Acceptance-based behavior therapy for social anxiety disorder using videoconferencing

Abstract

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in the United States (Grant et al., 2005; Kessler, Berglund, Demler, Jin, & Walters, 2005). Without treatment, SAD follows a chronic, unremitting course (Grant, et al., 2005), and is associated with high personal costs including decreased quality of life, work productivity, and quality of social relationships (Lipsitz & Schneier, 2000). However, more than 80% of people with SAD do not receive any type of treatment (Grant, et al., 2005), despite the existence of empirically supported cognitive behavioral treatments. Some individuals with SAD are unwilling to seek treatment in person due to their fears of social interaction, but may be willing to engage in remote treatment. Also, because CBT therapists are clustered around metropolitan areas, individuals living in non-metropolitan areas of the country have limited or no access to CBT therapists competent in the treatment of SAD. Interventions conducted through electronic communication media, such as the internet, have the potential to reach individuals who otherwise would not receive CBT. Videoconferencing technology potentially holds great promise in the widespread delivery of CBT. This uncontrolled pilot study assessed the feasibility, acceptability, and initial efficacy of an acceptance-based CBT intervention using Skype videoconferencing to treat adults with generalized SAD. Participants received 12 sessions of weekly therapy and were assessed at pre-treatment, mid-treatment, and post-treatment. Participants and therapists rated this treatment using Skype as acceptable and feasible. Most technical difficulties did not significantly impact the quality of the sessions. Analyses showed significant pre- to post-treatment improvements in social anxiety symptoms, depression, disability, and quality of life, with effect sizes comparable to or larger than previously published results of studies delivering in-person CBT for SAD. Implications and future directions are discussed.