerard J %A Cho,Chung-Yean %A Choi,Seungmoon %A Lee,Seung-Moo %A Cho,Chul-Hyun %+ Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 449954775, david0203@gmail.com %K anxiety %K social anxiety disorder %K virtual reality %K intervention %K effectiveness %K questionnaires %D 2020 %7 6.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social anxiety disorder (SAD) is characterized by excessive fear of negative evaluation and humiliation in social interactions and situations. Virtual reality (VR) treatment is a promising intervention option for SAD. Objective: The purpose of this study was to create a participatory and interactive VR intervention for SAD. Treatment progress, including the severity of symptoms and the cognitive and emotional aspects of SAD, was analyzed to evaluate the effectiveness of the intervention. Methods: In total, 32 individuals with SAD and 34 healthy control participants were enrolled in the study through advertisements for online bulletin boards at universities. A VR intervention was designed consisting of three stages (introduction, core, and finishing) and three difficulty levels (easy, medium, and hard) that could be selected by the participants. The core stage was the exposure intervention in which participants engaged in social situations. The effectiveness of treatment was assessed through Beck Anxiety inventory (BAI), State‐Trait Anxiety Inventory (STAI), Internalized Shame Scale (ISS), Post-Event Rumination Scale (PERS), Social Phobia Scale (SPS), Social Interaction Anxiety Scale (SIAS), Brief-Fear of Negative Evaluation Scale (BFNE), and Liebowitz Social Anxiety Scale (LSAS). Results: In the SAD group, scores on the BAI (F=4.616, P=.009), STAI-Trait (F=4.670, P=.004), ISS (F=6.924, P=.001), PERS-negative (F=1.008, P<.001), SPS (F=8.456, P<.001), BFNE (F=6.117, P=.004), KSAD (F=13.259, P<.001), and LSAS (F=4.103, P=.009) significantly improved over the treatment process. Compared with the healthy control group before treatment, the SAD group showed significantly higher scores on all scales (P<.001), and these significant differences persisted even after treatment (P<.001). In the comparison between the VR treatment responder and nonresponder subgroups, there was no significant difference across the course of the VR session. Conclusions: These findings indicated that a participatory and interactive VR intervention had a significant effect on alleviation of the clinical symptoms of SAD, confirming the usefulness of VR for the treatment of SAD. VR treatment is expected to be one of various beneficial therapeutic approaches in the future. Trial Registration: Clinical Research Information Service (CRIS) KCT0003854; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=13508 %M 33021481 %R 10.2196/23024 %U http://www.jmir.org/2020/10/e23024/ %U https://doi.org/10.2196/23024 %U http://www.ncbi.nlm.nih.gov/pubmed/33021481 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e13234 %T Comment on “Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial” %A Zargaran,David %A Walsh,Caoimhe %A Koumpa,Foteini Stefania %A Ashraf,Muhammad Arsalan %A White,Amelia Jayne %A Patel,Nikhil %A Tanna,Ravina %A Trepekli,Anna %A Zargaran,Alexander %+ St Thomas' Hospital, Westminster Bridge Rd,, London, SE1 7PH, United Kingdom, 44 02071887188, Davidzargaran@gmail.com %K internet %K CBT %K cognitive behavioral therapy %K telemedicine %K telehealth %D 2020 %7 12.8.2020 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 32784172 %R 10.2196/13234 %U https://www.jmir.org/2020/8/e13234 %U https://doi.org/10.2196/13234 %U http://www.ncbi.nlm.nih.gov/pubmed/32784172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17915 %T Evidence Regarding Automatic Processing Computerized Tasks Designed For Health Interventions in Real-World Settings Among Adults: Systematic Scoping Review %A Jayasinghe,Harshani %A Short,Camille E %A Braunack-Mayer,Annette %A Merkin,Ashley %A Hume,Clare %+ School of Public Health, The University of Adelaide, Level 9, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, 5000, Australia, 61 8313 4634, harshani.jayasinghepedige@adelaide.edu.au %K automatic processing %K computerized tasks %K health interventions %K real-world %K adult %K behavior change, mobile phone %D 2020 %7 29.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Dual process theories propose that the brain uses 2 types of thinking to influence behavior: automatic processing and reflective processing. Automatic processing is fast, immediate, nonconscious, and unintentional, whereas reflective processing focuses on logical reasoning, and it is slow, step by step, and intentional. Most digital psychological health interventions tend to solely target the reflective system, although the automatic processing pathway can have strong influences on behavior. Laboratory-based research has highlighted that automatic processing tasks can create behavior change; however, there are substantial gaps in the field on the design, implementation, and delivery of automatic processing tasks in real-world settings. It is important to identify and summarize the existing literature in this area to inform the translation of laboratory-based research to real-world settings. Objective: This scoping review aims to explore the effectiveness of automatic training tasks, types of training tasks commonly used, mode of delivery, and impacts of gamification on automatic processing tasks designed for digital psychological health interventions in real-world settings among adults. Methods: The scoping review methodology proposed by Arskey and O’Malley and Colquhoun was applied. A scoping review was chosen because of the novelty of the digital automatic processing field and to encompass a broad review of the existing evidence base. Electronic databases and gray literature databases were searched with the search terms “automatic processing,” “computerised technologies,” “health intervention,” “real-world,” and “adults” and synonyms of these words. The search was up to date until September 2018. A manual search was also completed on the reference lists of the included studies. Results: A total of 14 studies met all inclusion criteria. There was a wide variety of health conditions targeted, with the most prevalent being alcohol abuse followed by social anxiety. Attention bias modification tasks were the most prevalent type of automatic processing task, and the majority of tasks were most commonly delivered over the web via a personal computer. Of the 14 studies included in the review, 8 demonstrated significant changes to automatic processes and 4 demonstrated significant behavioral changes as a result of changed automatic processes. Conclusions: This is the first review to synthesize the evidence on automatic processing tasks in real-world settings targeting adults. This review has highlighted promising, albeit limited, research demonstrating that automatic processing tasks may be used effectively in a real-world setting to influence behavior change. %M 32499213 %R 10.2196/17915 %U http://www.jmir.org/2020/7/e17915/ %U https://doi.org/10.2196/17915 %U http://www.ncbi.nlm.nih.gov/pubmed/32499213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17712 %T Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study %A Attridge,Mark D %A Morfitt,Russell C %A Roseborough,David J %A Jones,Edward R %+ Attridge Consulting, Inc, 1129 Cedar Lake Rd S, Minneapolis, MN, United States, 1 612 889 2398, mark@attridgeconsulting.com %K anxiety %K cognitive behavioral %K college %K depression %K insomnia %K mental health %K social phobia %K stress %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand. Objective: This study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users. Methods: Archival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison. Results: The percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication. Conclusions: Self-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers. %M 32706662 %R 10.2196/17712 %U http://formative.jmir.org/2020/7/e17712/ %U https://doi.org/10.2196/17712 %U http://www.ncbi.nlm.nih.gov/pubmed/32706662 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e15797 %T The Effect of Shame on Patients With Social Anxiety Disorder in Internet-Based Cognitive Behavioral Therapy: Randomized Controlled Trial %A Wang,Haoyu %A Zhao,Qingxue %A Mu,Wenting %A Rodriguez,Marcus %A Qian,Mingyi %A Berger,Thomas %+ School of Psychological and Cognitive Sciences, Peking University, The Philosophical Building 2nd Fl., Yiheyuan Road, Haidian District, Beijing, China, 86 62761081, qmy@pku.edu.cn %K internet-based intervention %K cognitive behavioral therapy %K phobia %K social %K shame %K implosive therapy %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Prior research has demonstrated the efficacy of internet-based cognitive behavioral therapy (ICBT) for social anxiety disorder (SAD). However, it is unclear how shame influences the efficacy of this treatment. Objective: This study aimed to investigate the role shame played in the ICBT treatment process for participants with SAD. Methods: A total of 104 Chinese participants (73 females; age: mean 24.92, SD 4.59 years) were randomly assigned to self-help ICBT, guided ICBT, or wait list control groups. For the guided ICBT group, half of the participants were assigned to the group at a time due to resource constraints. This led to a time difference among the three groups. Participants were assessed before and immediately after the intervention using the Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), and Experience of Shame Scale (ESS). Results: Participants’ social anxiety symptoms (self-help: differences between pre- and posttreatment SIAS=−12.71; Cohen d=1.01; 95% CI 9.08 to 16.32; P<.001 and differences between pre- and posttreatment SPS=11.13; Cohen d=0.89; 95% CI 6.98 to 15.28; P<.001; guided: SIAS=19.45; Cohen d=1.20; 95% CI 14.67 to 24.24; P<.001 and SPS=13.45; Cohen d=0.96; 95% CI 8.26 to 18.64; P<.001) and shame proneness (self-help: differences between pre- and posttreatment ESS=7.34; Cohen d=0.75; 95% CI 3.99 to 10.69; P<.001 and guided: differences between pre- and posttreatment ESS=9.97; Cohen d=0.88; 95% CI 5.36 to 14.57; P<.001) in both the self-help and guided ICBT groups reduced significantly after treatment, with no significant differences between the two intervention groups. Across all the ICBT sessions, the only significant predictors of reductions in shame proneness were the average number of words participants wrote in the exposure module (β=.222; SE 0.175; t96=2.317; P=.02) and gender (β=−.33; SE 0.002; t77=−3.13; P=.002). We also found a mediation effect, wherein reductions in shame fully mediated the relationship between the average number of words participants wrote in the exposure module and reductions in social anxiety symptoms (SIAS: β=−.0049; SE 0.0016; 95% CI −0.0085 to −0.0019 and SPS: β=−.0039; SE 0.0015; 95% CI −0.0075 to −0.0012). Conclusions: The findings of this study suggest that participants’ engagement in the exposure module in ICBT alleviates social anxiety symptoms by reducing the levels of shame proneness. Our study provides a new perspective for understanding the role of shame in the treatment of social anxiety. The possible mechanisms of the mediation effect and clinical implications are discussed. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900021952; http://www.chictr.org.cn/showproj.aspx?proj=36977 %M 32347799 %R 10.2196/15797 %U https://mental.jmir.org/2020/7/e15797 %U https://doi.org/10.2196/15797 %U http://www.ncbi.nlm.nih.gov/pubmed/32347799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16875 %T Digital Biomarkers of Social Anxiety Severity: Digital Phenotyping Using Passive Smartphone Sensors %A Jacobson,Nicholas C %A Summers,Berta %A Wilhelm,Sabine %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Office # 333S, Lebanon, NH, 03766, United States, 1 6036467037, Nicholas.C.Jacobson@dartmouth.edu %K biomarkers %K machine learning %K technology assessment, biomedical %K social anxiety %K social anxiety disorder %K mobile phone %D 2020 %7 29.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social anxiety disorder is a highly prevalent and burdensome condition. Persons with social anxiety frequently avoid seeking physician support and rarely receive treatment. Social anxiety symptoms are frequently underreported and underrecognized, creating a barrier to the accurate assessment of these symptoms. Consequently, more research is needed to identify passive biomarkers of social anxiety symptom severity. Digital phenotyping, the use of passive sensor data to inform health care decisions, offers a possible method of addressing this assessment barrier. Objective: This study aims to determine whether passive sensor data acquired from smartphone data can accurately predict social anxiety symptom severity using a publicly available dataset. Methods: In this study, participants (n=59) completed self-report assessments of their social anxiety symptom severity, depressive symptom severity, positive affect, and negative affect. Next, participants installed an app, which passively collected data about their movement (accelerometers) and social contact (incoming and outgoing calls and texts) over 2 weeks. Afterward, these passive sensor data were used to form digital biomarkers, which were paired with machine learning models to predict participants’ social anxiety symptom severity. Results: The results suggested that these passive sensor data could be utilized to accurately predict participants’ social anxiety symptom severity (r=0.702 between predicted and observed symptom severity) and demonstrated discriminant validity between depression, negative affect, and positive affect. Conclusions: These results suggest that smartphone sensor data may be utilized to accurately detect social anxiety symptom severity and discriminate social anxiety symptom severity from depressive symptoms, negative affect, and positive affect. %M 32348284 %R 10.2196/16875 %U http://www.jmir.org/2020/5/e16875/ %U https://doi.org/10.2196/16875 %U http://www.ncbi.nlm.nih.gov/pubmed/32348284 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e17157 %T Long-Term Effectiveness and Cost-Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder in Japan: One-Year Follow-Up of a Single-Arm Trial %A Matsumoto,Kazuki %A Hamatani,Sayo %A Nagai,Kazue %A Sutoh,Chihiro %A Nakagawa,Akiko %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba, , Japan, 81 08 043 226 2975, axpa0219@chiba-u.jp %K long-term effectiveness %K cost-effectiveness %K videoconference-delivered cognitive behavioral therapy %K internet-based cognitive behavioral therapy %K obsessive-compulsive disorder %K panic disorder %K social anxiety disorder %D 2020 %7 23.4.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. Objective: The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. Methods: Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire–9 (PHQ-9), General Anxiety Disorder–7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. Results: Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was −4.1 (F1=4.45, P=.04), the change in PDSS was −4.4 (F1=6.83, P=.001), and the change in LSAS was −30.9 (F1=6.73, P=.01). The change in the PHQ-9 at 12 months was −2.7 (F1=7.72, P=.007), and the change in the GAD-7 was −3.0 (F1=7.09, P=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (P=.01). Total costs to provide the VCBT were ¥60,800 to ¥81,960 per patient. The set threshold was ¥189,500 ($1723, €1579, and £1354) calculated based on willingness to pay in Japan. Conclusions: VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030495 %M 32324150 %R 10.2196/17157 %U http://mental.jmir.org/2020/4/e17157/ %U https://doi.org/10.2196/17157 %U http://www.ncbi.nlm.nih.gov/pubmed/32324150 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16804 %T Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial %A Powell,John %A Williams,Veronika %A Atherton,Helen %A Bennett,Kylie %A Yang,Yaling %A Davoudianfar,Mina %A Hellsing,Annika %A Martin,Angela %A Mollison,Jill %A Shanyinde,Milensu %A Yu,Ly-Mee %A Griffiths,Kathleen M %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865617768, john.powell@phc.ox.ac.uk %K randomized controlled trial %K internet %K self-care %K social anxiety %D 2020 %7 10.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. Objective: This study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. Methods: We conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). Results: A total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; P=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. Conclusions: For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. Trial Registration: ClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878 %M 31821151 %R 10.2196/16804 %U http://www.jmir.org/2020/1/e16804/ %U https://doi.org/10.2196/16804 %U http://www.ncbi.nlm.nih.gov/pubmed/31821151 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 11 %P e15747 %T Prognosis Prediction Using Therapeutic Agreement of Video Conference–Delivered Cognitive Behavioral Therapy: Retrospective Secondary Analysis of a Single-Arm Pilot Trial %A Matsumoto,Kazuki %A Yoshida,Tokiko %A Hamatani,Sayo %A Sutoh,Chihiro %A Hirano,Yoshiyuki %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 2608670, Japan, 81 08 043 226 2975, axpa0219@chiba-u.jp %K therapeutic alliance %K cognitive behavioral therapy %K obsessive-compulsive disorder %K panic disorder %K social anxiety disorder %K video conferencing %D 2019 %7 15.11.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: The therapist-patient therapeutic alliance is known to be an important factor in cognitive behavioral therapy (CBT). However, findings by previous studies for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD) have not been consistent regarding whether this alliance provides symptomatic improvements. Objective: This study investigated predictors of symptom improvement in patients receiving CBT via video conferencing. Methods: A total of 29 patients who participated in a previous clinical trial were recruited for the current study. Therapeutic alliance and clinical background in patients with OCD, PD, and SAD were measured at first session or the eighth session, which were calculated by multiple regression analyses to estimate the impact on therapeutic response percentage change. Results: The multiple regression analyses showed that, among the independent variables, only patients’ agreement in the therapeutic alliance remained viable, as other variables were a best fit for the excluded model (P=.002). The results show that patients’ agreement on therapeutic goals and tasks explains the prognosis, as the normalization factor beta was 0.54 (SE 32.73; 95% CI 1.23-5.17; P=.002) and the adjusted R2 was .266. Conclusions: Patients' agreement on therapeutic goals and tasks predicts improvement after CBT via video conferencing. Trial Registration: UMIN Clinical Trial Repository UMIN000026609; https://tinyurl.com/ye6dcbwt %M 31730037 %R 10.2196/15747 %U http://mental.jmir.org/2019/11/e15747/ %U https://doi.org/10.2196/15747 %U http://www.ncbi.nlm.nih.gov/pubmed/31730037 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13869 %T Exposure Therapy With Personalized Real-Time Arousal Detection and Feedback to Alleviate Social Anxiety Symptoms in an Analogue Adult Sample: Pilot Proof-of-Concept Randomized Controlled Trial %A Lin,Xiangting Bernice %A Lee,Tih-Shih %A Cheung,Yin Bun %A Ling,Joanna %A Poon,Shi Hui %A Lim,Leslie %A Zhang,Hai Hong %A Chin,Zheng Yang %A Wang,Chuan Chu %A Krishnan,Ranga %A Guan,Cuntai %+ Neuroscience and Behavioral Disorders Program, Duke University - National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore, 65 92765827, bernice.lin@duke-nus.edu.sg %K social anxiety %K public speaking anxiety %K exposure therapy %K arousal feedback %K randomized controlled trial %D 2019 %7 14.6.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Exposure therapy is highly effective for social anxiety disorder. However, there is room for improvement. Objective: This is a first attempt to examine the feasibility of an arousal feedback–based exposure therapy to alleviate social anxiety symptoms in an analogue adult sample. Methods: A randomized, pilot, proof-of-concept trial was conducted to evaluate the acceptability, safety, and preliminary efficacy of our treatment program. Sessions were administered once a week for 4 weeks (1 hour each) to an analogue sample of 50 young adults who reported at least minimal social anxiety symptoms. Participants in both intervention and waitlist control groups completed assessments for social anxiety symptoms at the baseline, week 5, and week 10. Results: Most participants found the intervention acceptable (82.0%, 95% CI 69.0%-91.0%). Seven (14.9%, 95% CI 7.0%-28.0%) participants reported at least one mild adverse event over the course of study. No moderate or serious adverse events were reported. Participants in the intervention group demonstrated greater improvements on all outcome measures of public speaking anxiety from baseline to week 5 as compared to the waitlist control group (Cohen d=0.61-1.39). Effect size of the difference in mean change on the overall Liebowitz Social Anxiety Scale was small (Cohen d=0.13). Conclusions: Our results indicated that it is worthwhile to proceed to a larger trial for our treatment program. This new medium of administration for exposure therapy may be feasible for treating a subset of social anxiety symptoms. Additional studies are warranted to explore its therapeutic mechanisms. Trial Registration: ClinicalTrials.gov NCT02493010; https://clinicaltrials.gov/ct2/show/NCT02493010 %M 31199347 %R 10.2196/13869 %U http://mental.jmir.org/2019/6/e13869/ %U https://doi.org/10.2196/13869 %U http://www.ncbi.nlm.nih.gov/pubmed/31199347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e14167 %T Exploring the Extent of the Hikikomori Phenomenon on Twitter: Mixed Methods Study of Western Language Tweets %A Pereira-Sanchez,Victor %A Alvarez-Mon,Miguel Angel %A Asunsolo del Barco,Angel %A Alvarez-Mon,Melchor %A Teo,Alan %+ Department of Psychiatry, Clinica Universidad de Navarra, Avda Pio XII, 36, Pamplona, 31008, Spain, 34 948255400, maalvarezdemon@icloud.com %K social isolation %K loneliness %K hikikomori %K hidden youth %K social media %K Twitter %K social withdrawal %D 2019 %7 29.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Hikikomori is a severe form of social withdrawal, originally described in Japan but recently reported in other countries. Debate exists as to what extent hikikomori is viewed as a problem outside of the Japanese context. Objective: We aimed to explore perceptions about hikikomori outside Japan by analyzing Western language content from the popular social media platform, Twitter. Methods: We conducted a mixed methods analysis of all publicly available tweets using the hashtag #hikikomori between February 1 and August 16, 2018, in 5 Western languages (Catalan, English, French, Italian, and Spanish). Tweets were first classified as to whether they described hikikomori as a problem or a nonproblematic phenomenon. Tweets regarding hikikomori as a problem were then subclassified in terms of the type of problem (medical, social, or anecdotal) they referred to, and we marked if they referenced scientific publications or the presence of hikikomori in countries other than Japan. We also examined measures of interest in content related to hikikomori, including retweets, likes, and associated hashtags. Results: A total of 1042 tweets used #hikikomori, and 656 (62.3%) were included in the content analysis. Most of the included tweets were written in English (44.20%) and Italian (34.16%), and a majority (56.70%) discussed hikikomori as a problem. Tweets referencing scientific publications (3.96%) and hikikomori as present in countries other than Japan (13.57%) were less common. Tweets mentioning hikikomori outside Japan were statistically more likely to be retweeted (P=.01) and liked (P=.01) than those not mentioning it, whereas tweets with explicit scientific references were statistically more retweeted (P=.01) but not liked (P=.10) than those without that reference. Retweet and like figures were not statistically significantly different among other categories and subcategories. The most associated hashtags included references to Japan, mental health, and the youth. Conclusions: Hikikomori is a repeated word in non-Japanese Western languages on Twitter, suggesting the presence of hikikomori in countries outside Japan. Most tweets treat hikikomori as a problem, but the ways they post about it are highly heterogeneous. %M 31144665 %R 10.2196/14167 %U http://www.jmir.org/2019/5/e14167/ %U https://doi.org/10.2196/14167 %U http://www.ncbi.nlm.nih.gov/pubmed/31144665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13446 %T Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series %A Thew,Graham R %A Powell,Candice LYM %A Kwok,Amy PL %A Lissillour Chan,Mandy H %A Wild,Jennifer %A Warnock-Parkes,Emma %A Leung,Patrick WL %A Clark,David M %+ Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford, OX1 1TW, United Kingdom, 44 01865 618600, graham.thew@psy.ox.ac.uk %K anxiety %K social phobia %K internet %K cognitive therapy %K clinical competence %K cross-cultural comparison %K Hong Kong %K benchmarking %K psychology, clinical %K mental health %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients’ clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. %M 31094320 %R 10.2196/13446 %U http://formative.jmir.org/2019/2/e13446/ %U https://doi.org/10.2196/13446 %U http://www.ncbi.nlm.nih.gov/pubmed/31094320 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11566 %T Evaluating a Web-Based Social Anxiety Intervention Among Community Users: Analysis of Real-World Data %A McCall,Hugh Cameron %A Helgadottir,Fjola Dogg %A Menzies,Ross G %A Hadjistavropoulos,Heather D %A Chen,Frances S %+ AI-Therapy, 5515 Stellar Place, North Vancouver, BC, V7R 4N3, Canada, 1 604 652 5440, fjola@ai-therapy.com %K social anxiety %K internet %K cognitive behavioral therapy %K psychotherapy %K mental health %D 2019 %7 10.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social anxiety is both harmful and prevalent. It also currently remains among the most undertreated major mental disorders, due, in part, to socially anxious individuals’ concerns about the stigma and expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions may render them particularly helpful in addressing these concerns, and they are also highly scalable, but most tend to be only somewhat effective without therapist support. However, a recent evaluation of a new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called Overcome Social Anxiety found that it was highly effective. Objective: The initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in symptom severity among university undergraduates. The aim of this study was to extend the results of the initial study and investigate their generalizability by directly evaluating the intervention’s effectiveness among a general community sample. Methods: While signing up for Overcome Social Anxiety, users consented to the usage of their anonymized outcome data for research purposes. Before and after completing the intervention, users completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors (Avoidance Questionnaire). Results: Participants who completed the intervention (102/369, 27.7%) experienced significant reductions in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001; Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42). Conclusions: Our results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the general community. The completion rate is the highest documented for a fully automated intervention for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of anxiety, and stress in addition to symptoms of social anxiety. %M 30632965 %R 10.2196/11566 %U http://www.jmir.org/2019/1/e11566/ %U https://doi.org/10.2196/11566 %U http://www.ncbi.nlm.nih.gov/pubmed/30632965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e12091 %T Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial %A Matsumoto,Kazuki %A Sutoh,Chihiro %A Asano,Kenichi %A Seki,Yoichi %A Urao,Yuko %A Yokoo,Mizue %A Takanashi,Rieko %A Yoshida,Tokiko %A Tanaka,Mari %A Noguchi,Remi %A Nagata,Shinobu %A Oshiro,Keiko %A Numata,Noriko %A Hirose,Motohisa %A Yoshimura,Kensuke %A Nagai,Kazue %A Sato,Yasunori %A Kishimoto,Taishiro %A Nakagawa,Akiko %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1, Chuo-ku, Chiba-shi, Chiba,, Japan, 81 43 226 2027, csutoh@graduate.chiba-u.jp %K clinical trial %K cognitive behavioral therapy %K feasibility study %K obsessive-compulsive disorder %K panic disorder %K social anxiety disorder %K videoconference %D 2018 %7 17.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time. Objectives: This study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD. Methods: A total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants’ points and 95% CIs were estimated by the paired t tests with the change between pre- and posttreatment. Results: A significant reduction in symptom of obsession-compulsion (Y-BOCS=−6.2; Cohen d=0.74; 95% CI −9.4 to −3.0, P=.002), panic (PDSS=−5.6; Cohen d=0.89; 95% CI −9.83 to −1.37; P=.02), social anxiety (LSAS=−33.6; Cohen d=1.10; 95% CI −59.62 to −7.49, P=.02) were observed. In addition, depression (PHQ-9=−1.72; Cohen d=0.27; 95% CI −3.26 to −0.19; P=.03) and general anxiety (GAD-7=−3.03; Cohen d=0.61; 95% CI −4.57 to −1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95% CI −0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95% CI 1.24 to 7.04; P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30). Conclusions: Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable. %M 30559094 %R 10.2196/12091 %U http://www.jmir.org/2018/12/e12091/ %U https://doi.org/10.2196/12091 %U http://www.ncbi.nlm.nih.gov/pubmed/30559094 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10101 %T Predicting Social Anxiety From Global Positioning System Traces of College Students: Feasibility Study %A Boukhechba,Mehdi %A Chow,Philip %A Fua,Karl %A Teachman,Bethany A %A Barnes,Laura E %+ School of Engineering and Applied Science, Systems and Information Engineering Department, University of Virginia, 151 Engineer's Way, Olsson Hall 101B, Charlottesville, VA, 22904, United States, 1 (434) 924 1723, lb3dp@virginia.edu %K mental health %K mHealth %K mobility %K GPS %K social anxiety disorder %D 2018 %7 04.07.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social anxiety is highly prevalent among college students. Current methodologies for detecting symptoms are based on client self-report in traditional clinical settings. Self-report is subject to recall bias, while visiting a clinic requires a high level of motivation. Assessment methods that use passively collected data hold promise for detecting social anxiety symptoms and supplementing self-report measures. Continuously collected location data may provide a fine-grained and ecologically valid way to assess social anxiety in situ. Objective: The objective of our study was to examine the feasibility of leveraging noninvasive mobile sensing technology to passively assess college students’ social anxiety levels. Specifically, we explored the different relationships between mobility and social anxiety to build a predictive model that assessed social anxiety from passively generated Global Positioning System (GPS) data. Methods: We recruited 228 undergraduate participants from a Southeast American university. Social anxiety symptoms were assessed using self-report instruments at a baseline laboratory session. An app installed on participants’ personal mobile phones passively sensed data from the GPS sensor for 2 weeks. The proposed framework supports longitudinal, dynamic tracking of college students to evaluate the relationship between their social anxiety and movement patterns in the college campus environment. We first extracted the following mobility features: (1) cumulative staying time at each different location, (2) the distribution of visits over time, (3) the entropy of locations, and (4) the frequency of transitions between locations. Next, we studied the correlation between these features and participants’ social anxiety scores to enhance the understanding of how students’ social anxiety levels are associated with their mobility. Finally, we used a neural network-based prediction method to predict social anxiety symptoms from the extracted daily mobility features. Results: Several mobility features correlated with social anxiety levels. Location entropy was negatively associated with social anxiety (during weekdays, r=−0.67; and during weekends, r=−0.51). More (vs less) socially anxious students were found to avoid public areas and engage in less leisure activities during evenings and weekends, choosing instead to spend more time at home after school (4 pm-12 am). Our prediction method based on extracted mobility features from GPS trajectories successfully classified participants as high or low socially anxious with an accuracy of 85% and predicted their social anxiety score (on a scale of 0-80) with a root-mean-square error of 7.06. Conclusions: Results indicate that extracting and analyzing mobility features may help to reveal how social anxiety symptoms manifest in the daily lives of college students. Given the ubiquity of mobile phones in our society, understanding how to leverage passively sensed data has strong potential to address the growing needs for mental health monitoring and treatment. %M 29973337 %R 10.2196/10101 %U http://mental.jmir.org/2018/3/e10101/ %U https://doi.org/10.2196/10101 %U http://www.ncbi.nlm.nih.gov/pubmed/29973337 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10034 %T Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps %A Zhang,Melvyn %A Ying,JiangBo %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K smartphone %K mHealth %K psychiatry %K telemedicine %K mobile applications %D 2018 %7 24.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective: The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods: To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations. Results: The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions: This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically. %M 29793899 %R 10.2196/10034 %U http://mhealth.jmir.org/2018/5/e10034/ %U https://doi.org/10.2196/10034 %U http://www.ncbi.nlm.nih.gov/pubmed/29793899 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e34 %T Harnessing Social Media to Explore Youth Social Withdrawal in Three Major Cities in China: Cross-Sectional Web Survey %A Liu,Lucia Lin %A Li,Tim MH %A Teo,Alan R %A Kato,Takahiro A %A Wong,Paul WC %+ Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, 5/F, The Jockey Club Tower, Centennial Campus, Pokfulam Road, Hong Kong,, China (Hong Kong), 852 39175029, paulw@hku.hk %K adolescent %K social withdrawal %K hikikomori %K youth social issues %K Web survey %K China %D 2018 %7 10.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature. Objective: The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China. Methods: A cross-sectional open Web survey was conducted from October 2015 to May 2016 to identify and reach socially withdrawn youth in 3 metropolitan cities in China: Beijing, Shanghai, and Shenzhen. To advertise the survey, 3 social media platforms were used: Weibo, WeChat, and Wandianba, a social networking gaming website. Results: In total, 137 participants completed the survey, among whom 13 (9.5%) were identified as belonging to the withdrawal group, 7 (5.1%) to the asocial group, and 9 (6.6%) to the hikikomori group (both withdrawn and asocial for more than 3 months). The cost of recruitment via Weibo was US $7.27 per participant. Conclusions: Several social media platforms in China are viable and inexpensive tools to reach socially withdrawn youth, and internet platforms that specialize in a certain culture or type of entertainment appeared to be more effective in reaching socially withdrawn youth. %M 29748164 %R 10.2196/mental.8509 %U http://mental.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/mental.8509 %U http://www.ncbi.nlm.nih.gov/pubmed/29748164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e91 %T Evaluating a Web-Based Social Anxiety Intervention Among University Students: Randomized Controlled Trial %A McCall,Hugh Cameron %A Richardson,Chris G %A Helgadottir,Fjola Dogg %A Chen,Frances S %+ Department of Psychology, University of British Columbia, 3521-2136 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 822 2549, frances.chen@psych.ubc.ca %K social anxiety %K clinical trial %K internet %K cognitive behavior therapy %D 2018 %7 21.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Treatment rates for social anxiety, a prevalent and potentially debilitating condition, remain among the lowest of all major mental disorders today. Although computer-delivered interventions are well poised to surmount key barriers to the treatment of social anxiety, most are only marginally effective when delivered as stand-alone treatments. A new, Web-based cognitive behavioral therapy (CBT) intervention called Overcome Social Anxiety was recently created to address the limitations of prior computer-delivered interventions. Users of Overcome Social Anxiety are self-directed through various CBT modules incorporating cognitive restructuring and behavioral experiments. The intervention is personalized to each user’s symptoms, and automatic email reminders and time limits are used to encourage adherence. Objective: The purpose of this study was to conduct a randomized controlled trial to investigate the effectiveness of Overcome Social Anxiety in reducing social anxiety symptoms in a nonclinical sample of university students. As a secondary aim, we also investigated whether Overcome Social Anxiety would increase life satisfaction in this sample. Methods: Following eligibility screening, participants were randomly assigned to a treatment condition or a wait-list control condition. Only those assigned to the treatment condition were given access to Overcome Social Anxiety; they were asked to complete the program within 4 months. The social interaction anxiety scale (SIAS), the fear of negative evaluation scale (FNE), and the quality of life enjoyment and satisfaction questionnaire—short form (Q-LES-Q-SF) were administered to participants from both conditions during baseline and 4-month follow-up lab visits. Results: Over the course of the study, participants assigned to the treatment condition experienced a significant reduction in social anxiety (SIAS: P<.001, Cohen d=0.72; FNE: P<.001, Cohen d=0.82), whereas those assigned to the control condition did not (SIAS: P=.13, Cohen d=0.26; FNE: P=.40, Cohen d=0.14). Additionally, a direct comparison of the average change in social anxiety in the 2 conditions over the course of the study showed that those assigned to the treatment condition experienced significantly more improvement than those assigned to the control condition (SIAS: P=.03, Cohen d=0.56; FNE: P=.001, Cohen d=0.97). Although participants assigned to the treatment condition experienced a slight increase in life satisfaction, as measured by Q-LES-Q-SF scores, and those assigned to the control condition experienced a slight decrease, these changes were not statistically significant (treatment: P=.35, Cohen d=−0.18; control: P=.30, Cohen d=0.18). Conclusions: Our findings indicate that Overcome Social Anxiety is an effective intervention for treating symptoms of social anxiety and that it may have further utility in serving as a model for the development of new interventions. Additionally, our findings provide evidence that contemporary Web-based interventions can be sophisticated enough to benefit users even when delivered as stand-alone treatments, suggesting that further opportunities likely exist for the development of other Web-based mental health interventions. Trial Registration: ClinicalTrials.gov NCT02792127; https://clinicaltrials.gov/ct2/show/record/NCT02792127 (Archived by WebCite at http://www.webcitation.org/6xGSRh7MG) %M 29563078 %R 10.2196/jmir.8630 %U http://www.jmir.org/2018/3/e91/ %U https://doi.org/10.2196/jmir.8630 %U http://www.ncbi.nlm.nih.gov/pubmed/29563078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e33 %T Gender Differences in and the Relationships Between Social Anxiety and Problematic Internet Use: Canonical Analysis %A Baloğlu,Mustafa %A Özteke Kozan,Hatice İrem %A Kesici,Şahin %+ Department of Special Education, Faculty of Education, Hacettepe University, Beytepe Campus, Ankara, 06610, Turkey, 90 3127806315, baloglu@hotmail.com %K anxiety %K Internet %K sex characteristics %K social anxiety disorder %K addictive behavior %D 2018 %7 24.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The cognitive-behavioral model of problematic Internet use (PIU) proposes that psychological well-being is associated with specific thoughts and behaviors on the Internet. Hence, there is growing concern that PIU is associated with psychological impairments. Objective: Given the proposal of gender schema theory and social role theory, men and women are predisposed to experience social anxiety and engage in Internet use differently. Thus, an investigation of gender differences in these areas is warranted. According to the cognitive-behavioral model of PIU, social anxiety is associated with specific cognitions and behaviors on the Internet. Thus, an investigation of the association between social anxiety and PIU is essential. In addition, research that takes into account the multidimensional nature of social anxiety and PIU is lacking. Therefore, this study aimed to explore multivariate gender differences in and the relationships between social anxiety and PIU. Methods: Participants included 505 college students, of whom 241 (47.7%) were women and 264 (52.3%) were men. Participants’ ages ranged from 18 to 22 years, with a mean age of 20.34 (SD=1.16). The Social Anxiety Scale and Problematic Internet Use Scale were used in data collection. Multivariate analysis of variance (MANOVA) and canonical correlation analysis were used. Results: Mean differences between men and women were not statistically significant in social anxiety (λ=.02, F3,501=2.47, P=.06). In all three PIU dimensions, men scored higher than women, and MANOVA shows that multivariate difference was statistically significant (λ=.94, F3,501=10.69, P<.001). Of the canonical correlation functions computed for men, only the first was significant (Rc=.43, λ=.78, χ29=64.7, P<.001) and accounted for 19% of the overlapping variance. Similarly, only the first canonical function was significant for women (Rc=.36, λ=.87, χ29=33.9, P<.001), which accounted for 13% of the overlapping variance. Conclusions: On the basis of the findings, we conclude that enhanced educational opportunities for women and their increasing role in the society have led women to become more active and thus closed the gap in social anxiety levels between men and women. We found that men showed more difficulties than women in terms of running away from personal problems (ie, social benefit), used the Internet more excessively, and experienced more interpersonal problems with significant others due to Internet use. We conclude that men are under a greater risk of social impairments due to PIU. Our overall conclusion is that there is a substantial amount of association between social anxiety and PIU and the association is stronger for men than it is for women. We advise that future research continue to investigate PIU and social anxiety as multidimensional constructs. %M 29367182 %R 10.2196/jmir.8947 %U http://www.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/jmir.8947 %U http://www.ncbi.nlm.nih.gov/pubmed/29367182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e62 %T Using Mobile Sensing to Test Clinical Models of Depression, Social Anxiety, State Affect, and Social Isolation Among College Students %A Chow,Philip I %A Fua,Karl %A Huang,Yu %A Bonelli,Wesley %A Xiong,Haoyi %A Barnes,Laura E %A Teachman,Bethany A %+ School of Engineering and Applied Science, University of Virginia, 151 Engineer's Way, Olsson Hall 101B, PO Box 400747, Charlottesville, VA, 22904-4747, United States, 1 434 924 1723, lbarnes@virginia.edu %K mental health %K depression %K social anxiety %K affect %K homestay %K mobile health %K mHealth %D 2017 %7 03.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Research in psychology demonstrates a strong link between state affect (moment-to-moment experiences of positive or negative emotionality) and trait affect (eg, relatively enduring depression and social anxiety symptoms), and a tendency to withdraw (eg, spending time at home). However, existing work is based almost exclusively on static, self-reported descriptions of emotions and behavior that limit generalizability. Despite adoption of increasingly sophisticated research designs and technology (eg, mobile sensing using a global positioning system [GPS]), little research has integrated these seemingly disparate forms of data to improve understanding of how emotional experiences in everyday life are associated with time spent at home, and whether this is influenced by depression or social anxiety symptoms. Objective: We hypothesized that more time spent at home would be associated with more negative and less positive affect. Methods: We recruited 72 undergraduate participants from a southeast university in the United States. We assessed depression and social anxiety symptoms using self-report instruments at baseline. An app (Sensus) installed on participants’ personal mobile phones repeatedly collected in situ self-reported state affect and GPS location data for up to 2 weeks. Time spent at home was a proxy for social isolation. Results: We tested separate models examining the relations between state affect and time spent at home, with levels of depression and social anxiety as moderators. Models differed only in the temporal links examined. One model focused on associations between changes in affect and time spent at home within short, 4-hour time windows. The other 3 models focused on associations between mean-level affect within a day and time spent at home (1) the same day, (2) the following day, and (3) the previous day. Overall, we obtained many of the expected main effects (although there were some null effects), in which higher social anxiety was associated with more time or greater likelihood of spending time at home, and more negative or less positive affect was linked to longer homestay. Interactions indicated that, among individuals higher in social anxiety, higher negative affect and lower positive affect within a day was associated with greater likelihood of spending time at home the following day. Conclusions: Results demonstrate the feasibility and utility of modeling the relationship between affect and homestay using fine-grained GPS data. Although these findings must be replicated in a larger study and with clinical samples, they suggest that integrating repeated state affect assessments in situ with continuous GPS data can increase understanding of how actual homestay is related to affect in everyday life and to symptoms of anxiety and depression. %M 28258049 %R 10.2196/jmir.6820 %U http://www.jmir.org/2017/3/e62/ %U https://doi.org/10.2196/jmir.6820 %U http://www.ncbi.nlm.nih.gov/pubmed/28258049 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e20 %T Community Structure of a Mental Health Internet Support Group: Modularity in User Thread Participation %A Carron-Arthur,Bradley %A Reynolds,Julia %A Bennett,Kylie %A Bennett,Anthony %A Cunningham,John Alastair %A Griffiths,Kathleen Margaret %+ National Institute for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston road, Acton, 2601, Australia, 61 2 6125 6825, Bradley.Carron-Arthur@anu.edu.au %K internet %K support group %K social network %K modularity %K mental health %K super user %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Little is known about the community structure of mental health Internet support groups, quantitatively. A greater understanding of the factors, which lead to user interaction, is needed to explain the design information of these services and future research concerning their utility. Objective: A study was conducted to determine the characteristics of users associated with the subgroup community structure of an Internet support group for mental health issues. Methods: A social network analysis of the Internet support group BlueBoard (blueboard.anu.edu.au) was performed to determine the modularity of the community using the Louvain method. Demographic characteristics age, gender, residential location, type of user (consumer, carer, or other), registration date, and posting frequency in subforums (depression, generalized anxiety, social anxiety, panic disorder, bipolar disorder, obsessive compulsive disorder, borderline personality disorder, eating disorders, carers, general (eg, “chit chat”), and suggestions box) of the BlueBoard users were assessed as potential predictors of the resulting subgroup structure. Results: The analysis of modularity identified five main subgroups in the BlueBoard community. Registration date was found to be the largest contributor to the modularity outcome as observed by multinomial logistic regression. The addition of this variable to the final model containing all other factors improved its classification accuracy by 46.3%, that is, from 37.9% to 84.2%. Further investigation of this variable revealed that the most active and central users registered significantly earlier than the median registration time in each group. Conclusions: The five subgroups resembled five generations of BlueBoard in distinct eras that transcended discussion about different mental health issues. This finding may be due to the activity of highly engaged and central users who communicate with many other users. Future research should seek to determine the generalizability of this finding and investigate the role that highly active and central users may play in the formation of this phenomenon. %M 27242012 %R 10.2196/mental.4961 %U http://mental.jmir.org/2016/2/e20/ %U https://doi.org/10.2196/mental.4961 %U http://www.ncbi.nlm.nih.gov/pubmed/27242012 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e232 %T Posttreatment Attrition and Its Predictors, Attrition Bias, and Treatment Efficacy of the Anxiety Online Programs %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave, Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K posttreatment attrition %K posttreatment predictors %K treatment efficacy %K online therapy %K e-mental health %K cognitive behavioral therapy %K Internet interventions %K fully automated %K self-help %K Web treatment %K generalized anxiety disorder %K obsessive compulsive disorder %D 2014 %7 14.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. Objective: The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Methods: A complex algorithm was used to diagnose participants’ mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. Results: On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman’s method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD. Conclusions: Results identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 25316533 %R 10.2196/jmir.3513 %U http://www.jmir.org/2014/10/e232/ %U https://doi.org/10.2196/jmir.3513 %U http://www.ncbi.nlm.nih.gov/pubmed/25316533 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e152 %T Pretreatment Attrition and Formal Withdrawal During Treatment and Their Predictors: An Exploratory Study of the Anxiety Online Data %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave, Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K pretreatment attrition %K treatment withdrawal dropouts %K predictors, anxiety disorders %K eTherapy %K e-mental health %K Internet interventions %D 2014 %7 17.06.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Although in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. Objective: This exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. Methods: Participants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. Results: Of 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25%). The treatment commencers differed significantly (P<.001-.03) from the noncommencers on several variables (reason for registering, mental health concerns, postsecondary education, where first heard about Anxiety Online, Kessler-6 score, stage of change, quality of life, relationship status, preferred method of learning, and smoking status). Those who formally withdrew during treatment differed significantly (P=.002-.03) from those who did not formally withdraw in that they were less likely to express concerns about anxiety, stress, and depression; to rate their quality of life as very poor, poor, or good; to report adequate level of social support; and to report readiness to make or were in the process of making changes. Conclusions: This exploratory study identified predictors of pretreatment attrition and formal withdrawal during treatment dropouts for the Anxiety Online program. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 24938311 %R 10.2196/jmir.2989 %U http://www.jmir.org/2014/6/e152/ %U https://doi.org/10.2196/jmir.2989 %U http://www.ncbi.nlm.nih.gov/pubmed/24938311 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e229 %T Telephone Versus Internet Administration of Self-Report Measures of Social Anxiety, Depressive Symptoms, and Insomnia: Psychometric Evaluation of a Method to Reduce the Impact of Missing Data %A Hedman,Erik %A Ljótsson,Brjánn %A Blom,Kerstin %A El Alaoui,Samir %A Kraepelien,Martin %A Rück,Christian %A Andersson,Gerhard %A Svanborg,Cecilia %A Lindefors,Nils %A Kaldo,Viktor %+ Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Retzius väg 8, Stockholm, 171 77, Sweden, 46 08 524 800 00, kire.hedman@ki.se %K Internet %K telephone %K self-report measures %K missing data %K method validation %D 2013 %7 18.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection. Objective: The aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties. Methods: The Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone. Results: As predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S. Conclusions: Telephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates. %M 24140566 %R 10.2196/jmir.2818 %U http://www.jmir.org/2013/10/e229/ %U https://doi.org/10.2196/jmir.2818 %U http://www.ncbi.nlm.nih.gov/pubmed/24140566 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e89 %T Anxiety Online—A Virtual Clinic: Preliminary Outcomes Following Completion of Five Fully Automated Treatment Programs for Anxiety Disorders and Symptoms %A Klein,Britt %A Meyer,Denny %A Austin,David William %A Kyrios,Michael %+ National eTherapy Centre, Faculty of Life and Social Sciences, Swinburne University, Mail H99, PO Box 218, Hawthorn, Melbourne, 3122, Australia, 61 392148851, bklein@swin.edu.au %K eTherapy %K Internet interventions %K e-mental health %K cognitive behavior therapy %K generalized anxiety disorder %K panic disorder %K obsessive compulsive disorder %K social anxiety disorder %K posttraumatic stress disorder %K self-help %K fully automated %K Web treatment %D 2011 %7 04.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of e-mental health interventions to treat or prevent mental illness and to enhance wellbeing has risen rapidly over the past decade. This development assists the public in sidestepping some of the obstacles that are often encountered when trying to access traditional face-to-face mental health care services. Objective: The objective of our study was to investigate the posttreatment effectiveness of five fully automated self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders. Methods: We used a naturalistic participant choice, quasi-experimental design to evaluate each of the five Anxiety Online fully automated self-help e-therapy programs. Participants were required to have at least subclinical levels of one of the anxiety disorders to be offered the associated disorder-specific fully automated self-help e-therapy program. These programs are offered free of charge via Anxiety Online. Results: A total of 225 people self-selected one of the five e-therapy programs (GAD, n = 88; SAD, n = 50; PD/A, n = 40; PTSD, n = 30; OCD, n = 17) and completed their 12-week posttreatment assessment. Significant improvements were found on 21/25 measures across the five fully automated self-help programs. At postassessment we observed significant reductions on all five anxiety disorder clinical disorder severity ratings (Cohen d range 0.72–1.22), increased confidence in managing one’s own mental health care (Cohen d range 0.70–1.17), and decreases in the total number of clinical diagnoses (except for the PD/A program, where a positive trend was found) (Cohen d range 0.45–1.08). In addition, we found significant improvements in quality of life for the GAD, OCD, PTSD, and SAD e-therapy programs (Cohen d range 0.11–0.96) and significant reductions relating to general psychological distress levels for the GAD, PD/A, and PTSD e-therapy programs (Cohen d range 0.23–1.16). Overall, treatment satisfaction was good across all five e-therapy programs, and posttreatment assessment completers reported using their e-therapy program an average of 395.60 (SD 272.2) minutes over the 12-week treatment period. Conclusions: Overall, all five fully automated self-help e-therapy programs appear to be delivering promising high-quality outcomes; however, the results require replication. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG) %M 22057287 %R 10.2196/jmir.1918 %U http://www.jmir.org/2011/4/e89/ %U https://doi.org/10.2196/jmir.1918 %U http://www.ncbi.nlm.nih.gov/pubmed/22057287 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 2 %P e39 %T A 5-Year Follow-up of Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder %A Hedman,Erik %A Furmark,Tomas %A Carlbring,Per %A Ljótsson,Brjánn %A Rück,Christian %A Lindefors,Nils %A Andersson,Gerhard %+ Department of Clinical Neuroscience, Karolinska Institutet, Internet Psychiatry M46, Karolinska University Hospital Huddinge, Stockholm, 141 86, Sweden, 46 8 585 857 91, erik.hedman.2@ki.se %K Internet %K cognitive behavior therapy %K anxiety disorders %K social anxiety disorder %K 5-year follow-up %D 2011 %7 15.06.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavior therapy (CBT) has been shown to be a promising method to disseminate cognitive behavior therapy for social anxiety disorder (SAD). Several trials have demonstrated that Internet-based CBT can be effective for SAD in the shorter term. However, the long-term effects of Internet-based CBT for SAD are less well known. Objective: Our objective was to investigate the effect of Internet-based CBT for SAD 5 years after completed treatment. Method: We conducted a 5-year follow-up study of 80 persons with SAD who had undergone Internet-based CBT. The assessment comprised a diagnostic interview and self-report questionnaires. The main outcome measure was the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR). Additional measures of social anxiety were the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). Attrition rates were low: 89% (71/80) of the participants completed the diagnostic interview and 80% (64/80) responded to the questionnaires. Results: Mixed-effect models analysis showed a significant effect of time on the three social anxiety measures, LSAS-SR, SIAS, and SPS (F3,98-102 = 16.05 - 29.20, P < .001) indicating improvement. From baseline to 5-year follow-up, participants’ mean scores on the LSAS-SR were reduced from 71.3 (95% confidence interval [CI] 66.1-76.5) to 40.3 (95% CI 35.2 - 45.3). The effect sizes of the LSAS-SR were large (Cohen’s d range 1.30 - 1.40, 95% CI 0.77 - 1.90). Improvements gained at the 1-year follow-up were sustained 5 years after completed treatment. Conclusions: Internet-based CBT for SAD is a treatment that can result in large and enduring effects. Trial registration: Clinicaltrials.gov NCT01145690; http://clinicaltrials.gov/ct2/show/NCT01145690 (Archived by WebCite at http://www.webcitation.org/5ygRxDLfK) %M 21676694 %R 10.2196/jmir.1776 %U http://www.jmir.org/2011/2/e39/ %U https://doi.org/10.2196/jmir.1776 %U http://www.ncbi.nlm.nih.gov/pubmed/21676694