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Cited by 24Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series

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Thew, Graham R, Powell, Candice LYM, Kwok, Amy PL, Lissillour Chan, Mandy H, Wild, Jennifer, Warnock-Parkes, Emma, Leung, Patrick WL, Clark, David M·2019·JMIR Formative Research
DOI 10.2196/13446PMC PMC6540721

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Abstract

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.

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  • The Hong Kong trials used the English version of iCT-SAD and included only English-speaking participants.

    “As the Hong Kong trials used the English version of iCT-SAD and included only English-speaking participants”

    From Translated and culturally adapted internet-delivered cognitive therapy for social anxiety disorder in Japanese clinical settings: study protocol for a randomised controlled trial (2024) · cites this paper as [12]

    The Methods (Pilot Case Series, Participants and Procedure; page unavailable) say that all six Hong Kong patients had sufficient English proficiency to use the program and that the program was written in English. The paper documents one pilot case series, however, and does not establish that other Hong Kong trials used the English version or included only English-speaking participants. (LLM, conf=0.85)

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  • Results of a pilot trial and randomised controlled trial in Hong Kong showed outcomes comparable to the UK trial, suggesting that it is possible to transport iCT-SAD between cultures without a substantial drop in efficacy.

    “Results of a pilot trial and randomised controlled trial in Hong Kong showed outcomes comparable to the UK trial, which suggests that it is possible to transport iCT-SAD between cultures without a substantial drop in efficacy [11, 12].”

    From Translated and culturally adapted internet-delivered cognitive therapy for social anxiety disorder in Japanese clinical settings: study protocol for a randomised controlled trial (2024) · cites this paper as [12]

    The Discussion (Principal Findings; page unavailable) says outcomes in the six-patient Hong Kong pilot case series were comparable to UK results and suggests efficacy may have been maintained across cultural settings. But the Conclusions (page unavailable) say a randomized controlled trial was still in progress, so this paper does not support attributing comparable RCT results to it. (LLM, conf=0.92)

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1 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. [20]NICE Social anxiety disorder: The NICE guideline on recognition, assessment and treatment 2013 Cambridge, UK RCPsych Publications
  2. [27]Brown TA Barlow DH DiNardo PA Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV): Client Interview Schedule 1994 New York Oxford University Press
  3. [30]Oxford Centre for Anxiety Disorders and Trauma 2019 2019-04-22 OXCADAT Resources: Resources for cognitive therapy for PTSD, social anxiety disorder and panic disorder https://oxcadatresources.com/
  4. [39]Cohen J Statistical Power Analysis For The Behavioral Sciences (2nd Edition) 1988 Hillsdale, NJ Lawrence Erlbaum Associates

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Authors
Thew, G. R., Powell, C. L., Kwok, A. P., Lissillour Chan, M. H., Wild, J., Warnock-Parkes, E., Leung, P. W., & Clark, D. M.
Affiliations
  • National Health Service (GB)
  • Hospital Authority (HK)
  • University of Oxford (GB)
  • Chinese University of Hong Kong (HK)
Corresponding author
Thew, Graham R
ORCID
Venue
JMIR Formative Research
Publisher
JMIR Publications Inc.
Published
2019-05-15
Volume
3
Issue
2
Pages
e13446
ISSN
2561-326X (ISSN-L)
DOI
10.2196/13446
PMC
PMC6540721
OpenAlex
W2945395858
Cited by
24
References
40
Citations by year
2026: 2 · 2025: 1 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 3
FWCI
3.37
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Formative Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
  • Wellcome Trust (200796/Z/16/Z, 102176, 069777)
  • National Institute for Health and Care Research (NIHR-INF-0087)
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 › Psychotherapy Techniques and Applications
Keywords
social anxiety disorder, therapist training, cognitive behavioral therapy, Hong Kong, cultural adaptation, feasibility and acceptability, Liebowitz Social Anxiety Scale, clinical supervision

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