A computer-based self-treatment for social phobia : Development, evaluation and a controlled treatment study

Abstract

Social phobia is one of the most prevalent and debilitating anxiety disorders. The main purpose of the present thesis was to develop and evaluate a computer-based self-treatment for social phobia within the framework of cognitive behavior therapy. In the formative evaluation, the focus was to create a comprehensible program that could support the learning process. Multimedia and interactive features were applied according to recommendations from leading researchers, as well as feedback from participants (Ps). In the pilot study, it was demonstrated that the self-treatment could reduce social anxiety. In the summative evaluation, a controlled treatment study generated a final judgement, showing that the self-treatment could lead to a clinically significant improvement in about 35% of the Ps working at the university with the self-treatment. In particular, the results indicated that older Ps with an onset age in the mid and the late adolescence were more likely to be successful, whereas Ps with severe forms of social phobia and depression were not. Aspects important to the learning process were investigate, showing that the use of external resources and high levels of intrinsic, rather than extrinsic motivation, were important to treatment outcome. Results from an impromptu speech task showed that thoughts after the speech were associated with the level of social anxiety, rather than thoughts in anticipation of the speech or behavioral variables. Thus, the results lend support to the assumption that cognitive aspects play a crucial role in social phobia. In particular, post-event processing should be further investigated. Social support was also suggested to be further investigated, as well as the learning process during computer-based self-treatments.

Das Hauptziel der Dissertation war eine CD-ROM gesteuerte Selbstbehandlung der sozialen Phobie zu entwickeln, zu evaluieren (eine formative Evaluation) und die Endversion in einer kontrollierten Studie zu testen (eine summative Evaluation). Die Grundlage der CD-ROM war die Kognitive Verhaltenstherapie. Die Ergebnisse in der formativen Evaluation zeigten, dass die CD-ROM zu einer Reduktion der sozialen Angst führen kann. Verbesserungsvorschläge der CD-ROM wurden von sowohl Patientinnen, als auch Experten gemacht. Ca. 35% der Patientinnen in der summativen Evaluation zeigten eine klinisch-signifikante Verbesserung nach der Behandlung. Erfolgreich waren Patientinnen, die älter waren, über niedriger Angst und Depressivität berichteten, mit Debüt in der Pubertät (eher als in der Kindheit). Eine hohe intrinsische Motivation und die Verwendung von externen Ressourcen spielten eine wichtige Rolle in dem Lernprozess. Gedanken nach einer Rede in einem Verhaltenstest konnte zwischen sozial-phobischen Menschen (starke Angst vs niedrige Angst) differenzieren. Kognitive Aspekte spielen eine wichtige Rolle in sozialer Phobie, insbesondere so genannte „Post-event processing“ sollte weiter untersucht werden. Soziale Unterstützung und Lernprozesse sollten ebenfalls weiter untersucht werden in computergestütztes Lernen und Selbstbehandlungen.