September 20, 2021
The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Taylor Wilmer, PhD, NSAC Montgomery Co., Maryland/Northern Virginia (Center for Anxiety and Behavioral Change). The article, A Preliminary Examination of the Acceptability, Feasibility, and Effectiveness of a Telehealth Cognitive-Behavioral Therapy Group for Social Anxiety Disorder, focuses on the implementation of group cognitive behavioral therapy (CBT) via telehealth for individuals with social anxiety disorder (SAD).
Given COVID-19 social distancing requirements and increasing mental health needs of the community during the pandemic, Nauphal and colleagues sought to determine the acceptability, feasibility, and effectiveness of telehealth group-based CBT for SAD. In this study, Social Self-Reappraisal Therapy (SSRT) was adapted for telehealth delivery via eight (8) two-hour virtual group therapy sessions. The paper details specific adaptations for telehealth and COVID-19 restrictions, including creating two exposure hierarchies (one that could be done while maintaining social distancing, and one that could be used when social distancing restrictions were lifted), defining “eye contact” as looking at other participants’ faces on the screen for visual social feedback (rather than looking directly at the camera), tailoring in-session exposures to be feasible within the videoconferencing platform (e.g., speeches, discussions), and modifying homework exposures to adhere to social distancing requirements (e.g., joining a virtual group, speaking up during a virtual meeting or class).
Five adults diagnosed with SAD enrolled in the telehealth group treatment. Participants completed self-report questionnaires at pre- and post-treatment to assess social anxiety symptoms, anxiety and stress, and depression. Participants also reported on treatment satisfaction and group cohesion at posttreatment. Results indicated that, on average, participants experienced large decreases in social anxiety symptoms (d=1.07) and moderate decreases in stress (d=0.56-0.65) and depression (d=0.41-0.58). Participants also reported high satisfaction with the treatment itself, high acceptability of the telehealth delivery of treatment, and a positive group dynamic.
This study demonstrated preliminary support for the acceptability and effectiveness of group CBT for SAD delivered via telehealth. Researchers note that virtual group exposures may be particularly relevant in a post-pandemic world, especially for individuals who attend work or school remotely. Researchers also identified limitations of conducting exposures via telehealth, including lower elicited anxiety in virtual exposures and difficulty identifying non-verbal safety behaviors. Limitations of this study include the small sample size and non-randomized design. Future research would benefit from a randomized controlled comparison of telehealth group CBT for SAD versus other validated treatment formats (e.g., in-person CBT, virtual individual CBT).
How have you modified treatment delivery in the transition to telehealth? How have you gotten creative with exposures to account for pandemic-related safety measures?
Maya Nauphal, Caroline Swetlitz, Lisa Smith and Anthony Rosellini. A preliminary examination of the acceptability, feasibility, and effectiveness of a telehealth cognitive-behavioral therapy group for social anxiety disorder. Cognitive and Behavioral Practice, June 28, 2021.
Taylor Wilmer, PhD (she/her)
NSAC Montgomery Co., Maryland / Northern Virginia
(Center for Anxiety & Behavioral Change)