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

Graham R Thew,Candice Lym Powell,Emma Warnock-Parkes,Jennifer Wild,Mandy H Lissillour Chan,Amy Pl Kwok,Patrick Wl Leung,David M Clark

doi:10.2196/13446

Abstract

BackgroundGuided 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.ObjectiveThis 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.MethodsTraining 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.ResultsThe 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.ConclusionsThe 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.

Highlights

BackgroundThe delivery of psychological therapies via the internet has received a good deal of research attention in recent years
The training program was effective at increasing therapists’ internet-based Cognitive Therapy for social anxiety disorder (iCT-social anxiety disorder (SAD)) knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner
As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. (JMIR Form Res 2019;3(2):e13446) doi:10.2196/13446

Summary

Introduction

BackgroundThe delivery of psychological therapies via the internet has received a good deal of research attention in recent years. Some guided internet treatments have shown results comparable to face-to-face treatment in RCTs, despite requiring much less clinician time [1,7-9] These findings suggest that internet therapies have substantial potential for expanding access to effective psychological treatments, which is critical given the undertreatment of common mental health problems such as social anxiety in almost all countries [10]. This potential will only be realized if the results that are obtained by the developers of these internet interventions in tightly controlled RCTs can be maintained when those interventions are made available in other settings, providing treatment routinely and with guidance from clinicians who were not involved in developing the program. Descriptions of therapist training and its evaluation are often limited or absent within dissemination studies

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