Psychotherapy of social phobia via the internet

In a recent article ( Effectiveness of Internet-Based Cognitive – Behavior Therapy for Social Anxiety Disorder in Clinical Psychiatry – ), the authors reported the results of a study on the efficacy of Internet Cognitive Behavioral Therapy (ICBT) protocol for the treatment of social anxiety disorder in patients belonging to psychiatry services.

As known, social phobia is a very common and highly disabling disorder; it tends to a chronic course and is often the cause of depressive disorders and pathological addictions.

The cognitive behavioral therapy , with some shadow, has long proved its effectiveness in the treatment of this debilitating disorder. This has led to the development of several protocols, including the one being studied in this article.

The aim of the study was to investigate the efficacy of ICBT in treating social phobia in a group of patients belonging to the psychiatry service. A second objective was to evaluate whether treatment adherence was associated with symptomatic improvement; finally, given the longitudinal nature of the study, see if the increased experience of the therapists in this protocol produced an improvement in outcomes.

The present study involved a sample of 654 patients belonging to the national psychiatric service. The inclusion criteria were meeting the DSM IV criteria, not undertaking other types of therapy during the trial, taking any drug therapy, if present, in a stable manner for at least four weeks, being able to read and write, being older at 16, have access to a computer, have no other psychiatric problems. Patients were given several questionnaires, including the Liebowitz Social Anxiety Scale Self Report.

The basic principle of ICBT is that the protocol, based on the model of Clark and Wells, does not actually deviate from a vis á vis therapy. Over the years (the present study began in 2009 and ended in 2013), the number of sessions has gone from 15 to 12 but without substantially changing the intervention.

As assumed, the basic principles of treatment were psychoeducation , cognitive restructuring and gradual in vivo exposure . Patients were provided with materials and worksheets via the internet. On average each patient sent 14.84 messages to the therapist, who on average responded with 15.33 messages.

The results demonstrate that ICBT is effective in reducing social phobic symptoms both at the end of the trial and at the 6-month follow-up.
One of the most important clinical implications of this study is that ICBT appears to have a similar efficacy to that of standard CBT and, therefore, given the difficulty in accessing patients with social phobia to treatment, this protocol could prove to be advantageous. In conclusion, however, it is also necessary to underline several weaknesses of the study, such as the absence of a control group.

These are clearly experiences of the Anglo-Saxon world, and in Italy we are still far from applying this type of intervention. One wonders, however, if all this skepticism makes sense to exist, given the increasingly overwhelming results reported by the efficacy trials of internet-based therapy .


by Abdullah Sam
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