Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis.

Carla Mcenery,John Gleeson,Chris Miles,Simon D’Alfonso,Mario Alvarez-Jimenez,Simon Rice,Michelle H Lim,Simmone Howell,Ann Knowles,Penni Russon

doi:10.3389/fpsyt.2019.00581

Abstract

Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP). Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics. Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented. Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.

Highlights

Social anxiety disorder (SAD) is recognized as one of the most common anxiety disorders, with a reported lifetime prevalence of 13.3% and a 12-month prevalence rate of 2.3% [1,2,3,4,5]
Findings show that individuals with a first episode of psychosis (FEP) diagnosis and SAD comorbidity exhibit poorer early adjustment and are more prone to relapse [10,11,12] in comparison to individuals with a FEP diagnosis only. These findings indicate that the treatment of comorbid SAD in individuals with a psychotic disorder diagnosis warrants distinct research and clinical focus in order to address the myriad of negative functional consequences and subjective distress associated with SAD comorbidity among psychosis populations
To maximize interactive usage and adherence to the intervention—in collaboration with a multidisciplinary team of clinicians; young adult fiction writers; a cartoonist; and focus group comprised of young people with the lived experience of SAD, FEP, and serious mental ill-health conditions or any combination thereof—we developed a number of therapeutic comics

Summary

Introduction

Social anxiety disorder (SAD) is recognized as one of the most common anxiety disorders, with a reported lifetime prevalence of 13.3% and a 12-month prevalence rate of 2.3% [1,2,3,4,5]. It is well established that SAD is a significant problem for people with psychotic disorder diagnosis [6,7,8,9,10]. A 2019 meta-analysis reported SAD prevalence rates of 25% for individuals with psychotic disorder diagnosis [6], and a growing body of evidence suggests that SAD is a relatively common occurrence following a first episode of psychosis (FEP) [10, 11]. Empirical findings indicate several observed differences between individuals with a psychotic disorder diagnosis compared to those individuals with comorbid psychotic disorder and SAD diagnostic presentations [8]. It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) designed to treat social anxiety symptoms in first episode psychosis (FEP)

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Conclusion