Comparison of the Effectiveness of Face-to-face and Internet-based Cognitive-Behavioral Therapy on Cognitive Distortions and Emotion Regulation in Adolescents with Social Anxiety Disorder

Document Type : Research Article

Authors

1 M. A. in Clinical Child and Adolescent Psychology, Department of Psychology, Faculty of Humanities, Institute of Higher Education Roshdiyeh, Tabriz, Iran

2 Assistant Professor, Department of Psychology, Faculty of Humanities, Institute of Higher Education Roshdiyeh, Tabriz, Iran.

Abstract

People with social anxiety face barriers to treatment under the pretext of avoiding interaction and the discomfort of self-disclosure. Using remote health services may be an alternative, but there is no research evidence on the effectiveness of Internet-based methods in social anxiety.Therefore, this study aimed to compare the effectiveness of face-to-face and Internet-based cognitive-behavioral therapy on cognitive distortions and emotion regulation in adolescents with social anxiety.The present study was a field experiment. A total of 51 adolescents with social anxiety disorder were selected by cluster sampling method and randomly assigned to three face-to-face, Internet-based, and control therapy groups. Three groups were interviewed at the beginning and end of the study and answered the social anxiety screening questionnaire (SASA) Levpušček & Videc (2008 ), cognitive distortion questionnaire (CDQ) Beck and Wismann(1978), and emotion regulation questionnaire (ERQ) Jojn and Gross(2003).The two experimental groups underwent therapeutic intervention during ten weekly sessions.The results of ANKOVA analysis showed that both forms of intervention effectively reduced cognitive distortions, improved emotion regulation, and reduced symptoms of social anxiety.Also, the results of MANKOVA analysis showed that in the components of the need to please others and repression, face-to-face intervention only was effective.None of the intervention methods significantly affected the two components of success and perfectionism. In general, in all variables, the impact of the face-to-face intervention was greater than the Internet-based intervention.These results can support the use of Internet-based cognitive-behavioral therapy for adolescents with social anxiety disorder who, due to circumstances, are unable to benefit from face-to-face treatment

Keywords

Main Subjects

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://www.psychiatry.org/psychiatrists/practice/dsm
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PloS one, 5(10), 1-6. https://doi.org/10.1016/j.janxdis.2018.01.001
Apolinário-Hagen, J., Harrer, M., Kählke, F., Fritsche, L., Salewski, C., & Ebert, D. D. (2018). Public attitudes toward guided internet-based therapies: web-based survey study. JMIR mental health, 5(2), 1-7.https://preprints.jmir.org/preprint/10735
Asbrand, J., Heinrichs, N., Nitschke, K., Wolf, O. T., Schmidtendorf, S., & Tuschen-Caffier, B. (2019). Repeated stress leads to enhanced cortisol stress response in child social anxiety disorder but this effect can be prevented with CBT. Psych neuroendocrinology, 109, 1-10. https://doi.org/10.1016/j.psyneuen.2019.06.003
Asher, M., Asnaani, A., & Aderka, I. M. (2017). Gender differences in social anxiety disorder: A review. Clinical Psychology Review, 56, 1–12. https://doi.org/10.1016/j.cpr.2017.05.004.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience, 17(3), 327-35. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow
Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: a meta-analysis. International clinical psychopharmacology, 30(4), 183-192. https://doi.org/10.1097/YIC.0000000000000078
Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2016). Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 39, 44-64. https://doi.org/10.1016/j.janxdis.2016.02.005
Barnett, M. D., Maciel, I. V., Johnson, D. M., & Ciepluch, I. (2021). Social anxiety and perceived social support: Gender differences and the mediating role of communication styles. Psychological reports, 124(1), 70-87. https://doi.org/10.1177/0033294119900975
Beck, A. T. (1963). Thinking and depression. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9, 324–333. https://pubmed.ncbi.nlm.nih.gov/14045261
Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. basic Books. https://psycnet.apa.org/record/2006-01301-000
Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press. https://www.guilford.com/books/Cognitive-Therapy-of-Depression/Beck-Rush-Shaw-Emery/9780898629194
Beidel, D. C., Tuerk, P. W., Spitalnick, J., Bowers, C. A., & Morrison, K. (2021). Treating Childhood Social Anxiety Disorder with Virtual Environments and Serious Games: A Randomized Trial. Behavior therapy, 52(6), 1351-1363. https://doi.org/10.1016/j.beth.2021.03.003
Bigdeli, A., Najafi, M., and Rostami, M. (1392). Relationship between attachment styles, emotional regulation and resilience with mental well-being in medical students. Iranian Journal of Medical Education, 13 (9), 729-721. http://ijme.mui.ac.ir/article-1-2694-en.html
Blasczyk-Schiep, S., Adamczewska, K., & Sokoła, K. (2019). Subclinical eating disorder symptoms and positive vs. negative affect in high school students: The mediating role of self-regulation. Current Issues in Personality Psychology, 7(2), 120–131. https://doi.org/10.5114/cipp.2019.83125
Clark DM, & Wells A. (1995). A cognitive model of social phobia. In Heimberg RG, Liebowitz MR, Hope DA, Schneier FR. (editors), Social phobia: diagnosis, assessment and treatment. New York: Guilford Press. https://psycnet.apa.org/record/1995-98887-000
Clark, D. M. (2001). A cognitive perspective on social phobia. In W. R. Crozier & L. E. Alden (Eds.), International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness (pp. 405–430). John Wiley & Sons Ltd. https://psycnet.apa.org/record/2001-05046-018
Coifman, K. G., & Summers, C. B. (2019). Understanding emotion inflexibility in risk for affective disease: Integrating current research and finding a path forward. Frontiers in Psychology, 392-397. https://doi.org/10.3389/fpsyg.2019.00392
Craske, M. G., Roy-Byrne, P. P., Stein, M. B., Sullivan, G., Sherbourne, C., & Bystritsky, A. (2009). Treatment for anxiety disorders: Efficacy to effectiveness to implementation. Behaviour research and therapy, 47(11), 931-937. https://doi.org/10.1016/j.brat.2009.07.012
Davis, T. E., Munson, M., & Trace, E. (2014). Anxiety disorders and phobias. New York: Springer Science and Business Media. https://doi.org/10.1007/978-1-4419-0234-4_11
Dixon, M. L., Moodie, C. A., Goldin, P. R., Farb, N., Heimberg, R. G., & Gross, J. J. (2020). Emotion regulation in social anxiety disorder: reappraisal and acceptance of negative self-beliefs. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 5(1), 119-129.
https://doi.org/10.1016/j.bpsc.2019.07.009
Eckman, P. S., & Shean, G. D. (1997). Habituation of cognitive and physiological arousal and social anxiety. Behaviour Research and Therapy, 35, 1113–1121. https://doi.org/10.1016/S0005-7967(97)80005-8
Ellis, A. (1991). Rational- emotive treatment of simple phobias. Psychotherapy, 28, 452- 456. https://doi.org/10.1037/0033-3204.28.3.452
Ghazanfari, F., and Nadri, M. (2019). Development of etiology model of adolescent social anxiety disorder based on the components of anxiety sensitivity, negative emotional regulation and avoidant and ambivalent insecure attachment style with the mediating role of emotion-coping strategy. Clinical Psychology Studies, 9 (35), 97-130. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=509996
Goodman, F. R., & Kashdan, T. B. (2021). The most important life goals of people with and without social anxiety disorder: Focusing on emotional interference and uncovering meaning in life. The Journal of Positive Psychology, 16(2), 272-281. https://doi.org/10.1080/17439760.2019.1689423
Goodman, F. R., Daniel, K. E., Eldesouky, L., Brown, B. A., & Kneeland, E. T. (2021). How do people with social anxiety disorder manage daily stressors? Deconstructing emotion regulation flexibility in daily life. Journal of Affective Disorders Reports, 6, 1-7. https://doi.org/10.1016/j.jadr.2021.100210
Griffiths, K. M. (2013). Towards a framework for increasing help-seeking for social anxiety disorder. Australian & New Zealand Journal of Psychiatry, 47(10), 899-903. https://doi.org/10.1177/0004867413493335
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348
Hearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2018). Do worry and its associated cognitive variables alter following CBT treatment in a youth population with Social Anxiety Disorder? Results from a randomized controlled trial. Journal of anxiety disorders, 53, 46–57. https://doi.org/10.1016/j.janxdis.2017.11.005
Heimberg, R. G. & Becker, R. E. (2002). Cognitive – behavioral group Therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guil ford press. https://psycnet.apa.org/record/2002-17460
Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety: Clinical, developmental, and social perspectives (pp. 395–422). Sydney, Australia: Elsevier Inc. https://doi.org/10.1016/B978-0-12-375096-9.00015-8
Henschel, S., Doba, K., & Nandrino, J. L. (2019). Emotion regulation processes and psycho-form and somatoform dissociation in adolescents and young adults with cumulative maltreatment. Journal of Trauma & Dissociation, 20(2), 197–211. https://doi.org/10.1080/15299732.2018.1502714
Heydarian Fard, Z., Bakhshipour, B., & Faramarzi, M. (2016). The effectiveness of group cognitive-behavioral therapy on social anxiety, social self-efficacy and rumination in students with social anxiety disorder. Clinical Psychology Studies, 6 (21), 152-172. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=297332
Hiekkaranta, A. P., Kirtley, O. J., Lafit, G., Decoster, J., Derom, C., de Hert, M., ... & Myin-Germeys, I. (2021). Emotion regulation in response to daily negative and positive events in youth: The role of event intensity and psychopathology. Behaviour Research and Therapy, 144, 1-7. https://doi.org/10.1016/j.brat.2021.103916
Hoffart, A., & Johnson, S. U. (2020). Within-person networks of clinical features of social anxiety disorder during cognitive and interpersonal therapy. Journal of Anxiety Disorders, 76, 1-10. https://doi.org/10.1016/j.janxdis.2020.102312
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behavior Therapy, 36(4), 195-209. https://doi.org/10.1080/16506070701421313
Hofmann, S. G., & Otto, M. W. (2017). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder-specific treatment techniques. Routledge. https://doi.org/10.4324/9780203927526
Hofmann, S.G., Sawyer, A.T., Fang, A., Asnaani, A., 2012. Emotion dysregulation model of mood and anxiety disorders. Anxiety, 29 (5), 409–416. https://doi.org/10.1002/da.21888
Hullu, E., Sportel, B. E., Nauta, M. H., & de Jong, P. J. (2017). Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: two-year follow-up of a randomized controlled trial. Journal of behavior therapy and experimental psychiatry, 55, 81-89. https://doi.org/10.1016/j.jbtep.2016.11.011
Huppert, J. D., Pasupuleti, R. V., Foa, E. B., & Mathews, A. (2007). Interpretation biases in social anxiety: Response generation, response selection, and self-appraisals. Behaviour research and therapy, 45(7), 1505-1515. https://doi.org/10.1016/j.brat.2007.01.006
Kampmann, I. L., Emmelkamp, P. M., & Morina, N. (2016). Meta-analysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders, 42, 71-84. https://doi.org/10.1017/S0033291721001690
Kashdan, T.B., Weeks, J.W., Savostyanova, A.A., 2011. Whether, how, and when social anxiety shapes positive experiences and events: a self-regulatory framework and treatment implications. Clinical Psychology Review, 31(5), 786–799. https://doi.org/10.1016/j.cpr.2011.03.012
Kasper, S. (2006). Anxiety disorders: under-diagnosed and insufficiently treated. International Journal of Psychiatry in Clinical Practice, 10, 3-9. https://doi.org/10.1080/13651500600552297
Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual. Workbook Publishing. https://www.workbookpublishing.com/000
Khodaei, A. Shukri, O; Paklek, M; Ground, F; Tulabi, Saeed (1390). Factor structure and psychometric properties of adolescent social anxiety scale. Journal of Behavioral Sciences, 5 (3), 216-209. http://noo.rs/cjKP9
Kuru, E., Safak, Y., Özdemir, İ., Tulacı, R. G., Özdel, K., Özkula, N. G., & Örsel, S. (2018). Cognitive distortions in patients with social anxiety disorder: Comparison of a clinical group and healthy controls. The European Journal of Psychiatry, 32(2), 97-104. https://doi.org/10.1016/j.ejpsy.2017.08.004
Levpušček, M. P., & Videc, M. (2008). Psychometric properties of the Social Anxiety Scale for Adolescents (SASA) and its relation to positive imaginary audience and academic performance in Slovene adolescents. Studia Psychologica, 50(1), 49-65. http://www.elis.sk/download_file.php%3Fproduct_id%3D1207%26session_id%3D7thft6kgjsuvv7d68pnlka7971
McEvoy, P. M., Erceg-Hurn, D. M., Barber, K. C., Dupasquier, J. R., & Moscovitch, D. A. (2018). Transportability of imagery-enhanced CBT for social anxiety disorder. Behaviour research and therapy, 106, 86-94. https://doi.org/10.1016/j.brat.2018.05.007
Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P.S., Wells, K. B., Pincus, H. A., & Kessler, R. C. (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication (NCS-R). Psychological Medicine, 41(8), 1-7. https://doi.org/10.1017/S0033291710002291
Moscovitch, D.A., 2009. What is the core fear in social phobia? a new model to facilitate individualized case conceptualization and treatment. Cognitive Behavioral Practice. 16 (2), 123–134. https://doi.org/10.1016/j.cbpra.2008.04.002
Moscovitch, D.A., Rowa, K., Paulitzki, J.R., Ierullo, M.D., Chiang, B., Antony, M.M., McCabe, R.E., 2013. Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder. Behav. Res. Ther. 51 (8), 476–486. https://doi.org/10.1016/j.brat.2013.05.002
Musiat, P., & Tarrier, N. (2014). Collateral outcomes in e-mental health: a systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychological medicine, 44(15), 3137-3150. https://doi.org/10.1017/S0033291714000245
Naderzadeh, H; Salehi, M.; Jafari Roshan, M.; Small Waiting, R (1398). Structural equation modeling the relationship between symptoms of social anxiety disorder and early maladaptive schemas and cognitive distortions in adolescents. Research in Mental Health, 13 (1), 57-40. https://www.sid.ir/fa/journal/ViewPaper.aspx?ID=508298
Nauphal, M., Swetlitz, C., Smith, L., & Rosellini, A. J. (2021). A Preliminary Examination of the Acceptability, Feasibility, and Effectiveness of a Telehealth Cognitive-Behavioral Therapy Group for Social Anxiety Disorder. Cognitive and Behavioral Practice, 28(4), 730-742. https://doi.org/10.1016/j.cbpra.2021.04.011
Osório, F. L., Loureiro, S. R., Hallak, J. E. C., Machado‐de‐Sousa, J. P., Ushirohira, J. M., Baes, C. V., ... & Crippa, J. A. S. (2019). Clinical validity and intrarater and test–retest reliability of the Structured Clinical Interview for DSM‐5–Clinician Version (SCID‐5‐CV). Psychiatry and clinical neurosciences, 73(12), 754-760. https://doi.org/10.1111/pcn.12931
Peros, O. M., Webb, L., Fox, S., Bernstein, A., & Hoffman, L. (2021). Conducting Exposure-Based Groups via Telehealth for Adolescents and Young Adults with Social Anxiety Disorder. Cognitive and Behavioral Practice, 28(4), 679-689. https://doi.org/10.1016/j.cbpra.2021.04.001
Qalandari, F. (1394). Prevalence of social anxiety disorder and related demographic factors in the adult population of South Khorasan. International Conference on New Research Findings in Psychology and Educational Sciences, Tehran. https://civilica.com/doc/463404
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behavior Research and Therapy, 35(8), 741–756. https://doi.org/10.1016/S0005-7967(97)00022-3
Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical psychology review, 24(7), 737-767. https://doi.org/10.1016/j.cpr.2004.06.004
Rezaei, P. (1382). Evaluation of sense of responsibility, control of dysfunctional thoughts and ideas in patients with obsessive-compulsive disorder. Master Thesis in General Psychology. Islamic Azad University, Arsanjan. https://doi.org/10.1016/j.cpr.2004.06.004
Rukmini, S., Sudhir, P. M., Bhaskar, A., & Arumugham, S. S. (2021). Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures. Journal of Affective Disorders Reports, 6, 1-9. https://doi.org/10.1016/j.jadr.2021.100194
Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological medicine, 38(1), 15-28. https://doi.org/10.1017/S0033291707001699
Schluter, M. G., Kim, H. S., Poole, J. C., Hodgins, D. C., McGrath, D. S., Dobson, K. S., & Taveres, H. (2019). Gambling-related cognitive distortions mediate the relationship between depression and disordered gambling severity. Addictive Behaviors, 90, 318-323. https://doi.org/10.1016/j.addbeh.2018.11.038
Smith, T. W., Houston, B. K., & Zurawski, R. M. (1984). Irrational beliefs and the arousal of emotional distress. Journal of Counseling Psychology, 31(2), 190–201. https://doi.org/10.1037/0022-0167.31.2.190
Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the society for research in child development, 59(2-3), 25-52. https://doi.org/10.2307/1166137
Tolbert, D., & Pinquart, M. (2015). A meta-analytic review on the prevention of symptoms of anxiety in children and adolescents. Journal of Anxiety Disorders, 25 (6), 1046-1059. https://doi.org/10.1016/j.janxdis.2011.07.001
Thurston, M. D., Goldin, P., Heimberg, R., & Gross, J. J. (2017). Self-views in social anxiety disorder: The impact of CBT versus MBSR. Journal of anxiety disorders, 47, 83-90. https://doi.org/10.1016/j.janxdis.2017.01.001
Uhl, K., Halpern, L. F., Tam, C., Fox, J. K., & Ryan, J. L. (2019). Relations of emotion regulation, negative and positive affect to anxiety and depression in middle childhood. Journal of Child and Family Studies, 1–12. https://link.springer.com/article/10.1007/s10826-019-01474-w
Van Ballegooijen, W., Cuijpers, P., Van Straten, A., Karyotaki, E., Andersson, G., Smit, J. H., & Riper, H. (2014). Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PloS one, 9(7), 1-8. https://doi.org/10.1371/journal.pone.0100674
Voncken, M. J., Dijk, C., Stöhr, F., Niesten, I. J., Schruers, K., & Kuypers, K. P. (2021). The effect of intranasally administered oxytocin on observed social behavior in social anxiety disorder. European Neuropsychopharmacology, 53, 25-33. https://doi.org/10.1016/j.euroneuro.2021.07.005
Watson, P. J., Sherbak, J., & Morris, R. J. (1998). Irrational beliefs, individualism-collectivism, and adjustment. Personality and Individual Differences, 24(2), 173-179. https://doi.org/10.1016/S0191-8869(97)00168-2
Weissman AN, Beck AT. (1978). Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Paper presented at the meeting of the Association for the Advancement of Behavior Therapy; Chicago. https://eric.ed.gov/?id=ED167619
Wersebe, H., Sijbrandij, M., & Cuijpers, P. (2013). Psychological group-treatments of social anxiety disorder: A meta-analysis. PloS ONE, 8(12), 1-6. https://doi.org/10.1371/journal.pone.0079034
Xu, Y., Schneier, F., Heimberg, R. G., Princisvalle, K., Liebowitz, M. R., Wang, S., & Blanco, C. (2012). Gender differences in social anxiety disorder: Results from the national epidemiologic sample on alcohol and related conditions. Journal of Anxiety Disorders, 26, 12–19. https://doi.org/10.1016/j.janxdis.2011.08.006
Journal of Modern Psychology
Volume 1, Issue 4 - Serial Number 4
February 2022
Pages 44-65

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  • Receive Date: 06 November 2021
  • Revise Date: 16 December 2021
  • Accept Date: 06 January 2022
  • First Publish Date: 01 February 2022

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