Predictors of treatment outcomes and adherence in internet-based cognitive behavioral therapy for social anxiety in China
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Abstract
Background: Although internet-based cognitive behaviour therapy (ICBT) is an effective treatment for social anxiety disorder (SAD), a substantial proportion of patients do not achieve clinically significant improvement. More research is needed to identify which factors predict treatment adherence and outcomes. Aims: The aims of this study were to (1) identify demographic and clinical factors associated with treatment adherence and outcomes in ICBT for social anxiety in China, and (2) explore whether low-intensity therapist support results in improved treatment adherence or outcomes. Method: Participants were assigned to either therapist-guided ( N = 183) or self-guided ICBT ( N = 72). Level of social anxiety was measured at both pre- and post-treatment. Treatment adherence and outcomes were analysed using a two-step linear and logistic regression approach. Clinical and demographic characteristics were examined. Results: No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with SAD were significantly less likely to drop out (OR 0.531, p = .03) compared with subclinical participants with social anxiety symptoms. Older participants ( B = 0.17, SE = 0.04, p = .008) and participants with a diagnosis of SAD ( B = 0.16, SE = 0.44, p = .01) tended to complete more modules. Participants who completed more modules ( B = 0.24, SE = 0.03, p = .01) and participants who identified as female ( B = –0.20, SE = 0.18, p = .04) reported greater reductions in SAD symptoms. Conclusions: Understanding of factors related to adherence and outcome is necessary to prevent drop-out and optimize outcome.
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Several studies on ICBT with treatment programs adapted to specific cultures in China, Korea, and Pakistan yielded results supporting the effectiveness of ICBT.
“Recently, several studies on ICBT with treatment programs adapted to specific cultures have been conducted in China, Korea, and Pakistan, yielding results supporting the effectiveness of ICBT [14-16].”
From Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial (2024) · cites this paper as [15]
Chen et al. [47] highlighted a significant gap in understanding the link between students' SE and digital therapeutic environments, and noted that inconvenient usage environments can undermine user confidence, reducing intentions to adopt the technology.
“While Chen et al. [47] highlighted a significant gap in understanding the link between students’ SE and digital therapeutic environments, inconvenient usage environments can undermine user confidence, reducing intentions to adopt the technology.”
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Adherence and Engagement in Videoconference Interventions for Treatment-resistant Depression
Castro, A., Serra, P. R., Navarra‐Ventura, G., Forteza-Rey, I., Bennasar‐Veny, M., García-Robles, A., Salvá, J., Ibarra, O., Gómez-Juanes, R., & Garcı́a-Toro, M. (2026) · Clínica y Salud · doi:10.5093/clh2026a4
Schüller, J. S., Kujat, J., Schittenhelm, J. M., von Rechenberg, R., Čerič, A., Hoyer, J., & Stangier, U. (2026) · Clinical Psychology in Europe · doi:10.32872/cpe.15687
“…cost savings by reducing personnel involvement, mixed evidence on the role of therapist guidance in improving adherence and reducing attrition (Chen et al., 2020; Dryman et al., 2017) raises concerns that a reduction in treatment effectiveness due to lower adherence and retention could offset…”
Exploring Prolonged Grief Experiences of Ethnoracial Minoritized Caregivers: An Emic Perspective
Dsouza, V. F., Reardon, B., & Giscombé, C. L. W. (2026) · Research in Nursing & Health · doi:10.1002/nur.70092
Pan, M., Zhang, S., Zhao, M., Zhang, L., Li, H., Liu, L., Wang, Y., & Qian, Q. (2026) · Journal of Attention Disorders · doi:10.1177/10870547261483459
- Authors
- Chen, H., Rodriguez, M. A., Qian, M., Kishimoto, T., Lin, M., & Berger, T.
- Affiliations
- Peking University (CN)
- Pitzer College (US)
- University of Bern (CH)
- Corresponding author
- Qian, Mingyi
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-01-13
- Volume
- 48
- Issue
- 3
- Pages
- 291-303
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W2998800858
- Cited by
- 33
- References
- 66
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 1
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- internet-based cognitive behavioral therapy, social anxiety disorder, medication adherence, predictors of treatment outcome, treatment discontinuation, demographic factors
- MeSH terms
- Anxiety, China, Female, Humans, Cognitive Behavioral Therapy, Treatment Outcome, Internet
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