Exploring the concurrent use of standardised and idiographic measures to assess cognitive behavioural therapy in a university student with autistic spectrum condition – a single case experimental design

Brief Form of the Social Phobia and Anxiety Inventory (SPAI-B) for Adolescents

Most research on autism spectrum conditions is done on young children and not as much on young adults with autism spectrum conditions. Because of this, not much is known about how common autism spectrum conditions are in young adults and how they affect their mental and social health, especially in Southeast Asia. Based on self-reports, 2.8% of the 2732 university students we looked at in Malaysia might have been diagnosed or thought to have an autism spectrum condition. Students who said they had or thought they had autism spectrum conditions had lower self-efficacy, more stress and a lower quality of life than students who said they did not have autism spectrum conditions. The results showed that university students with autism spectrum condition are more likely to have bad psychological and social outcomes than their peers without autism spectrum condition. Also, the link between autistic traits and psychosocial outcomes could depend on the culture.

Considering the need for developing and examining evidenced-based programs using a brief group format for management of social anxiety disorder (SAD) at the community level, we studied the efficacy of two brief versions of cognitive-behavioral therapy (CBT) programs, brief cognitive-behavioral group therapy (bCBGT), and verbal exposure augmented cognitive behavioral therapy (VE-CBT), on social anxiety among university students. A single-center, randomized, parallel-group design was adopted. We delivered six weekly two-hour group sessions, bCBGT and VE-CBT, to 41 university students diagnosed with SAD. An independent rater assessed participants using the Liebowitz Social Anxiety Scale (LSAS) and Clinical Global Impression scale-Severity (CGI-S) at baseline, postintervention, and two-month follow-up. A patient-rated measure, Social Phobia Inventory (SPIN), was assessed at the same time-points. There was a significant improvement in severity of social anxiety from baseline to posttreatment and baseline to two-month follow-up in both groups. However, the treatment effects in bCBGT were statistically superior to VE-CBT at postintervention (SPIN, P = 0.038; LSAS, P = 0.028; CGI-S, P = 0.036) and follow-up (SPIN, P = 0.006; LSAS, P = 0.01; CGI-S, P = 0.04). Brief CBT treatments, both bCBGT and VE-CBT, are efficacious for SAD among university students. They have the potential to address barriers associated with SAD management. However, we recommend a longer follow-up and replications in diverse settings.Clinical trial registration number: CTRI/2019/11/021954.

Andrew Thompson,, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia: Recent estimates regarding prevalence of Autism Spectrum Conditions (ASCs) in community samples range between 1 and 1.5 per 100 [1]. ASCs are associated with increased rates of comorbid psychiatric disorders including depression, anxiety disorders and obsessive compulsive disorder [2]. The main diagnostic and treat-ment issues in those presenting with ASC and psychiatric comorbidity are non-recognition of an existing ASC and misdiagnosis of an ASC occurring with another disorder such as psychosis [3]. Both non-recognition and misdi-agnosis are likely to signifi cantly impair treatment and delay recovery. At Orygen Youth Health, a mental health service for 15 to 25 year olds in Melbourne, Australia, we conducted an audit of all current cases in November 2007 to ascer-tain the prevalence of ASCs within the service. Treating clinicians were interviewed using a specifi c audit tool to determine whether any of the clients on their caseloads had an existing formal diagnosis of ASC or appeared to meet DSM-IV criteria for an ASC. The interview was pre-ceded by three local professional development sessions on diagnosis, treatment and comorbidity of mental illness and ASC provided by the study lead author (R.F.). Infor mation on ASC status was obtained for 476 of the 523 current patients. A total of 3.4% (n 16) had a con- fi rmed diagnosis of ASC and 7.8% (n 37) w ere reported by case managers to have a possible ASC diagnosis. A total of 3.4% (n 10) of those with psychotic disorders and 4.1% (n 5) of those with mood and anxiety disorders had a confi rmed diagnosis of ASC. There was no relationship between ASC status and gender χ (2) 2.91, p 0.233, ho wever there was a signifi cant difference between the three groups with respect to age, F(2, 473) 7.78, p 0.001, with post hoc anal yses (using Games-Howell test) revealing that those with a confi rmed diagnosis of ASC were signifi cantly younger on average than those with either possible ASC (p 0.002) or no ASC (p 0.001). It is interesting that this audit did not fi nd a gender difference in those with ASC as it is generally agreed that there is a 4:1 male female ratio [4]. This may be because there was a female predominance in this clinical sample. Those with a confi rmed ASC diagnosis were younger than those without in this sample, which may represent the additional impact of having an ASC as well as psychiatric illness. These results raise some impor tant issues for clinicians, service developers and commissioners. There are consid-erably higher rates of confi rmed ASCs within this clinical service compared to community settings, with the possi-bility that there are also additional undiagnosed cases. If these ASCs are not recognized it is unlikely that treat-ment will be optimal. Following this audit, and with sup-port from the Victorian Government, a developmental disorders clinic was established in Orygen Youth Health in 2009. It is hoped that through raising awareness of ASCs within youth and adult mental health settings that services might develop to provide expert treatment for a complex group of individuals who appear to be more prevalent than appreciated in such settings.

Single‐case experimental designs (SCEDs) may offer a reliable and internally valid way to evaluate technology‐enhanced learning (TEL). A systematic review was conducted to provide an overview of what, why and how SCEDs are used to evaluate TEL. Accordingly, 136 studies from nine databases fulfilling the inclusion criteria were included. The results showed that most of the studies were conducted in the field of special education focusing on evaluating the effectiveness of computer‐assisted instructions, video prompts and mobile devices to improve language and communication, socio‐emotional, skills and mental health. The research objective of most studies was to evaluate the effects of the intervention; often no specific justification for using SCED was provided. Additionally, multiple baseline and phase designs were the most common SCED types, with most measurements in the intervention phase. Frequent data collection methods were observation, tests, questionnaires and task analysis, whereas, visual and descriptive analysis were common methods for data analysis. Nearly half of the studies did not acknowledge any limitations, while a few mentioned generalization and small sample size as limitations. The review provides valuable insights into utilizing SCEDs to advance TEL evaluation methodology and concludes with a reflection on further opportunities that SCEDs can offer for evaluating TEL. Practitioner notes What is already known about this topic SCEDs use multiple measurements to study a single participant over multiple conditions, in the absence and presence of an intervention SCEDs can be rigorous designs for evaluating behaviour change caused by any intervention, including for testing technology‐based interventions. What this paper adds Reveals patterns, trends and gaps in the use of SCED for TEL. Identifies the study disciplines, EdTech tools and outcome variables studied using SCEDs. Provides a comprehensive understanding of how SCEDs are used to evaluate TEL by shedding light on methodological techniques. Enriches insights about justifications and limitations of using SCEDs for TEL. Implications for practice and/or policy Informs about the use of the rigorous method, SCED, for evaluation of technology‐driven interventions across various disciplines. Contributes therefore to the quality of an evidence base, which provides policymakers, and different stakeholders a consolidated resource to design, implement and decide about TEL.

BackgroundAlthough Cognitive Behavioural Therapy (CBT) is effective for 60% of adolescents with anxiety disorders, only 36% are in remission post‐intervention. This indicates that more effective treatments are needed which should be reflected in the NICE guidelines. We hypothesised that Single‐case experimental designs (SCEDs) may provide a framework for accelerating the development of novel interventions. The primary purpose of this review was to investigate whether SCEDs are currently followed by randomised controlled trials (RCTs) of CBT intervention for adolescent anxiety disorders named in the NICE guidelines. The secondary objective was to investigate whether using SCEDs prior to RCTs could be a helpful approach.MethodFor the primary search of SCEDs five databases were used (PsycINFO, PubMed, PsycArticles, Web of Science and ProQuest). Nineteen articles met eligibility criteria including a total of 107 participants. For the secondary search of RCTs named in the NICE guidelines for adolescent anxiety disorders 53 articles met inclusion criteria and were included in the systematic review.ResultsThe 19 SCED studies included in the review were conducted with participants with a diverse range of anxiety disorders and across a range of CBT formats. Two of the SCEDs were followed by RCTs, but neither of these were named in the NICE guidelines for anxiety disorders. All of the SCEDs identified were rated as low quality with none meeting the criteria for the highest or second highest quality rating. From the secondary searches, none of the RCTs named in the NICE guide were preceded by SCEDs.ConclusionsIt was concluded that currently SCEDs were not followed by RCTs of CBT interventions named in the NICE guidelines for adolescent anxiety disorders. However, it was suggested that SCEDs may provide an important framework for the development of more effective interventions for adolescents with anxiety.

Objective To analyze the internet-based cognitive behavior therapy (ICBT) intervent medical university students' social anxiety, and provide experiences and theoretical basis for future social anxiety interventions. Methods 45 medical students of social anxiety were voluntarily divided into the one-to-one intervention group, one-to-five intervention group and control group. The control group did not intervene, one-to-one intervention group and one-to-five intervention group were interfered single person or team by cognitive behavioral therapy, respectively. The level and symptom of social anxiety of the 3 groups were assessed before and after the intervention by social phobia inventory(SPIN) and Social anxiety symptoms interview inventory. Results After the intervention, the scores of SPIN and the 3 subscales within it (fear, avoidance and physiological) of one-to-one ICBT group and one-to-five ICBT group were lower than those of the control group (SPIN scores: one-to-one ICBT group 15.60±7.87, one-to-five ICBT group 14.87±8.83, control group 20.20±11.46). Variance analysis showed that, in addition to physiological subscale(F=0.641, P>0.05), the scores of SPIN, fear and avoidance subscales had significant differences among the 3 groups (F=3.764, P=0.018; F=3.606, P=0.021; F=5.444, P=0.005). In the analysis of participants' social anxiety symptoms, after treatment, in one-to-one ICBT group, there was 1 participant changed into subthreshold social anxiety and 1 participant into normal in the 2 threshold social anxiety participants. All the 3 subthreshold social anxiety participants changed into normal. In one-to-five ICBT group, there was 1 threshold social anxiety participant lapsed to subthreshold social anxiety, 1 subthreshold social anxiety participants still remained in subthreshold social anxiety, 2 symptomatic social anxiety participants changed into normal. But there were no significant changes in control group. Conclusions All the two methods of intervention have a certain effect.The effect of one-to-one intervention therapy is most significant. Key words: Medical students; Social anxiety; Internet-based cognitive behavior therapy

Traits similar to those shown in autism spectrum condition (ASC) are apparent in relatives of individuals with ASC, and in the general population without necessarily meeting diagnostic criteria for an ASC. We assess whether the Autism-Spectrum Quotient (AQ), a self-report measure, has hierarchical properties using Mokken scaling. Hierarchical scales allow the presence of a latent trait to be identified by discovering whether and how many specific items form an ordered array along it. Data were collected from 2 groups: (1) people with ASC (n = 449: 240 males, 209 females, M(age) 35.4 years, SD = 12.8) and (2) university students (n = 943: 465 males, 475 females, M(age) = 23.0 years, SD = 8.4). A single Mokken scale was obtained in the data from university students and 3 scales were obtained in the data from people with ASC. The scales all showed moderate Mokken scaling properties with the single scale obtained from university students showing weak invariant item ordering and 2 of the scales from people with ASC showing weak invariant item ordering. The AQ formed reliable Mokken scales. There was a large overlap between the scale from the university student sample and the sample with ASC, with the first scale, relating to social interaction, being almost identical. The present study confirms the utility of the AQ as a single instrument that can dimensionalize autistic traits in both university student and clinical samples of ASC, and confirms that items of the AQ are consistently ordered relative to one another.

This study aimed to determine the effectiveness of schema therapy in the treatment of social anxiety disorder. Method: The research method was a single-case experimental design with multiple baselines. Five clients were selected by purposive sampling method. They were received 20 individual sessions based on Young's schema therapy model. The Social Phobia Inventory (SPIN), Liebowitz Social Anxiety Scale(LSAS), Young Schema Questionnaire (YSQ: long form), Brief Fear of Negative Evaluation Scale (BFNE), General Self-Efficacy Scale (GSE-10) and Short form Health Survey Questionnaire (SF-36). For analyzing the data, the Improved Diagnostic Method and Clinical Significance were used. The results showed the Young's Schema Therapy model significantly reduced the activity of the early maladaptive schemas in all areas of schemas and consequently improved the treatment indices (i.e., fear and avoidance) both statistically and clinically. Schema therapy could be an effective intervention for the treatment of social anxiety disorder in women.

Objectives: This study aimed to determine the effectiveness of schema therapy in the treatment of social anxiety disorder.Method: The research method was a single-case experimental design with multiple baselines. Five patients were selected by purposive sampling method. They were treated in 20 individual sessions according to Young's schema therapy model. The data were collected by test of SocialPhobia Inventory (SPIN), Liebowitz Social Anxiety Scale(LSAS), Young Schema Questionnaire (YSQ: long form), Brief fear of Negative evaluation Scale(BFNE), General Self-Efficacy Scale(GSE-10) and Short from Health survey(SF-36). For analyzing the data, the Improve Diagnostic Method and clinical significance were used. Results: .The results showed the Young's Schema Therapy model reduced significantly the activity of the early maladaptive schemas in all areas of schemas and consequently decreased the main targets of the treatment (fear and avoidance) statistically and clinically. Conclusion: Schema therapy in the treatment of social anxiety disorder in women is necessary for efficiency and effectiveness. Keywords: Schema Therapy; Early Maladaptive Schema; Social Anxiety Disorder

Aims This study is pertinent to the current political and policy driven climate regarding increasing rights, choices, inclusion, independence and awareness for people with autism spectrum conditions (ASC). Since the implementation of Transforming Care (NHS England, 2015), commentators have focused upon the reduction of hospital beds within learning disabilities and mental health services. This qualitative study explored how patients with ASC, a group known to be extremely vulnerable to psychological issues, experience admission to acute mental health inpatient facilities in the United Kingdom (UK). Anxiety is a common characteristic for people who live with ASC, but its recognition can be compounded by the difficulty in disentangling features of ASC from those of anxiety disorders. Despite growing acknowledgement that admission to acute mental health facilities should be a last resort, reported figures on admissions continue to rise (NICE, 2014) and there remains a dearth of research highlighting how those who are most vulnerable in the inpatient setting experience this environment. The lived experiences of those with ASC could nonetheless help to inform service development. Method During 2015-2017 phenomenological enquiry using qualitative methods facilitated one-to-one semi-structured interviews to capture the experiences of 20 adults from the East of England who were former psychiatric inpatients with an established diagnosis of ASC. Verbatim transcripts of audio recordings from each interview were analysed using Interpretative Phenomenological Analysis (IPA). Findings IPA enabled the identification of broad themes, which explained in rich detail participant reflections on the situations and events within the acute care mental health facilities that triggered responses such as anxiety, fear, agitation and social avoidance anxiety. It was then possible to establish the broad behavioural patterns associated with their responses some of which has been reported by other commentators i.e., isolating themselves from others, including other patients and staff; ceasing to eat and sleep adequately; and, all too often, self-harming or exhibiting aggressive and violent behaviours (Lidstone et al., 2014; Donna et al., 2010; Bunyan et al., 2017). Emergent new themes were discovered in the same way and the original contribution of this research includes; creative self-help strategies to deal with anxiety, the notable impact of the sensory environment, interesting relational patterns with family/friends, staff and peers, including the disconnection from family and friends and confused connections to staff and peers. Implications This study provides further evidence that hospitalisation of a person with ASC should be the last resort. However, it is inevitable that in the future some people will need a mental health inpatient bed and the reductionist approach to inpatient services and the emergence of single person community services, whilst warranting applause, will leave gaps in service provision. Therefore, the…

As scientist practitioners, educational psychologists (EPs) are equipped with the necessary research skills to evaluate both the impact of their involvement and the effectiveness of interventions in schools. An increasing area of priority within schools is supporting young people with social, emotional and mental health (SEMH) needs. This paper explores the use of single case experimental designs (SCEDs) as a methodology which can be used to evaluate EP involvement within real world practice. To exemplify this, the evaluation of an SEMH intervention delivered by school staff across four different secondary school settings using a SCED is presented. The challenges and benefits of using a SCED as a research methodology are discussed. The authors conclude that SCEDs provide a flexible and practical method which could be used to evaluate the impact of interventions implemented within typical EP practice. An implication of how such implementation research could be shared within the profession is proposed.

Objective: Clark and Wells cognitive model of social anxiety has significant empirical support and has informed evidence-based treatments for Social Anxiety Disorder. However, to date, research for this model is related to face-to-face social interactions. Considering the increased rates of Internet use and social media worldwide, this study aimed to examine the utility of this model regarding online social interactions, the role of Internet use as an avoidance strategy for face-to-face interactions, and the relationship between social anxiety, online social interactions, and wellbeing. Method: A 109 individuals were recruited via social media to complete a battery of self-report questionnaires assessing social anxiety and Internet use. Results: The findings support the cognitive model of Social Anxiety Disorder and lend support to its relevance in online social interactions. Furthermore, we found that individuals with a high level of social anxiety experience fewer negative social cognitions, less fear of negative evaluation, and prefer online social communication compared to face-to-face communication. However, social anxiety was not significantly associated with Internet use. In contrast to previous research, online social interaction was related to poorer wellbeing regardless of social anxiety. Conclusion: These findings suggest that Internet use and social anxiety related to online social interactions may be important areas for mental health assessment. Despite study limitations, our findings encourage future research in this area. KEY POINTS What is already known about this topic: Social Anxiety Disorder is a prominent and chronic mental health problem. Clark and Wells (1995) cognitive model of social anxiety has significant empirical support for face-to-face interactions. Social Anxiety Disorder is associated with problematic Internet use. What this topic adds: Key aspects of the cognitive model for social anxiety were supported for online social situations. Individuals with social anxiety may be less likely to experience negative social cognitions and fear of negative evaluation while socialising online. Social anxiety symptoms are associated with a preference for online social interaction and Internet use as an avoidance strategy.

Objective The objective of the Entourage project was to develop an innovative digital mental health intervention addressing key barriers experienced by young people in accessing evidence‐based therapy for social anxiety. In particular, Entourage takes a specific focus on reaching young men, given their lower rates of service engagement. Method This article discusses the theoretical underpinnings, therapeutic mechanisms, persuasive technology elements, and development process of a novel approach incorporating graphic medicine, clinical and peer support, and social networking. Results Based on an integrated cognitive model of social anxiety disorder and consistent with the principles of cognitive behavioural therapy (CBT), a novel digital intervention for social anxiety was developed (Entourage). Using the moderated online social therapy (MOST) model, Entourage provides young people with a digital strengths‐based platform to overcome social anxiety symptoms. Designed in close partnership with young people with a lived experience of mental ill‐health, and overseen by a steering group of young men, Entourage applies graphic medicine through bespoke therapy comics to help users understand and overcome symptoms. Program e‐mentors (expert clinicians and trained peer workers) work in tandem to maintain engagement, support participant skill acquisition, and promote opportunities for social connectedness. Behavioural experiments and in‐vivo exposure activities facilitate restructuring of maladaptive social anxiety‐focussed cognitions. Conclusions Entourage represents an innovative approach to managing social anxiety in young people. Intervention elements seek to ensure longer‐term engagement of users, in particular young men, who have unmet service needs. Results of a single‐group clinical trial of Entourage are forthcoming. KEY POINTS (1) Young people experiencing problematic levels of social anxiety also face a range of barriers in accessing traditional face‐to‐face therapy, particularly as the nature of the disorder involves avoidance of interpersonal interaction. (2) Digital interventions applying CBT for social anxiety have shown promise, however new approaches are needed that provide therapeutic content alongside opportunities for behavioural application of therapy. (3) Entourage represents an innovative application of an integrated cognitive model of social anxiety. Combined with strengths based approaches to accessible online treatment for young people, it involves graphic medicine, clinical and peer support, and social networking.

Research suggests that paranoia and social anxiety can be understood as part of the same continuum, having shared processes such as the anticipation of threat, cognitive biases, poor self-concept, worry and safety-seeking behaviours. There is limited research on whether evidence-based interventions for social anxiety could be used with individuals who experience paranoia; however, an existing brief intervention study using techniques taken from cognitive behavioural therapy (CBT) for social anxiety has had promising results.This paper uses a single-case experimental design to explore whether using a clinical model of the maintenance of paranoia followed by CBT for social anxiety can be an effective formulation and intervention method in cases where social anxiety processes appear to be maintaining paranoid thoughts. This may be an effective formulation and intervention method, resulting in a reduction in anxiety and a reduction in the distress associated with paranoid thoughts. The clinical implications are discussed along with limitations and recommendations for further research.Key learning aims(1)To describe shared processes in social anxiety and paranoia.(2)To identify the benefits and limitations of using a clinical model of paranoia and CBT for social anxiety for formulation and intervention with individuals experiencing paranoia.(3)To identify areas where further research is warranted in treatment for individuals experiencing paranoia.