Outcome predictors in guided and unguided self-help for social anxiety disorder

Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.     

The Rumsfeld effect: the unknown unknown

A set of studies tested whether people can use awareness of ignorance to provide enhanced test consistency over time if they are allowed to place uncertain items into a "don't know" category. For factual knowledge this did occur, but for a range of other forms of knowledge relating to conceptual knowledge and personal identity, no such effect was seen. Known unknowns would appear to be largely restricted to factual kinds of knowledge.     

A Review of Published Self-help Books for Panic Disorder

This brief review of 14 self-help books on panic disorder compares: target group, treatment time, included components, existence of structured exercises, and whether or not daily record-keeping is encouraged. Six of the books cover all components deemed necessary for a multimodal cognitive-behavioral treatment package, and five of these are recommended. The reviews are followed by a brief summary of published bibliotherapy studies in which a selection of the books has been used. The results of these studies suggest that bibliotherapy is effective, with an effect size ranging from d = 0.5 to d = 1.5.     

On Alice in Wonderland,Statistics, and Whether CBT Should Take the Prize

This article reports the development of a protocol for the therapeutic application of “attention control” for chronic pain. Attention control is the limitation of the impact of pain by switching or retuning attention. An expert systems approach was used to develop the protocol. In the first stage an extensive literature search retrieved published and unpublished accounts of attention control strategies and a draft treatment manual was prepared. In the second stage 6 experts were recruited and they independently read and reviewed the draft manual. They were interviewed using a semi‐structured protocol to elicit their views on the draft manual. The manual was then revised to accommodate the information and expertise. In addition to providing expert opinion on the manual the experts also raised issues about the process of change in psychological treatment for chronic pain. These issues were organized into a process model of change in chronic pain.     

CBT and Behavioural Medicine: On Definitions,Applications and Practical Considerations

Abstract

In the late seventies, behavioural medicine was conceptualized as a promising area for the application of cognitive-behaviour therapy (CBT) to medical problems. Although many studies have been published in which CBT has been applied to somatic conditions, they do not always call it behavioural medicine. It is uncertain if the term “behavioural medicine” is the most appropriate to use in the future; its impact on medicine and psychology can be questioned. However, in this paper it is concluded that CBT has great potential in the treatment of somatic conditions. In addition, practical considerations when applying CBT in multidisciplinary somatic team situations are discussed. A combined “scientist-practitioner” role is seen as especially promising for the introduction of CBT in a context wider than isolated research studies.     

Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy

According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in ICT and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.     

Is human classification by experienced untrained observers a gold standard in fixation detection?

Manual classification is still a common method to evaluate event detection algorithms. The procedure is often as follows: Two or three human coders and the algorithm classify a significant quantity of data. In the gold standard approach, deviations from the human classifications are considered to be due to mistakes of the algorithm. However, little is known about human classification in eye tracking. To what extent do the classifications from a larger group of human coders agree? Twelve experienced but untrained human coders classified fixations in 6 min of adult and infant eye-tracking data. When using the sample-based Cohen’s kappa, the classifications of the humans agreed near perfectly. However, we found substantial differences between the classifications when we examined fixation duration and number of fixations. We hypothesized that the human coders applied different (implicit) thresholds and selection rules. Indeed, when spatially close fixations were merged, most of the classification differences disappeared. On the basis of the nature of these intercoder differences, we concluded that fixation classification by experienced untrained human coders is not a gold standard. To bridge the gap between agreement measures (e.g., Cohen’s kappa) and eye movement parameters (fixation duration, number of fixations), we suggest the use of the event-based F1 score and two new measures: the relative timing offset (RTO) and the relative timing deviation (RTD).     

The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55–1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.