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Protecting cognition from emotional conflict is crucial for effective mental functioning. Previous research indicates that anxiety interferes with a flexible engagement in cognitive control and is associated with stronger reactivity to negative stimuli. Using an established conflict task (Etkin et al., 2006), the present study investigates whether adaptation to emotional conflict (conflict adaptation effects, CAE, e.g. , Fonzo et al., 2019, Jeong & Cho, 2020) and reactivity to negative stimuli (emotional reactivity, ER, e.g. Fonzo et al., 2017; Gorka et al., 2019) predict outcomes in cognitive behavior therapy (CBT). Behavioral and EEG read-outs will be used to examine whether (i) CAE and ER are associated with symptom severity, whether (ii) CAE and ER predict treatment-related symptom improvement, and (iii) whether CAE and ER show treatment-related changes from pre-to post. Our study is part of a two-armed randomized controlled clinical trial in which anxiety is treated with a transdiagnostic protocol (Barlow et al., 2017). In the CBT group patients receive immediate treatment, while in the WAIT group patients undergo a waiting time of 16 weeks before receiving treatment. In the emotional conflict task a facial expression (fearful or happy) is presented overlaid with an emotion word (‘FEAR’ or ‘HAPPY’). Participants are instructed to indicate the facial emotion, while ignoring the emotion word (words are either congruent or incongruent with the face). Incongruency in trial n typically results in increased cognitive control in the following trial n + 1 (e.g., resulting in smaller reaction times (RT) slow-downs, if n+1 is a conflict trial). These trial-by-trial adjustments are referred to as CAE, conflict adaptation effects. Emotional reactivity is operationalized as increased neural activation to negative as compared to positive stimuli in the absence of conflict (e.g. Fonzo et al., 2017).

Negativity bias and impairments in cognitive flexibility are known deficits in anxiety disorders and important targets of evidence-based psychotherapy, such as Cognitive Behaviour Therapy (CBT). The present study uses 2 event-related potentials (ERPs), the Feedback Related Negativity (FRN) and the Late Positive Potential (LPP), as well as behavioural indices during a standardised probabilistic reversal learning task (based on Bernardoni et al, 2018) to probe these deficits and develop predictors of CBT outcome. The study is part of a randomized clinical trial using a transdiagnostic CBT protocol, the Unified Protocol (UP, Barlow, 2017), to treat anxiety. There are two treatment arms depending on whether treatment is delivered immediately (CBT group) or after 16 weeks waiting (WAIT group), with EEG measurements taken before and after this time period.

This study investigated a 10-week guided internet-based intervention adapted from the Unified Protocol for mixed anxiety, depressive, and somatic symptom disorder. N=129 were randomized to treatment or waitlist. We assessed the treatment's effect on symptom distress, negative/positive affect, satisfaction with life as well as anxiety, depression, and somatic symptom burden. Additionally, treatment satisfaction, negative effects of treatment, and adherence (program usage) are reported.

BACKGROUND: Social anxiety disorder (SAD) is highly prevalent among university students, but the majority of affected students remain untreated. Internet- and mobile-based self-help interventions (IMIs) may be a promising strategy to address this unmet need. This study aims to investigate the efficacy and cost-effectiveness of an unguided internet-based treatment for SAD among university students. The intervention is optimized for the treatment of university students and includes one module targeting fear of positive evaluations that is a neglected aspect of SAD treatment. METHODS: The study is a two arm randomized controlled trial in which 200 university students with a primary diagnosis of SAD will be assigned randomly to either a wait-list control group (WLC) or the intervention group (IG). The intervention consists of 9 sessions of an internet-based cognitive-behavioral treatment, which also includes a module on fear of positive evaluation (FPE). Guidance is delivered only on the basis of standardized automatic messages, consisting of positive reinforcements for session completion, reminders, and motivational messages in response to non-adherence. All participants will additionally have full access to treatment as usual. Diagnostic status will be assessed through Structured Clinical Interviews for DSM Disorders (SCID). Assessments will be completed at baseline, 10 weeks and 6-month follow-up. The primary outcome will be SAD symptoms at post-treatment, assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). Secondary outcomes will include diagnostic status, depression, quality of life and fear of positive evaluation. Cost-effectiveness and cost-utility analyses will be evaluated from a societal and health provider perspective. DISCUSSION: Results of this study will contribute to growing evidence for the efficacy and cost-effectiveness of unguided IMIs for the treatment of SAD in university students. Consequently, this trial may provide valuable information for policy makers and clinicians regarding the allocation of limited treatment resources to such interventions. TRIAL REGISTRATION: DRKS00011424 (German Clinical Trials Register (DRKS)) Registered 14/12/2016. ispartof: BMC PSYCHIATRY vol:19 issue:1 ispartof: location:England status: published

Das Spektrum internetbasierter psychologischer Behandlungsangebote bei psychischen Problemen und Erkrankungen bewegt sich zwischen webbasierten Selbsthilfeprogrammen, die das Internet als Informationsmedium verwenden, und Email-, Chat- und Video-Therapien, in welchen das Internet zu Kommunikationszwecken zwischen Hilfesuchenden und Professionellen genutzt wird. Dieser Beitrag fokussiert auf eine Beratungs- und Therapieform, die die Möglichkeiten des Internets als Informations- und Kommunikationsmedium in sogenannten geleiteten Selbsthilfeansätzen kombiniert. Internetbasierte geleitete Selbsthilfeansätze, in welchen Klienten während der Bearbeitung eines Selbsthilfeprogramms von Therapeuten via Internet (z.B. Email) unterstützt werden, wurden in den letzten Jahren intensiv erforscht. Im Bereich von Angststörungen und Depressionen liegen besonders viele Studien vor. Verschiedene Forschergruppen haben hier in der Regel große Behandlungseffekte gefunden, die mit der Wirkung von Face-to-Face-Therapien vergleichbar sind. In diesem Beitrag wird der geleitete Selbsthilfeansatz dargestellt und die empirische Evidenz diskutiert., The spectrum of internet-based psychological treatments ranges between 1) web-based self-help programs that use the Internet as an information medium, and 2) e-mail, chat and video therapies using the Internet for communication between help-seekers and professionals. This paper focuses on a treatment format that combines the potential of the Internet as an information and communication medium in so called guided self-help approaches. Internet-based guided self-help approaches, in which the presentation of a web-based self-help program is combined with minimal but regular therapist contact, have been evaluated in numerous controlled trials for a range of clinical conditions including anxiety disorders and depression. This paper illustrates the internetbased guided self-help approach and summarizes the empirical evidence.

Predicting therapeutic outcome in the mental health domain is of utmost importance to enable therapists to provide the most effective treatment to a patient. Using information from the writings of a patient can potentially be a valuable source of information, especially now that more and more treatments involve computer-based exercises or electronic conversations between patient and therapist. In this paper, we study predictive modeling using writings of patients under treatment for a social anxiety disorder. We extract a wealth of information from the text written by patients including their usage of words, the topics they talk about, the sentiment of the messages, and the style of writing. In addition, we study trends over time with respect to those measures. We then apply machine learning algorithms to generate the predictive models. Based on a dataset of 69 patients we are able to show that we can predict therapy outcome with an Area Under the Curve (AUC) of 0.83 halfway through the therapy and with a precision of 0.78 when using the full data (i.e., the entire treatment period). Due to the limited number of participants it is hard to generalize the results, but they do show great potential in this type of information.

BACKGROUND: Social anxiety disorder (SAD) is one of the most common mental disorders and causes subjective suffering and economic burden worldwide. Although effective treatments are available, a lot of cases go untreated. Internet-based self-help is a low-threshold and flexible treatment alternative for SAD. Various studies have already shown that internet-based self-help can be effective to reduce social phobic symptoms significantly. Most of the interventions tested include therapist support, whereas the role of peer support within internet-based self-help has not yet been fully understood. There is evidence suggesting that patients' mutual exchange via integrated discussion forums can increase the efficacy of internet-based treatments. This study aims at investigating the added value of therapist-guided group support on the treatment outcome of internet-based self-help for SAD. METHODS/DESIGN: The study is conducted as a randomized controlled trial. A total of 150 adults with a diagnosis of SAD are randomly assigned to either a waiting-list control group or one of the active conditions. The participants in the two active conditions use the same internet-based self-help program, either with individual support by a psychologist or therapist-guided group support. In the group guided condition, participants can communicate with each other via an integrated, protected discussion forum. Subjects are recruited via topic related websites and links; diagnostic status will be assessed with a telephone interview. The primary outcome variables are symptoms of SAD and diagnostic status after the intervention. Secondary endpoints are general symptomology, depression, quality of life, as well as the primary outcome variables 6 months later. Furthermore, process variables such as group processes, the change in symptoms and working alliance will be studied. DISCUSSION: The results of this study should indicate whether group-guided support could enhance the efficacy of an internet-based self-help treatment for SAD. This novel treatment format, if shown effective, could represent a cost-effective option and could further be modified to treat other conditions, as well.

A growing body of evidence suggests that internet-based cognitive behavioural treatments (ICBT) are effective to treat social anxiety disorder (SAD). Whereas the efficacy of clinician-guided ICBT has been established, ICBT in a group format has not yet been systematically investigated. This three-arm RCT compared the efficacy of clinician-guided group ICBT (GT) with clinician guided individual ICBT (IT) and a wait-list (WL). A total of 149 individuals meeting the diagnostic criteria for SAD were randomly assigned to one of three conditions. Primary endpoints were self-report measures of SAD and diagnostic status taken at baseline, after the twelve-week intervention and at six-month follow-up. Secondary endpoints were symptoms of depression, interpersonal problems and general symptomatology. At post-treatment, both active conditions showed superior outcome regarding SAD symptoms (GT vs. WL: d = 0.84-0.74; IT vs. WL: d = 0.94-1.22). The two active conditions did not differ significantly in symptom reduction (d = 0.12-0.26, all ps > 0.63), diagnostic response rate or attrition. Treatment gains were maintained at follow-up. The group format reduced weekly therapist time per participant by 71% (IT: 17 min, GT: 5 min). Findings indicate that a clinician-guided group format is a promising approach in treating SAD.