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Computer Therapy May Help Anxious Patients
by Caroline Cassels, Medscape Today
September 28, 2011
An emerging therapy known as cognitive behavior modification (CBM), which uses computer software to help divert patients' attention away from anxiety and interpret situations more calmly, is showing promise in the treatment of social anxiety disorder (SAD), new research suggests.
A small, randomized controlled trial of 32 anxious patients showed CBM to have a medium to large effect size on SAD without the presence of a therapist, suggesting the treatment may have potential as a cost-effective, widely accessible, first-line treatment.
"This certainly isn't going to replace [traditional] therapy. I see it more as a very inexpensive, very easy to deliver, first-line intervention that could help a lot of people. For those it doesn't help, then maybe we could devote the more expensive and time-intensive resources to them," lead author Courtney Beard, PhD, assistant professor of psychiatry and human behavior in the Warren Alpert Medical School of Brown University in Providence, Rhode Island, said in a statement. The study was published online September 2 in Depression and Anxiety.
Looking for "Real World" Utility
According to investigators, the therapy addresses 2 key components of SAD: attention bias and interpretation bias, in which patients tend to focus on the negative and interpret situations in a negative light. Preliminary research of CBM that targets attention bias (CBM-A) is effective for SAD. Similarly, results from a study examining CBM that focuses on interpretation bias (CBM-I) have been promising. A logical next step, note the researchers, was to examine the combination of CBM-A and CBM-I for SAD, known as attention and interpretation modification (AIM).
"We aimed to examine the potential for AIM to have real world utility," the investigators write.
The study's primary outcomes were to examine AIM's efficacy in addition to participants' perceived credibility of and satisfaction with the treatment.
The 4-week trial included 8 twice-weekly computer sessions with no therapist contact. Patients were screened for study entry using the Liebowitz Social Anxiety Scale–self-report. Those scoring 30 and above were invited to participate in the pretreatment assessment. Inclusion criteria included a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, diagnosis of SAD.
Patients were excluded from participating if they had current suicidal intent, substance dependence, psychosis, or manic episode, or were receiving cognitive behavioral therapy or change pharmacological treatment in the 12 weeks before study entry.
Perceived credibility of AIM was assessed using a combination of attrition rates, number of sessions attended, the Credibility/Expectancy Questionnaire, and a posttreatment exit questionnaire. A total of 20 participants were randomly assigned to receive AIM (n = 20) or placebo condition (n = 12). There were no differences between the 2 study groups at baseline.
Need for Replication
In the attention technique group, participants were trained to ignore a worrying social cue and focus on completing a task instead. Participants were quickly shown a disgusted face and a neutral face on a split computer screen. One face was rapidly replaced with a letter, either an "E" or an "F." Their task was to report which letter they saw.
In the active treatment group, the neutral face was always the one replaced, forcing anxious participants to divert their attention away from the worrisome disgusted face. In the placebo condition group, either face had an equal chance of being replaced.
In the interpretation portion of the study, participants in the active treatment group were required to complete a word–sentence association task in which they received positive feedback for making benign interpretations of word–sentence pairs, and negative feedback for making negative interpretations.
The investigators found that participants receiving AIM reported significantly reduced self-reported symptoms of social anxiety relative to placebo and characterized the effect size as "medium to large." They also report that these gains were also evident on a behavioral measure in which patients were required to undertake impromptu public speaking. Furthermore, they note, participants rated AIM as moderately credible and acceptable.
"Should these findings be replicated in larger samples, AIM has the potential to be a widely accessible and efficacious treatment for SAD," the authors write.
The study was supported by the National Institute of Mental Health. The authors have disclosed no relevant financial relationships.
Depression Anxiety. Published online September 2, 2011. Abstract
by Caroline Cassels, Medscape Today
September 28, 2011
An emerging therapy known as cognitive behavior modification (CBM), which uses computer software to help divert patients' attention away from anxiety and interpret situations more calmly, is showing promise in the treatment of social anxiety disorder (SAD), new research suggests.
A small, randomized controlled trial of 32 anxious patients showed CBM to have a medium to large effect size on SAD without the presence of a therapist, suggesting the treatment may have potential as a cost-effective, widely accessible, first-line treatment.
"This certainly isn't going to replace [traditional] therapy. I see it more as a very inexpensive, very easy to deliver, first-line intervention that could help a lot of people. For those it doesn't help, then maybe we could devote the more expensive and time-intensive resources to them," lead author Courtney Beard, PhD, assistant professor of psychiatry and human behavior in the Warren Alpert Medical School of Brown University in Providence, Rhode Island, said in a statement. The study was published online September 2 in Depression and Anxiety.
Looking for "Real World" Utility
According to investigators, the therapy addresses 2 key components of SAD: attention bias and interpretation bias, in which patients tend to focus on the negative and interpret situations in a negative light. Preliminary research of CBM that targets attention bias (CBM-A) is effective for SAD. Similarly, results from a study examining CBM that focuses on interpretation bias (CBM-I) have been promising. A logical next step, note the researchers, was to examine the combination of CBM-A and CBM-I for SAD, known as attention and interpretation modification (AIM).
"We aimed to examine the potential for AIM to have real world utility," the investigators write.
The study's primary outcomes were to examine AIM's efficacy in addition to participants' perceived credibility of and satisfaction with the treatment.
The 4-week trial included 8 twice-weekly computer sessions with no therapist contact. Patients were screened for study entry using the Liebowitz Social Anxiety Scale–self-report. Those scoring 30 and above were invited to participate in the pretreatment assessment. Inclusion criteria included a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, diagnosis of SAD.
Patients were excluded from participating if they had current suicidal intent, substance dependence, psychosis, or manic episode, or were receiving cognitive behavioral therapy or change pharmacological treatment in the 12 weeks before study entry.
Perceived credibility of AIM was assessed using a combination of attrition rates, number of sessions attended, the Credibility/Expectancy Questionnaire, and a posttreatment exit questionnaire. A total of 20 participants were randomly assigned to receive AIM (n = 20) or placebo condition (n = 12). There were no differences between the 2 study groups at baseline.
Need for Replication
In the attention technique group, participants were trained to ignore a worrying social cue and focus on completing a task instead. Participants were quickly shown a disgusted face and a neutral face on a split computer screen. One face was rapidly replaced with a letter, either an "E" or an "F." Their task was to report which letter they saw.
In the active treatment group, the neutral face was always the one replaced, forcing anxious participants to divert their attention away from the worrisome disgusted face. In the placebo condition group, either face had an equal chance of being replaced.
In the interpretation portion of the study, participants in the active treatment group were required to complete a word–sentence association task in which they received positive feedback for making benign interpretations of word–sentence pairs, and negative feedback for making negative interpretations.
The investigators found that participants receiving AIM reported significantly reduced self-reported symptoms of social anxiety relative to placebo and characterized the effect size as "medium to large." They also report that these gains were also evident on a behavioral measure in which patients were required to undertake impromptu public speaking. Furthermore, they note, participants rated AIM as moderately credible and acceptable.
"Should these findings be replicated in larger samples, AIM has the potential to be a widely accessible and efficacious treatment for SAD," the authors write.
The study was supported by the National Institute of Mental Health. The authors have disclosed no relevant financial relationships.
Depression Anxiety. Published online September 2, 2011. Abstract
