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Review
. 2020 Jul 16:13:e30.
doi: 10.1017/S1754470X2000032X.

Treating social anxiety disorder remotely with cognitive therapy

Emma Warnock-Parkes  1   2   3 , Jennifer Wild  1   2 , Graham R Thew  1   2 , Alice Kerr  3 , Nick Grey  4   5 , Richard Stott  3 , Anke Ehlers  1   2 , David M Clark  1   2
Affiliations
Review

Treating social anxiety disorder remotely with cognitive therapy

Emma Warnock-Parkes et al. Cogn Behav Therap. .

Abstract

Remote delivery of evidence-based psychological therapies via video conference has become particularly relevant following the COVID-19 pandemic, and is likely to be an on-going method of treatment delivery post-COVID. Remotely delivered therapy could be of particular benefit for people with social anxiety disorder (SAD), who tend to avoid or delay seeking face-to-face therapy, often due to anxiety about travelling to appointments and meeting mental health professionals in person. Individual cognitive therapy for SAD (CT-SAD), based on the Clark and Wells (1995) model, is a highly effective treatment that is recommended as a first-line intervention in NICE guidance (NICE, 2013). All of the key features of face-to-face CT-SAD (including video feedback, attention training, behavioural experiments and memory-focused techniques) can be adapted for remote delivery. In this paper, we provide guidance for clinicians on how to deliver CT-SAD remotely, and suggest novel ways for therapists and patients to overcome the challenges of carrying out a range of behavioural experiments during remote treatment delivery.

Key learning aims: To learn how to deliver all of the core interventions of CT-SAD remotely.To learn novel ways of carrying out behavioural experiments remotely when some in-person social situations might not be possible.

Keywords: CBT; COVID-19; cognitive therapy; distance therapy; remote therapy; social anxiety disorder; social phobia.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Example of individualised cognitive model drawn out via screen share during the first remotely delivered CT-SAD session.
Figure 2.
Figure 2.
An example of a table that was completed and shared via screen share after the self-focused attention and safety behaviours experiment was carried out via video conferencing.
Figure 3.
Figure 3.
An example of a four-column table that was completed and shared via screen share when doing video feedback of the self-focused attention and safety behaviours experiment via video conferencing.
Figure 4.
Figure 4.
Example behavioural experiment record sheet completed by a patient carrying out a behavioural experiment giving a presentation to a virtual audience.
See this image and copyright information in PMC

References

Further reading

    1. Warnock-Parkes, E. L. , Wild, J. , Stott, R. , Grey, N. , Ehlers, A. , & Clark, D. M. (2017). Seeing is believing: using video feedback in cognitive therapy for social anxiety disorder. Cognitive and Behavioural Practice, 24, 245–255. - PMC - PubMed
    1. Wild, J. , & Clark, D. M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive Behavioural Practice, 18, 433–443. - PMC - PubMed

References

    1. Carruthers, S. E. , Warnock-Parkes, E. L. & Clark, D. M. (2019). Accessing social media: Help or hindrance for people with social anxiety? Journal of Experimental Psychopathology, 10.1177/2043808719837811. - DOI - PMC - PubMed
    1. Clark, D. M. (2005). Three questionnaires for measuring central constructs in the cognitive model of social phobia: preliminary analysis. Available from Professor David Clark, Department of Psychiatry, University of Oxford.
    1. Clark, D. M. , Ehlers, A. , Hackmann, A. , McManus, F. , Fennell, M. , Grey, N. , … & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578. - PubMed
    1. Clark, D. M. , Ehlers, A. , McManus, F. , Hackmann, A. , Fennell, M. , Campbell, H. , … & Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058–1067. - PubMed
    1. Clark, D. M. , & Wells, A. (1995). A cognitive model of social phobia In Heimberg G., Liebowitz M. R. M. R., Hope D. & Scheier F. (eds), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 69–93). New York, USA: Guilford Press.

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