a novel cbt informed intervention for social anxiety in people recovering from psychosis. ruth...
TRANSCRIPT
A novel CBT informed intervention for social anxiety in people recovering from psychosis.
Ruth Turner, Richard White,
Rebecca Lower, Lina Gega, David Fowler
Acknowledgements
• Everyone who has helped to make the Social Anxiety Research Clinic successful: Tony Reilly,Timothy Clarke, Felicity Waite, Evelina Medin, Kevin Lloyd, Rose Christopher, Emily Drake all of our participants,and the case managers within Central Norfolk Early Intervention Team
Social Anxiety Research Clinic
• Describe participants
• Brief description of intervention
• Describe findings
• Discussion of use of virtual environments
Background
• Up to 70% of people recovering from psychosis experience social anxiety.
• This is a significant barrier to social recovery.
• Social anxiety appears to be independent of the experience of positive symptoms
Studyoutline
Screen referred casesfor eligibility
Enrollment and Consent Procedure
Exclude non-consenters and cases not meeting inclusion
criteria
Baseline Assessment (N = 48)Social anxietyCognitive bias assessmentSchema, low-level psychotic symptomsQualitative interview
Randomisation by randomly ordered sealed envelopes
Allocated to immediate enhanced
CBT (N = 12)
Allocated to immediate standard
CBT (N = 12)
Assess primary outcome 6 weeks following end of intervention (18 weeks)
Assess primary/secondary outcomes at the end of the intervention period (12 weeks)
Treatment Group(N=24)
Waitlist control(N=24)
Allocated to delayed standard
CBT (N = 12)
Allocated to delayed enhanced
CBT (N = 12)
Wait for 12 weeks
Assess primary/secondary outcomes at the end of the 12 week wait
Assess primary outcome at 18 weeks
Assess primary/secondary outcomes at 24 weeks
Receive standard CBT for 8-12 sessions
Receive enhanced CBT for 8-12 sessions
Assess primary outcome 12 weeks following end of intervention (24 weeks)
Description of sample at baseline
• Demographics: ; 17 male, 5 female; Average age = 26 (S.D. 6)• PANSS (data for 13 participants) average score on positive sub-scale =
10.9 (S.D. = 3.0). 46% (n = 6) of participants scored 4 or more on one or more items of the sub-scale.
• BDI average score = 26.6 (S.D. 15.8)• SIAS:
SIAS
M (S.D.)
SARC 55.6 (10.7)
Social Phobia Comparison 34.6 (16.4)
Non-Clinical Comparison 18.8 (11.8)
Description of sample at baseline
BCSS
Positive Self Negative SelfPositive Other
Negative Other
M (S.D.) M (S.D.) M (S.D.) M (S.D.)SARC 6.8 (6.4) 9.2 (7.0) 8.6 (6.5) 9.0 (7.7)Psychosis Comparison 10.3 (6.4) 7.2 (5.9) 10.3 (6.0) 9.1 (6.8)Non-clinical 10.2 (4.2) 3.5 (3.5) 10.4 (4.5) 4.0 (4)
SSI SA SSI P SSI AE SSI total
M (S.D.) M (S.D.) M (S.D.) M (S.D.)
SARC 17.4 (4.7) 11.5 (7.6) 8.4 (5.5) 37.2 (15.0)
Psychosis Comparison 8.6 (6.7) 6.0 (6.4) 4.1 (5.7) 18.7 (15.7)
Non-Clinical 4.4 (5.1) 2.9 (3.6) 2.3 (3.4) 9.5 (9.2)
SSI
Formulation
Trigger People talking Performance/
expectations on me
Activates Beliefs and Assumptions
I am inadequate I have to be on guard or I will be
hurt Others are judgemental
Perceived Social Danger Others might be talking about
me I will be found out and punished
Processing self as social object
Focus on own anxiety Image – self sweating
Safety Behaviour Avoid social and
performance situations Listen in to others’
conversations
Anxiety Sweating
Heart racing Could not
concentrate
Based on Clarke and Wells model
Intervention• The intervention is an assisted self-help intervention which
follows four stages:– first stage included an assessment of social anxiety, goal setting and
psycho-education about social anxiety.– Stage two helped patients develop an individualised CBT formulation.
Patients identified their own idiosyncratic safety behaviours.– Stage three involved repeated exposure to anxiety provoking social
situations in the format of behavioural experiments– The final stage focussed on maximising patients’ gains by planning
further exposure-based behavioural experiments which were done either independently by the patient or with support from the care team.
• Additional interventions were piloted using computerised cognitive bias modification and virtual environments.
Outcomes - SIAS
• Baseline SIAS scores were compared to those at the 12, 18 and 24 week follow up points.
Baseline 12 weeks 18 weeks 24 weeks
Therapy 60.2 (11.19) 49.7 (12.23) 42.9 (8.15) 40.4 (10.95)
Waitlist 52.4 (9.19) 52.1 (13.69) 52.1 (12.76) 50.6 (13.09)
Outcome - SIAS12 week 18 week 24 week
Therapy N 10 7 8
Mean change score (SD) -10.50 (8.90) -17.29 (4.86) -16.75 (13.75)
Reliable improvement (n) 6 7 6
Reliable deterioration (n) 0 0 0
Clinically significant reliable change (n)
2 1 4
Waitlist N 11 9 8
Mean change score (SD) -.27 (11.34) -.56 (7.45) -1.0 (10.52)
Reliable improvement (n) 3 1 3
Reliable deterioration (n) 3 1 3
Clinically significant reliable change (n)
2 1 1
Additional pilot interventions
• Preliminary evidence that CBM-I sentence completion task can be used to train a more positive interpretation bias in this group.
• Virtual environments are being used to provide additional situations in which behavioural experiments can be conducted.
CAFÉ “sitting down waiting to order”
Conclusions
• Preliminary evidence that an assisted self-help intervention may help to reduce the level of social anxiety in people recovering from psychosis.
• Psychoeducation about social anxiety and the active engagement in behavioural experiments seems to be key.
