Evaluation of a smartphone application for self-help for patients with social anxiety disorder: a randomized controlled study-SMASH.

BACKGROUND: There is growing evidence that Internet-based cognitive behavioral therapy (ICBT) is as effective as a stand-alone treatment and helps facilitating access to treatment. Given the complexity of the treatment, we argue that the effect of ICBT could be even greater if guided by a therapist, as this could increase treatment adherence. We modified an established and well-evaluated treatment approach and developed a mobile application for treating social anxiety disorder (SAD). In the present study, we compare the efficacy of app use alone (APP) with video-based, therapist-guided app use (TG-APP) and with a wait-list control group (WLC) in terms of symptom reduction, and various secondary outcomes such as increase in quality of life or decrease of general psychological distress. METHODS/DESIGN: A within-between interaction design with randomization to one of three conditions will be used. In the APP condition, patients receive only the app without any additional contact with therapists, while in the TG-APP condition, therapists provide 8 sessions of video-based treatment in addition to using the app. The study will be conducted in two university outpatient treatment centers with reliably diagnosed SAD patients. The primary outcome will be defined as change in SAD symptoms, as measured by the Liebowitz Social Anxiety Scale (expert rating). Furthermore, a wide range of self-reports and clinician ratings for other symptoms (depression, general psychopathology) or quality of life will be used. A simulation-based power analysis for a 3 × 2 interaction effect (group × time) on the primary outcome in a linear mixed model resulted in a total sample size of N = 165. DISCUSSION: The present study will be one of the first to examine the additional benefit of therapist-guided video sessions regarding the use of an app treating SAD. Study results are pivotal to future treatment application in SAD.

Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial.

Dysfunctional cognitive processes and maladaptive interpersonal patterns have been postulated to maintain body dysmorphic disorder (BDD). The present trial evaluated CT for BDD (CT-BDD), which includes modules targeting maladaptive cognitive processing in BDD, as well as elements of schema therapy related to interpersonal problems. We investigated whether (a) CT-BDD is effective, as compared with a wait-list (WL) group at Week 12; (b) outcome of CT-BDD is maintained at posttreatment and 3- and 6-months follow-up; and (c) whether changes in shame and insight mediate changes in BDD symptom severity. Forty adults with BDD were randomized to 36 weeks immediate CT-BDD (n = 21), or to 12-week WL (n = 19). At Week 12, immediate CT-BDD was significantly superior to WL in clinician-rated BDD symptom severity, insight, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. Changes in outcomes were associated with moderate to large effect sizes at Week 12. Reductions in shame and increase in insight separately mediated changes in BDD symptom severity during treatment at Week 12. From baseline to posttreatment, significant improvements occurred within CT-BDD in clinician-rated symptom severity, insight, depression, global functioning, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. At posttreatment, improvements were associated with large effect sizes and were maintained at 3- and 6-month follow-up. Preliminary results support the efficacy of CT-BDD. Addressing interpersonal problems in addition to cognitive dysfunctions may increase the benefit of CBT for BDD patients.

Perceived vulnerability to disease, knowledge about COVID-19, and changes in preventive behavior during lockdown in a German convenience sample.

The COVID-19 pandemic has called worldwide for strong governmental measures to contain its spread, associated with considerable psychological distress. This study aimed at screening a convenience sample in Germany during lockdown for perceived vulnerability to disease, knowledge about COVID-19, symptoms of depression and anxiety, and behavioral responses. In an online survey, 1358 participants completed the perceived vulnerability to disease scale (PVD), the Patient Health Questionnaire (PHQ-4), and questionnaires on knowledge about COVID-19 and self-perceived change in behaviors in response to COVID-19. Lower and upper quartiles of the PVD were used to classify individuals into low and high PVD. A confirmatory factor analysis supported three factors representing risk, preventive and adaptive behavior as behavioral responses to COVID-19 lockdown. A structural equation model showed that the score of the knowledge scale significantly predicted the self-reported increase in adaptive and preventive behavior. The score in the PVD-subscale Perceived Infectability predicted a self-reported increase in preventive behavior, whereas the Germ Aversion score predicted a self-reported increase in preventive and a decrease in risk behavior. The score in PHQ-4 predicted a higher score in the perceived infectability and germ aversion subscales, and a self-reported decrease in adaptive behavior. Low-, medium- and high-PVD groups reported distinct patterns of behavior, knowledge, and mental health symptoms. This study shows that perceived vulnerability to disease is closely linked to preventive behaviors and may enhance adaptation to COVID-19 pandemic.

[Burn-On Instead of Burn-Out: Self-Care and Functional Coping Strategies Protect Psychotherapists from Psychological Stress During the Corona Pandemic]. / Burn-on statt Burn-out: Selbstfürsorge und funktionale Bewältigungsstrategien schützen PsychotherapeutInnen vor psychischen Belastungen während der Corona-Pandemie.

BACKGROUND AND OBJECTIVES: Due to the Corona pandemic, psychotherapists are confronted with new professional challenges. Regarding the patient care to be provided, the question of risk and protective factors for maintaining well-being during the pandemic appears relevant to prevent negative long-term consequences such as burnout. This is the first study investigating the influence of coping and self-care strategies on the psychological distress of psychotherapists in Germany during the Corona pandemic. METHODS: From April to June 2020, 155 psychotherapists completed an online questionnaire. Additionally, to job related changes, stress level, symptoms of burnout and well-being were assessed. Furthermore, the influence of active and passive coping strategies as well as of different areas of self-care (e. g., professional support, cognitive awareness for work-related stress and work-life balance) on psychological burden was examined. RESULTS: Psychotherapists worked an average of 1,22 hours less per week during the pandemic than before. On average, 38% of treatments were delivered via video therapy. Avoidant coping strategies were associated with increased stress levels, which predicted higher burnout scores and lower well-being. In contrast, a good work-life balance, a good daily balance at work and active coping had a positive effect. Contrary to expectation, cognitive awareness for work-related stress was related to lower well-being. DISCUSSION: Work-life balance can serve as a preventive strategy to reduce stress during the Corona pandemic and thereby reduce the risk for burnout and improve well-being. Avoidant coping strategies, on the other hand, are a risk factor for increased stress levels during pandemic and promote burnout and lower well-being. CONCLUSION: This study contributes to our knowledge regarding preventive measures to prevent stress and to maintain the well-being of psychotherapist in order to contribute to ongoing high quality patient care during the pandemic.

Development and validation of a new instrument to measure social pain.

Social pain is an emotional reaction to social exclusion which has been widely investigated in experimental settings. We developed the Social Pain Questionnaire (SPQ) and examined its factor structure, reliability, and construct validity. We constructed a 46-item pool that covered a broad range of situations related to social pain. Using three different subsamples (Online convenience sample: n = 623, Representative sample: n = 2531, Clinical sample of outpatients seeking psychotherapy: n = 270) we reduced the item pool to 10 items for the final SPQ scale, paying particular attention to content validity and factorial structure. Convergent, divergent and discriminant validity were assessed using standardized measures of related constructs and group differences. For the final 10-item version, a good factorial structure and reliability were found. Convergent validity was supported by correlations with related instruments of interpersonal sensitivity, attachment styles, depression and social anxiety. The representative and clinical sample differed significantly in social pain. The SPQ is an economic self-report measure with solid psychometric properties. Our data support the factorial, construct and convergent validity. The SPQ can be used to clarify the role of social pain in mental disorders and to incorporate interventions targeted towards social pain in psychotherapeutic settings.