Abstract
Several studies suggest that computer-based attention modification programmes can be a promising new approach for the treatment of various anxiety disorders, including social anxiety disorder (SAD). The current study investigates the efficacy of a four-week Internet-delivered version of an attentional training for SAD in a randomized controlled double-blind study. Sixty-eight individuals seeking treatment for SAD were randomly assigned to either an attention training group (ATG, N = 33) or a control group (CG, N = 35). Participants of the ATG completed modified dot-probe tasks designed to facilitate attentional disengagement from threat. Participants in the CG completed control dot-probe tasks. At post-assessment, participants in both groups showed significant symptom reductions with medium to large within-group effect sizes on social anxiety measures (ATG: Cohen’s d = .47–.80; CG: d = .56–.63). However, no significant differences between groups were found at post-treatment for any outcome measure. These findings will be discussed along with the results of a 4-months follow-up assessment.
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Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., & Burns, M. (2009). Attention training in individuals with generalized social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(5), 961–973. doi:10.1037/a0016685.
Amir, N., Elias, J., Klumpp, H., & Przeworski, A. (2003). Attentional bias to threat in social phobia: Facilitated processing of threat or difficulty disengaging attention from threat? Behaviour Research and Therapy, 41(11), 1325–1335. doi:10.1016/S0005-7967(03)00039-1.
Amir, N., Foa, E. B., & Coles, M. E. (1998). Automatic activation and strategic avoidance of threat-relevant information in social phobia. Journal of Abnormal Psychology, 107(2), 285–290. doi:10.1037/0021-843X.107.2.285.
Andersson, G., Carlbring, P., Holmström, A., Sparthan, E., Furmark, T., & Nilsson-Ihrfelt, E. (2006). Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(4), 677–686. doi:10.1037/0022-006X.74.4.677.
Asmundson, G. J. G., & Stein, M. B. (1994). Selective processing of social threat in patients with generalized social phobia: Evaluation using a dot-probe paradigm. Journal of Anxiety Disorders, 8(2), 107–117. doi:10.1016/0887-6185(94)90009-4.
Baker, S. L., Heinrichs, N., Kim, H.-J., & Hofmann, S. G. (2002). The Liebowitz social anxiety scale as a self-report instrument: A preliminary psychometric analysis. Behaviour Research and Therapy, 40(6), 701–715. doi:10.1016/S0005-7967(01)00060-2.
Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51(8), 859–870. doi:10.1111/j.1469-7610.2010.02251.x.
Beck, A., Steer, R., & Brown, G. (1996). Beck Depression Inventory-II (BDI-II). San Antonio, TX: Psychological Corporation.
Berger, T., Caspar, F., Richardson, R., Kneubuhler, B., Sutter, D., & Andersson, G. (2011). Internet-based treatment of social phobia: A randomized controlled trial comparing unguided with two types of guided self-help. Behaviour Research and Therapy, (in press). doi:10.1016/j.brat.2010.12.007.
Berger, T., Hohl, E. o., & Caspar, F. (2009). Internet-based treatment for social phobia: A randomized controlled trial. Journal of Clinical Psychology, 65(10), 1021–1035. doi:10.1002/jclp.20603.
Bradley, B. P., Mogg, K., & Lee, S. C. (1997). Attentional biases for negative information in induced and naturally occurring dysphoria. Behaviour Research and Therapy, 35(10), 911–927. doi:10.1016/S0005-7967(97)00053-3.
Buckner, J. D., Maner, J. K., & Schmidt, N. B. (2010). Difficulty disengaging attention from social threat in social anxiety. Cognitive Therapy and Research, 34(1), 99–105. doi:10.1007/s10608-008-9205-y.
Carlbring, P., Furmark, T., Steczkó, J., Ekselius, L., & Andersson, G. (2006). An open study of internet-based bibliotherapy with minimal therapist contact via email for social phobia. Clinical Psychologist, 10(1), 30–38. doi:10.1080/13284200500378662.
Carlbring, P., Gunnarsdóttir, M., Hedensjö, L., Andersson, G., Ekselius, L., & Furmark, T. (2007). Treatment of social phobia: Randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry, 190(2), 123–128. doi:10.1192/bjp.bp.105.020107.
Chen, Y. P., Ehlers, A., Clark, D. M., & Mansell, W. (2002). Patients with generalized social phobia direct their attention away from faces. Behaviour Research and Therapy, 40(6), 677–687. doi:10.1016/S0005-7967(01)00086-9.
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., & Grey, N. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 568–578. doi:10.1037/0022-006X.74.3.568.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, NY, USA: Guilford Press.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates.
Constans, J. I., Penn, D. L., Ihen, G. H., & Hope, D. A. (1999). Interpretive biases for ambiguous stimuli in social anxiety. Behaviour Research and Therapy, 37(7), 643–651. doi:10.1016/S0005-7967(98)00180-6.
Derogatis, L. R., & Cleary, P. A. (1977). Confirmation of the dimensional structure of the SCL-90: A study in construct validation. Journal of Clinical Psychology, 33(4), 981–989. doi:10.1002/1097-4679(197710)33:4.
Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 13(3), 595–605. doi:10.1017/S0033291700048017.
Fedoroff, I. C., & Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psychopharmacology, 21(3), 311–324. doi:10.1097/00004714-200106000-00011.
Franke, G. (2000). Brief Symptom Inventory von LR Derogatis; BSI;(kurzform der SCL-90-R); deutsche Version: Beltz Test.
Fresco, D. M., Coles, M. E., Heimberg, R. G., Leibowitz, M. R., Hami, S., & Stein, M. B. (2001). The Liebowitz Social Anxiety Scale: A comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 31(6), 1025–1035. doi:10.1017/S0033291701004056.
Fydrich, T., Renneberg, B., Schmitz, B., & Wittchen, H.-U. (1997). Strukturiertes Klinisches Interview für DSM-IV, Achse II: Persönlichkeitsstörungen. Göttingen: Hogrefe.
Gotlib, I. H., Krasnoperova, E., Yue, D. N., & Joormann, J. (2004). Attentional biases for negative interpersonal stimuli in clinical depression. Journal of Abnormal Psychology, 113(1), 127–135. doi:10.1037/0021-843X.113.1.121.
Gould, R. A., Buckminster, S., Pollack, M. H., Otto, M. W., & Yap, L. (1997). Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clinical Psychology: Science and Practice, 4(4), 291–306. doi:10.1111/j.1468-2850.1997.tb00123.x.
Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., & Leibenluft, E. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68(11), 982–990. doi:10.1016/j.biopsych.2010.07.021.
Hautzinger, M., Keller, F., & Kühner, C. (2006). Das beck depressions-inventar II. Revision. Frankfurt/Main: Harcourt Test Services.
Heimberg, R. G., Liebowitz, M. R., Hope, D. A., Schneier, F. R., Holt, C. S., & Welkowitz, L. A. (1998). Cognitive behavioral group therapy vs. phenelzine therapy for social phobia: 12-week outcome. Archives of General Psychiatry, 55(12), 1133–1141. doi:10.1001/archpsyc.55.12.1133.
Helfinstein, S. M., White, L. K., Bar-Haim, Y., & Fox, N. A. (2008). Affective primes suppress attention bias to threat in socially anxious individuals. Behaviour Research and Therapy, 46(7), 799–810. doi:10.1016/j.brat.2008.03.011.
Holländare, F., Askerlund, A.-M., Nieminen, A., & Engström, I. (2008). Can BDI-II and MADRS-S be transferred to online use without affecting their psychometric properties? E-Journal of Applied Psychology, 4(2), 63–65.
Hope, D. A., Rapee, R. M., Heimberg, R. G., & Dombeck, M. J. (1990). Representations of the self in social phobia: Vulnerability to social threat. Cognitive Therapy and Research, 14(2), 177–189. doi:10.1007/BF01176208.
Horenstein, M., & Segui, J. (1997). Chronometrics of attentional processes in anxiety disorders. Psychopathology, 30(1), 25–35.
Issakidis, C., & Andrews, G. (2002). Service utilisation for anxiety in an Australian community sample. Social Psychiatry and Psychiatric Epidemiology, 37(4), 153–163.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. doi:10.1037/0022-006X.59.1.12.
Joels, M., Pu, Z., Wiegert, O., Oitzl, M. S., & Krugers, H. J. (2006). Learning under stress: How does it work? Trends in Cognitive Sciences, 10(4), 152–158. doi:10.1016/j.tics.2006.02.002.
Keller, M. B. (2003). The lifelong course of social anxiety disorder: A clinical perspective. Acta Psychiatrica Scandinavica, 108(Supplement 417), 85–94. doi:10.1034/j.1600-0447.108.s417.6.x.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602. doi:10.1001/archpsyc.62.6.593.
Kühner, C., Bürger, C., Keller, F., & Hautzinger, M. (2007). Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II). Befunde aus deutschsprachigen Stichproben. Der Nervenarzt, 78(6), 651–656. doi:10.1007/s00115-006-2098-7.
Lincoln, T. M., Rief, W., Hahlweg, K., Frank, M., von Witzleben, I., & Schroeder, B. (2003). Effectiveness of an empirically supported treatment for social phobia in the field. Behaviour Research and Therapy, 41(11), 1251–1269. doi:10.1016/S0005-7967(03)00038-X.
Lundh, L.-G., & Öst, L.-G. (1996). Stroop interference, self-focus and perfectionism in social phobics. Personality and Individual Differences, 20(6), 725–731. doi:10.1016/0191-8869(96)00008-6.
Maidenberg, E., Chen, E., Craske, M., & Bohn, P. (1996). Specificity of attentional bias in panic disorder and social phobia. Journal of Anxiety Disorders, 10(6), 529–541. doi:10.1016/S0887-6185(96)00028-X.
Mattia, J. I., Heimberg, R. G., & Hope, D. A. (1993). The revised Stroop color-naming task in social phobics. Behaviour Research and Therapy, 31(3), 305–313. doi:10.1016/0005-7967(93)90029-T.
Mattick, R. P., & Clarke, J. C. (1989). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Unpublished manuscript.
Mogg, K., & Bradley, B. P. (2002). Selective orienting of attention to masked threat faces in social anxiety. Behaviour Research and Therapy, 40(12), 1403–1414. doi:10.1016/S0005-7967(02)00017-7.
Mogg, K., Philippot, P., & Bradley, B. P. (2004). Selective attention to angry faces in clinical social phobia. Journal of Abnormal Psychology, 113(1), 160–165. doi:10.1037/0021-843X.113.1.160.
Mühlberger, A., Wieser, M. J., & Pauli, P. (2008). Visual attention during virtual social situations depends on social anxiety. Cyber Psychology & Behavior, 11(4), 425–430. doi:10.1089/cpb.2007.0084.
Musa, C., Lepine, J. P., Clark, D. M., Mansell, W., & Ehlers, A. (2003). Selective attention in social phobia and the moderating effect of a concurrent depressive disorder. Behaviour Research and Therapy, 41(9), 1043–1054. doi:10.1016/S0005-7967(02)00212-7.
Olfson, M., Guardino, M., Struening, E., Schneier, F. R., Hellman, F., & Klein, D. F. (2000). Barriers to the treatment of social anxiety. The American Journal of Psychiatry, 157(4), 521–527. doi:10.1176/appi.ajp.157.4.521.
Pineles, S. L., & Mineka, S. (2005). Attentional biases to internal and external sources of potential threat in social anxiety. Journal of Abnormal Psychology, 114(2), 314–318. doi:10.1037/0021-843X.114.2.314.
Pishyar, R., Harris, L. M., & Menzies, R. G. (2004). Attentional bias for words and faces in social anxiety. Anxiety, Stress & Coping: An International Journal, 17(1), 23–36. doi:10.1080/10615800310001601458.
Posner, M. I. (1980). Orienting of attention. The Quarterly Journal of Experimental Psychology, 32(1), 3–25. doi:10.1080/00335558008248231.
Powers, M. B., Sigmarsson, S. R., & Emmelkamp, P. M. G. (2008). A meta-analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy, 1(2), 94–113. doi:10.1521/ijct.2008.1.2.94.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756. doi:10.1016/S0005-7967(97)00022-3.
Renneberg, B., Theobald, E., Nobs, M., & Weisbrod, M. (2005). Autobiographical memory in borderline personality disorder and depression. Cognitive Therapy and Research, 29(3), 343–358. doi:10.1007/s10608-005-4267-4.
Roberts, K. E., Hart, T. A., & Eastwood, J. D. (2010). Attentional biases to social and health threat words in individuals with and without high social anxiety or depression. Cognitive Therapy and Research, 34(4), 388–399. doi:10.1007/s10608-009-9245-y.
Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24(7), 883–908. doi:10.1016/j.cpr.2004.07.007.
Rosnow, R. L., & Rosenthal, R. (1991). If you’re looking at the cell means, you’re not looking at only the interaction (unless all main effects are zero). Psychological Bulletin, 110(3), 574–576. doi:10.1037/0033-2909.110.3.574.
Saile, H., Weiland-Heil, K., & Schwenkmezger, P. (2000). Lassen sich in klinischen Erstgesprächen valide Diagnosen stellen? Vergleich von klinischem Erstgespräch, strukturiertem Interview und Symptom-Checkliste. Zeitschrift für Klinische Psychologie und Psychotherapie: Forschung und Praxis, 29(3), 214–220. doi:10.1026//0084-5345.29.3.214.
Schiller, A. (2004). Effekte einer Alkoholgabe auf die Informationsverarbeitung bei sozial phobischen Frauen. Dissertation, Münster University Münster.
Schmidt, N. B., Richey, J. A., Buckner, J. D., & Timpano, K. R. (2009). Attention training for generalized social anxiety disorder. Journal of Abnormal Psychology, 118(1), 5–14. doi:10.1037/a0013643.
Stangier, U., & Heidenreich, T. (2003). Die Liebowitz Soziale Angst-Skala (LSAS). In P. Scalarum (Ed.), Internationale Skalen für Psychiatrie. Göttingen: Hogrefe.
Stangier, U., Heidenreich, T., Berardi, A., Golbs, U., & Hoyer, J. r. (1999). Die Erfassung sozialer Phobie durch Social Interaction Anxiety Scale (SIAS) und die Social Phobia Scale (SPS). Zeitschrift für Klinische Psychologie, 28(1), 28–36. doi:10.1026//0084-5345.28.1.28.
Stopa, L., & Clark, D. M. (2000). Social phobia and interpretation of social events. Behaviour Research and Therapy, 38(3), 273–283. doi:10.1016/S0005-7967(99)00043-1.
Titov, N., Andrews, G., & Schwencke, G. (2008a). Shyness 2: Treating social phobia online: Replication and extension. Australian and New Zealand Journal of Psychiatry, 42(7), 595–605. doi:10.1080/00048670802119820.
Titov, N., Andrews, G., Schwencke, G., Drobny, J., & Einstein, D. (2008b). Shyness 1: Distance treatment of social phobia over the internet. Australian and New Zealand Journal of Psychiatry, 42(7), 585–594. doi:10.1080/00048670802119762.
Tottenham, N., Tanaka, J. W., Leon, A. C., McCarry, T., Nurse, M., & Hare, T. A. (2009). The NimStim set of facial expressions: Judgments from untrained research participants. Psychiatry Research, 168(3), 242–249. doi:10.1016/j.psychres.2008.05.006.
Vassilopoulos, S. P. (2005). Social Anxiety and the Vigilance-Avoidance Pattern of Attentional Processing. Behavioural and Cognitive Psychotherapy, 33(1), 13–24. doi:10.1017/S1352465804001730.
Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 603–613. doi:10.1001/archpsyc.62.6.603.
Wittchen, H.-U., Wunderlich, U., Gruschwitz, S., & Zaudig, M. (1997). Strukturiertes klinisches Interview für DSM-IV. Göttingen: Hogrefe.
Wittchen, H.-U., Zaudig, M., Spengler, P., Mombour, W., Hiller, W., & Essau, C. A. (1991). Wie zuverlässig ist operationalisierte Diagnostik? Die Test-Retest-Reliabilität des Strukturierten Klinischen Interviews für DSM-III-R. Zeitschrift für Klinische Psychologie, 20(2), 136–153.
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Boettcher, J., Berger, T. & Renneberg, B. Internet-Based Attention Training for Social Anxiety: A Randomized Controlled Trial. Cogn Ther Res 36, 522–536 (2012). https://doi.org/10.1007/s10608-011-9374-y
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DOI: https://doi.org/10.1007/s10608-011-9374-y