This study evaluates underlying psychological and biological mediators in Internet-delivered cognitive behavior therapy for adults with social anxiety disorder.
Internet-delivered cognitive behavior therapy for social anxiety disorder has previously demonstrated to target and affect the brain´s fear network, typically neural response in the amygdala ameliorate after effective psychological treatment. Commonly, neuroimaging studies have performed brain imaging at pre- and post-intervention, yet, longitudinal study designs including several repeated measures of neural response over the course of treatment are currently missing in anxiety disorder. In the current study the participants will undergo magnetic resonance imaging (MRI) at four occasion. a) Twice before treatment initiation (9 weeks apart), b) at week 4 (during treatment), c) and directly after treatment termination. Biological aging can be quantified at the individual cell level by measuring telomere length in peripheral immune cells (leukocytes). Telomeres are located at the end of each chromosome and protect the genetic material during cell division. Telomerase is an enzyme that can lengthen telomeres, and have in this way a protective function against accelerated cellular aging. Variations in these bodily processes have been associated with psychiatric manifestations such as anxiety and depression. In the current study the participant´s telomere length and telomerase activity will be assessed at three occasion. a) Twice before treatment initiation (9 weeks apart), and b) directly after treatment termination.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Internet-delivered cognitive behavior therapy for social anxiety disorder. Similar to previous studies in our research group, the treatment will be delivered during 9 weeks. Each week the participant will be introduced to a module containing text material and homework assignments. The participants will receive feedback via text by a clinical psychologist once a week.
Umeå university
Umeå, Sweden
Clinically Global Impression-Improvement scale (CGI-I; Change from baseline)
Clinician administrated telephone-interview to determine the participant´s treatment response rates (very much worse to very much improved)
Time frame: At week 20 (post-treatment), and at 6, 12, and 60 months
Liebowitz Social Anxiety Scale, Self-report version (LSAS-SR; Change from baseline)
Self reported social anxiety symptoms on fear (scoring 0-3) and avoidance (scoring 0-3) in 24 social situations.
Time frame: Screening, Baseline 1 (week 0), Baseline 2 (week 9), weekly during treatment (week 10-19), week 20 (post-treatment), and at 6, 12, and 60 months
Clinically Global Impression-Severity scale (CGI-S)
Clinician administrated telephone-interview to determine the participant´s severity of illness
Time frame: Screening, week 20 (post-treatment), and at 6, 12, and 60 months
Social Phobia Screening Questionnaire (SPSQ)
Self reported social anxiety symptoms on distress (scoring 0-4) in 24 social situations.
Time frame: Screening, week 20 (post-treatment), and at 6, 12, and 60 months
Beck Anxiety Inventory (BAI)
Self reported anxiety symptoms
Time frame: Screening, week 20 (post-treatment), and at 6, 12, and 60 months
Social Interaction Anxiety Scale (SIAS)
Self reported social anxiety symptoms on distress (scoring 0-4) in 21 social situations.
Time frame: Screening, week 20 (post-treatment), and at 6, 12, and 60 months
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Social Phobia Scale (SPS)
Self reported social anxiety symptoms on distress (scoring 0-4) in 20 social situations.
Time frame: Screening, week 20 (post-treatment), and at 6, 12, and 60 months
Montgomery Åsberg Depression Rating Scale, Self-report version (MADRS-S)
Self reported depressive symptoms (scoring 0-6).
Time frame: Screening, Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment), and at 6, 12, and 60 months
Subjective unit of discomfort on fear and distress (SUD)
Self reported scoring 0-100 on fear and distress separately
Time frame: Before experimental tasks while undergoing MRI, at Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment)
Social Probability/Cost Questionnaire
40 items scoring 0 to 8. Foa et al., 1996, J Abnormal Psychology
Time frame: Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment), and at 6, 12, and 60 months
Quality of Life (QOLI)
Time frame: Screening, week 20 (post-treatment), and at 6, 12, and 60 months
Social Network Index (SNI)
Bickart et al., 2010, Nat Neurosci
Time frame: Baseline 1 (week 0)
Brown Attention-Deficit Disorder Scales (Brown ADD)
Time frame: Baseline 1 (week 0)
Difficulties in Emotion Regulation Scale (DERS)
Time frame: Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment), and at 6, 12, and 60 months
Treatment Credibility Scale (TCS)
Time frame: Baseline 2 (week 9), week 13 during treatment
Revised NEO Personality Inventory (NEO-PI-R)
Time frame: Baseline 1 (week 0)
Insomnia Severity Index (ISI)
Time frame: Baseline 1 (week 0)
Karolinska Sleep Questionnaire (KSQ)
Time frame: Baseline 1 (week 0)
State-Trait Anxiety Inventory (STAI-T)
Time frame: Baseline 1 (week 0)
State-Trait Anxiety Inventory (STAI-S)
Time frame: Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment)
MINI International Neuropsychiatric Interview
Swedish version 7.0.0
Time frame: Screening