Summary and Evaluation of a Randomized Controlled Trial for Internet-Based Treatment of Social Phobia

Summary and Evaluation of a Randomized Controlled Trial for Internet-Based Treatment of Social Phobia

As indicated by Andersson et al. (2006), the ever-expanding applications of the World Wide Web have provided mental health professionals with a host of alternative means by which to provide services to individuals in need. Following from empirical evidence supporting the efficacy of cognitive-behavioral, internet-based treatments for psychological disorders, Andersson and his colleagues have sought to develop and test one such application for the treatment of social phobia, a potentially life-debilitating disorder. The researchers’ primary objective is to provide further evidentiary support for the use of internet-based techniques to treat social phobia, essentially transcending the geographic, economic and psycho-social obstacles to treatment that some individuals may encounter.

Andersson and his colleagues conducted a true experimental study with random assignment to condition. Participants were selected based upon a number of inclusion criterion and baseline measures of social phobia were obtained utilizing validated protocols. Using true randomization techniques, eligible participants were assigned to either a treatment or waiting-list control group. In the treatment condition, participants were exposed to a 9-week, CBT based intervention consisting of a series of online self-help modules, periodic therapist interaction (via e-mail transmissions), and two physical (as opposed to cyber) group exposure sessions. Participants in the waiting-list control group were given no treatment for the nine-week period; however, in concordance with the ethical standards, received treatment upon conclusion of the initial nine week phase.

In concordance with cognitive-behavioral techniques of environmental and cognitive manipulations, treatment modules for the investigation consisted of psycho-education, in addition to exposure focused exercises and thought correction techniques. Following the completion of each module, participants were instructed to provide written accounts of their experience with the module and complete a brief examination. Responses were evaluated by an online therapist who assessed individual understanding of the presented material and, contingent upon adequate comprehension and completion, provided access to the subsequent module. In addition to the self-help component of the treatment, participants were encouraged to participate in two separate group exposure sessions held within the research facility.

Following the 9-week treatment/waiting phase of the experiment, participants were again assessed utilizing the same social anxiety measures employed at inception and pre and post-treatment scores for all participants were analyzed. According to the researchers, both the control and experimental groups displayed no statistically significant differences in social anxiety ratings prior to the treatment/waiting period. Between-group analyses following the treatment/waiting period, however, revealed significant differences in social anxiety, more specifically, participants in the treatment group showed substantial upward progression in outcome measures of social phobia as opposed to the control group, which failed to present any significant improvement. Furthermore, a 1-year follow-up of all participants indicated that the treatment appears to have lasting positive effects. However, it is unclear whether individuals obtained subsequent treatment following the initial phase of the experiment, and the possibility exists that participation in the study motivated individuals to initiate further treatment. Nonetheless, Anderson et al. are confident that their results indicate a functional relationship between the variables of interest, more specifically, that the proposed internet-based treatment systematically influences the dependent measure, social phobia.

Andersson and his colleagues are, for the most part, forthcoming and honest in their self-criticisms involving the methodology and findings of their research, however, several seemingly confounding issues have been understated. Although, the researchers admit that the compound nature of the treatment is potentially confounding, the fact that one cannot definitively state that the unique combination of self-help, therapist inter-action, and group exposure produced the changes in the dependent variable (as opposed to one or two of the components alone or in combination) is a significant threat to the internal validity of the study. Additionally, the comparison of the treatment group to a waiting-list control group fails to support the implication that the researchers’ unique treatment approach was responsible for the improvements, and could be attributed to the fact that participants were simply receiving some form of treatment, as opposed to none. Further research should address these issues by perhaps utilizing a multiple independent groups design and various treatment conditions (e.g., self-help only, self-help + therapist interaction, and self-help + interaction + group exposure). An additional benefit of this type of design is that every participant is immediately receiving treatment, as 9-weeks of waiting, while not exceedingly unethical, could potentially be discouraging to those in the waiting-list control group.

Overall, Andersson et al. provide an excellent starting point from which future explorations of internet-based treatments will undoubtedly emerge. Aside from the methodological imperfections mentioned, it remains my contention that the implications of this experiment support the furtherance of web-based, self-help treatments for social phobia. Such treatments possess the potential to provide much needed assistance and improve the quality of life for a great number of currently under-serviced individuals.

References

Andersson, G., Carlbring, P., Holmstrom, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E., et al. (2006). Internet-Based Self-Help With Therapist Feedback and In Vivo Group Exposure for Social Phobia: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 74(4).