Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats
Background: Compared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvemen...
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Elsevier
2024-12-01
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| Series: | Internet Interventions |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214782924000794 |
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| author | Graham R. Thew Anke Ehlers David M. Clark |
| author_facet | Graham R. Thew Anke Ehlers David M. Clark |
| author_sort | Graham R. Thew |
| collection | DOAJ |
| description | Background: Compared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvement differ between these treatment formats. Objective: To examine candidate change processes in an online therapist-guided cognitive therapy intervention for social anxiety disorder (iCT-SAD), and compare the results to the corresponding face-to-face therapy (CT-SAD). Methods: Data from a randomised controlled trial (n = 99) were analysed using Multilevel Structural Equation Models, incorporating the temporal precedence of the process variable, and disaggregating the within- and between-subject components of the predictors. These examined three candidate change processes: self-focused attention, negative social cognitions, and depressed mood. Moderated mediation models provided an additional test of the moderating effect of treatment format. Results: Negative social cognitions and self-focused attention were supported as significant mediators of clinical improvement in both CT-SAD and iCT-SAD. Effects were of similar strength and moderated mediation was not observed. There was also evidence of cyclical relationships between social anxiety symptoms and these process variables. Depressed mood also emerged as a significant but weak mediator in CT-SAD, but not in iCT-SAD. Moderated mediation was not observed. Conclusion: The online format of therapy showed a similar pattern of change processes to face-to-face treatment, with self-focused attention and negative social cognitions mediating clinical improvement in both treatments. Efforts to improve the efficacy and efficiency of SAD interventions by targeting these factors may therefore be equally applicable to online and face-to-face interventions. |
| format | Article |
| id | doaj-art-22d833f669864f1eaaba8cb87408ce05 |
| institution | OA Journals |
| issn | 2214-7829 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | Internet Interventions |
| spelling | doaj-art-22d833f669864f1eaaba8cb87408ce052025-08-20T01:58:55ZengElsevierInternet Interventions2214-78292024-12-013810078610.1016/j.invent.2024.100786Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formatsGraham R. Thew0Anke Ehlers1David M. Clark2Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; Corresponding author at: Oxford Centre for Anxiety Disorders and Trauma, Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, UK.Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, UK; Oxford Health NHS Foundation Trust, Oxford, UKDepartment of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, UKBackground: Compared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvement differ between these treatment formats. Objective: To examine candidate change processes in an online therapist-guided cognitive therapy intervention for social anxiety disorder (iCT-SAD), and compare the results to the corresponding face-to-face therapy (CT-SAD). Methods: Data from a randomised controlled trial (n = 99) were analysed using Multilevel Structural Equation Models, incorporating the temporal precedence of the process variable, and disaggregating the within- and between-subject components of the predictors. These examined three candidate change processes: self-focused attention, negative social cognitions, and depressed mood. Moderated mediation models provided an additional test of the moderating effect of treatment format. Results: Negative social cognitions and self-focused attention were supported as significant mediators of clinical improvement in both CT-SAD and iCT-SAD. Effects were of similar strength and moderated mediation was not observed. There was also evidence of cyclical relationships between social anxiety symptoms and these process variables. Depressed mood also emerged as a significant but weak mediator in CT-SAD, but not in iCT-SAD. Moderated mediation was not observed. Conclusion: The online format of therapy showed a similar pattern of change processes to face-to-face treatment, with self-focused attention and negative social cognitions mediating clinical improvement in both treatments. Efforts to improve the efficacy and efficiency of SAD interventions by targeting these factors may therefore be equally applicable to online and face-to-face interventions.http://www.sciencedirect.com/science/article/pii/S2214782924000794Social anxietyCognitive therapyMultilevel modelStructural equation model, change processes, mediation |
| spellingShingle | Graham R. Thew Anke Ehlers David M. Clark Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats Internet Interventions Social anxiety Cognitive therapy Multilevel model Structural equation model, change processes, mediation |
| title | Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats |
| title_full | Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats |
| title_fullStr | Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats |
| title_full_unstemmed | Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats |
| title_short | Change processes in cognitive therapy for social anxiety disorder: A comparison of face-to-face and internet-based treatment formats |
| title_sort | change processes in cognitive therapy for social anxiety disorder a comparison of face to face and internet based treatment formats |
| topic | Social anxiety Cognitive therapy Multilevel model Structural equation model, change processes, mediation |
| url | http://www.sciencedirect.com/science/article/pii/S2214782924000794 |
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