Evaluation of a Smartphone Application for Self-help for Social Anxiety

Study Overview
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Brief Summary
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The present study examines whether a self-help app can reduce symptoms of social anxiety disorder.

Detailed Description
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The study will test the effectiveness of a newly developed mobile app in treating patients with social anxiety. Participants will be randomly assigned to one of the following groups: app use only, therapist-guided app use, and a wait-list control group. Over a 12-week period, the study will examine whether mobile app use leads to significant reductions in symptoms associated with social anxiety, as well as improvements in secondary outcomes such as quality of life, depression, or psychological impairment.

Official Title
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Evaluation of a Smartphone Application for Self-help for Patients With Social Anxiety Disorder: a Randomized Controlled Study

Conditions
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Social Anxiety

Intervention / Treatment
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* Behavioral: Self-help Smartphone App
* Behavioral: Therapist-guided App Use


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current diagnosis of Social Anxiety Disorder Written informed consent before the start of the study Age: 18 to 65 years Possession of smartphone Familiarity with using smartphone apps Exclusion Criteria: Acute suicidality Active substance abuse or dependence Severe medical conditions (e.g., chronic cardiovascular disease) Severe depression Psychotic disorder Bipolar disorder Borderline personality disorder Current psychotherapeutic treatment Current psychopharmacological treatment No proficient skills in the German language

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Comparison of self-help app only, self-help app plus accompanying therapy sessions, and waitlist control group
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: App condition<br>All participants will receive access to the developed social anxiety disorder (SAD) treatment app for 12 weeks. | Behavioral: Self-help Smartphone App<br>* The app provides a 12-week adaptation of scientifically proven cognitive behavioral therapy techniques for the treatment of SAD and is intended for use as a mobile intervention. The app includes modules such as learning (e.g., creating a model, learning about the maintaining factors), changing the maintaining factors (e.g., safety behaviors), or behavioral experiments.<br>|
| Experimental: App with accompanying therapy sessions<br>In addition to being able to use the app to treat social anxiety over a 12-week period, participants will receive a total of 8 video therapy sessions based on cognitive behavioral therapy to accompany their use of the app. | Behavioral: Self-help Smartphone App<br>* The app provides a 12-week adaptation of scientifically proven cognitive behavioral therapy techniques for the treatment of SAD and is intended for use as a mobile intervention. The app includes modules such as learning (e.g., creating a model, learning about the maintaining factors), changing the maintaining factors (e.g., safety behaviors), or behavioral experiments.<br>Behavioral: Therapist-guided App Use<br>* In addition to using the app, patients receive a total of 8 video-based therapy sessions over the course of 12 weeks. The sessions include topics such as video feedback and behavioral experiments.<br>|
| No Intervention: Waitlist control condition<br>Delayed use of the mobile application after 12 weeks. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in SAD-related symptom severity measured by the Liebowitz Social Anxiety Scale | The LSAS is a clinician-rated interview designed to measure fear and avoidance in different social situations. The situations are rated on scale from 0 (not at all or never) to 3 (severe or most of the time), with higher scores indicating greater symptoms of social anxiety. | change from baseline (week 0) to week 12 (post) and to week 36 (follow-up) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in SAD-related symptoms measured by the Social Phobia Inventory (SPIN) | The SPIN is a self-report questionnaire designed to assess the amount of discomfort in different situations during the last week. The scale ranges from 0 (not at all) to 4 (extremely). The total score ranges from 0 to 68, with higher scores indicating more severe symptoms of social anxiety. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Change in the Social Phobic Cognition Questionnaire (SPK) | The SPK lists 22 SAD-related beliefs that are rated on two scales: thought frequency, ranging from 1 (thought never occurs) to 5 (thought always occurs) and belief rating, ranging from 0 (I do not believe this thought) to 100 (I am completely convinced this thought is true). Higher scores indicate more SAD-related beliefs. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Pain and Disability Index (PDI) | The PDI measures the amount of impairment and distress caused by the mental illness. It consists of 7 different categories (e.g., Social Activity) that are rated on a scale fom 0 (no disability) to 10 (total disability). Higher scores indicating higher levels of disability. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Beck Depression Inventory - Fast Screen (BDI-FS) | The BDI-FS assesses symptoms of depression using 7 items on a 4-point scale, with higher scores indicating greater severity. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| World Health Organization Quality of Life (WHO-QOL-BREF) | The WHO-QOL-BREF measures the overall quality of life and asks for ratings on varying 5-point-scales for different domains like physical health (e.g., how satisfied are you with...). Scores for each domain are transformed to a scale of 0 to 100, with higher overall scores indicating a higher quality of life. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Brief Symptom Inventory - 18-item version (BSI-18) | The BSI measures general psychological distress using 18 items like feelings of loneliness on a scale from 0 (not at all) to 4 (a lot). | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS) | The ACIPS measures the pleasure a person experiences in a social situation with a total of 17 items. The items are rated on a scale from 1 (very false for me) to 6 (very true for me), with higher total scores indicating higher interpersonal pleasure. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Social Pain Questionnaire-5 (SPQ-5) | Sensitivity to rejection in social situations are assessed with the Social Pain Questionnaire (SPQ-5). The questionnaire consists of 5 items rating from 0 (describes me perfectly) to 4 (not at all). Higher total scores indicate higher social pain. | baseline measurement only (week 0) before intervention starts | 
| Self-developed question regarding skills in using the Internet | A single question assesses participants' ability to use smartphone apps on a scale of 0 to 100, with higher scores indicating greater ability to use apps on the smartphone. We hypothesize that this variable could moderate the outcome effects. | baseline measurement only (week 0) before intervention starts | 
| self-developed question regarding the attitude towards online interventions | To assess a person's attitude toward online circumvention, a question is asked that is rated on a scale of 0 (not helpful at all) to 100 (extremely helpful), with higher scores indicating higher positive expectations. We hypothesize that this variable could moderate the outcome effects. | baseline measurement only (week 0) before intervention starts | 
| Client Satisfaction Questionnaire (CSQ) | Treatment satisfaction will be measured by using the Client Satisfaction Questionnaire (CSQ), which we adapted slightly to match the use of the app. The questionnaire consists of 8 questions rated on a scale from 1 (not at all) to 4 (definitely yes). | Only post measurement (week 12) | 
| Self-developed questionnaire on negative effects of treatment | Drawing on the results of Boettcher et al., we developed a brief (7-item) scale with items covering the negative side effects that were considered most relevant by a group of experts. The items are rated on a scale from 0 (do not agree at all) to 5 (fully agree). Please note, that the descriptive list of possible side effects is preliminary and may be slightly revised after the pilot study. As the list contains an open item, responses to this item will be evaluated after the pilot study and inclusion of further side effects in the list is possible should they be mentioned frequently. | Only post measurement (week 12) | 
| Clinical Global Impression (CGI) | The CGI-Severity scale provides information about the current severity of social phobic symptoms which are rated on a 7-step scale from normal or not ill at all to among the most severely ill patients by a clinician. The CGI-Improvement scale is a 7-point scale rating the change in symptom severity from 'improved by a lot' to 'a lot worse'. The use of the CGI, as a measure for symptom-specific improvement for patients with SAD, is supported by adequate psychometric properties and its practicability. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Quick Inventory of Depressive Symptoms (QIDS-C) | The Quick Inventory of Depressive Symptomatology (QIDS-C) is a 16-item rating instrument for the assessment of depressive symptoms by an independent interviewer. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Structured Clinical Interview for DSM 5 SCID-V-CV | Structured interview providing a formal diagnosis. Psychometric properties showed good reliability and specificity. | change from baseline to week 12 (post) and to week 36 (follow-up) | 
| Modified version of the Social Phobia Weekly Summary Scale (SPWSS) | Social anxiety and social approach behavior will be measured using a modified version of the Social Phobia Weekly Summary Scale (SPWSS). The individual points are rated on a scale from 0 to 100, with higher values indicating a higher rating of the respective item. | weekly questionnaire from baseline to week 12 (post), as well as assessments at baseline, 6 weeks (mid), 12 weeks (post), and 36 weeks (follow-up) |