بررسی برنامه خودیاری بر اساس DVD در افراد بشدت مضطرب اجتماعی . مطالعه آزمایشی

High social anxiety is a risk factor for the incidence of social anxiety disorder (SAD). Early diagnosis and intervention may prevent more severe psychiatric courses. Self-help programs may be a convenient, accessible, and effective intervention. This study examined the efficacy of a newly developed self-help program for SAD in individuals with subthreshold social anxiety. A total of 24 highly socially anxious individuals were randomly assigned to a DVD-based self-help program or to a wait-list control group. The self-help program is based on the cognitive model according to Clark and Wells (1995; adapted to German by Stangier, Clark, & Ehlers, 2006) and comprises eight sessions. ANOVAs based on an intention-to-treat model were used for data analyses. The self-help program was well accepted; just one person withdrew during the intervention. There were significant Time × Group interactions on all primary outcome measures. For the intervention group moderate to high within-groups effect sizes up to Cohen's d = 1.05 were obtained. Between-groups effect sizes ranged from 0.24 to 0.65 in favor of the active intervention. The newly developed DVD-based self-help program seems to be a promising intervention for highly socially anxious individuals as it reduces social anxiety symptoms.

Social anxiety disorder (SAD) has a lifetime prevalence ranging from 7% to 13% of the population in Western countries (Furmark, 2002). It is one of the most frequent psychiatric disorders (Kessler et al., 2005, Murphy et al., 2007, Schneier, 2006 and Stein, 2006). SAD is characterized by a marked and persistent fear of at least one social or performance situation and by the fear to act in an embarrassing or humiliating way (American Psychiatric Association, 1994). Subthreshold anxiety is also associated with significant impairment that might warrant treatment. Affected individuals are comparable to those who meet DSM-IV threshold SAD regarding disability (Davidson et al., 1994, Fehm et al., 2008 and Stein et al., 2000) and development of co-occurring or subsequent anxiety disorders, depression, and substance use disorders (Crum and Pratt, 2001, Merikangas et al., 2002 and Zhang et al., 2004). Furthermore, subthreshold social anxiety is associated with an increased risk for a progression into DSM-IV-diagnosed SAD (Acaturk et al., 2009, Costello et al., 1999 and Ialongo et al., 1995). Prevalence rates of subthreshold social anxiety vary up to 25% in general population samples (e. g. Fehm et al., 2008 and Ruscio et al., 2008). Early awareness of risk indicators and early intervention may prevent more severe psychiatric prognosis, which has been shown for several psychiatric disorders like psychosis (overview by Salokangas & McGlashan, 2008), depression (overview by Horowitz & Garber, 2006), and anxiety disorders in general (Dadds et al., 1997, Gardenswartz and Craske, 2001, Schmidt et al., 2007, Seligman et al., 1999 and Swinson et al., 1992). Due to the imminent impairments and disabilities it seems to be reasonable to make convenient, accessible, and effective interventions available for individuals who are at risk of developing SAD. This could be materialized by the use of self-help programs, which are standardized psychological treatments the patient can operate him- or herself. There has been little research on SAD regarding nontechnological self-help programs such as bibliotherapy (Abramowitz, Moore, Braddock, & Harrington, 2009). But to our knowledge there are three research groups that independently evaluated Internet-based self-help treatments for SAD: a Swedish, an Australian, and a Swiss group (Andersson et al., 2006, Berger et al., 2009, Carlbring et al., 2006, Carlbring et al., 2007, Tillfors et al., 2008, Titov et al., 2008, Titov et al., 2008 and Titov et al., 2008). All programs were based on cognitive–behavioral therapy (CBT) or cognitive therapy (CT). Overall, all three groups found significant improvements for treated SAD patients in contrast to untreated controls on social anxiety measures with medium to large within-groups effect-sizes (Cohen's d > 0.76) and medium to large between-groups effect sizes (Cohen's d > 0.5). All of these studies provided additional therapist contact via e-mail, telephone, and/or in-person meetings in at least one treatment group. The results concerning the role of therapist contact while using self-help programs are heterogeneous. There is some evidence that Internet-based self-help programs are more effective when combined with some additional therapist assistance than when applied as pure self-help ( Rapee, Abbott, Baillie, & Gaston, 2007; Titov, Andrews, Choi et al., 2008). On the other hand, one study showed similar effects for therapist-augmented versus pure self-help ( Furmark et al., 2009) and another study ( Tillfors et al., 2008) showed only little evidence that additional live exposure sessions further enhanced the treatment effect. Altogether, there is some empirical support for the efficacy of therapist-augmented self-help in reducing social anxiety in patients with SAD. However, no study so far examined the efficacy of a therapist-augmented self-help treatment in a sample of individuals with subthreshold SAD. The aim of the present study was to evaluate the efficacy of a therapist-augmented CT-based self-help program (SHP) as compared to a wait-list control group in individuals with subthreshold SAD. The novelty of the present study is to test the efficacy of SHP in a group of highly socially anxious individuals without SAD diagnosis, thus entering a rather neglected research area in clinical research practice. The study is unique in testing an intervention method in a population of highly socially anxious individuals and in using a DVD-based self-help treatment. A specific advantage of a DVD-based program over text-based Internet treatments is its higher portability given its nondependence on access to an Internet connection. Internet connections may impede the quality of the videos used in the program. Using a DVD-based self-help program allowed us to extensively use video-based sequences, which is more engaging than text on a Web page and that allows actual demonstrations of therapeutic techniques. Treating highly socially anxious individuals with the DVD-based SHP could be a chance to access vulnerable individuals at an early point and deploy preventive interventions to block SAD development before its symptoms profuse and become chronic. The underlying hypotheses are that SHP leads to a significant improvement in social anxiety symptoms from pre- to postintervention and that SHP is significantly more effective in reducing social anxiety symptoms as compared to a wait-list control.