“talk to me”: a self-applied telepsychology programme for treatment of fear of public speaking

Improving Mental Health Care: an

Internet Delivered Program for the

Treatment of Social Phobia

C. Botella

Director of the Clinical Psychology Area

Universitat Jaume I (Spain)

PSYCHOLOGY TECHNOLOGY

Who we are

ITC applications in

Psychology

http://www.labhuman.com/index.php

Mental Disorders

INTRODUCTION

CBT

INTRODUCTION

Social Anxiety Disorder (SAD) has a high prevalence

between 7% and 13% (Furmark, 2002; Andrews,

Henderson & Hall, 2001; Kessler, Berglund, Demler, Jin &

Walters, 2005).

SAD is usually associated to school phobia, separation

anxiety, and shyness.

If it’s not correctly treated, the development of the disorder

can be chronic and produce important problems in the life of

the person.

INTRODUCTION

Currently we have evidence based psychological

treatments (EBT) for SAD. Nevertheless:

- less of the 50% of people receive a correct treatment

- the cost and the time that require the treatment

- the lack of well prepared professionals.

- many patients decide do to not seek for help

That is, efficacious psychological treatments are not

available for both, practitioners and patients.

NEW WAYS OF DELIVERY CBT

One important challenge is to design new and more

cost-effective ways of delivering CBT

Reducing the contact between the patient and the

therapist by using self-help procedures

Using new technologies:

Computer-aided treatments

Virtual reality

The Internet

Internet-based programs have been successfully applied to the treatment of Social Phobia:

Botella et., (2000, 2004)

Anderson, et al., (2005, 2006)

Carlbring, et al., (2006, 2007)

Titov et al., (2008)

Berger, Hohl, & Caspar (2009)

INTERNET-BASED THERAPY

SELF-HELP AND THE INTERNET

However, there are only 2 telepsychology programs in which the whole

treatment is self-administered:

“TALK TO ME”

Fear of Public Speaking

The feared scenarios are real

videotaped audiences.

Its efficacy has been proven in:

a case study (Botella,

Hoffmann & Moscovitch, 2004)

a series of 12 cases (Botella,

Guillén et al., 2007)

“WITHOUT FEAR”

Small Animal Phobia The feared scenarios consist of a virtual environment. Its efficacy has been proven in:

a case study (Botella, Quero et al., in press), a series of 12 cases (Botella, Quero et al., in press).

In this presentation we will focus on TALK TO ME

Objective

To compare the efficacy of a self-administered internet-

based program for the treatment of Social Phobia versus

the same program applied by the therapist.

SOCIAL PHOBIA

77 participants

16 male (20.8%) and 61 female (79.2%)

Mean age was 24.40 (SD=5.78) ranging from 18 to 48

Educational level:

73 university students (94.8%)

3 went to high school (3.9%)

1 went to primary school (1.3%)

Method: Sample

Diagnosis: All participants met DSM-IV (APA, 1994, 2002) criteria for Social

Phobia.

Exclusion criteria: Current alcohol or drug dependence

Being in treatment for the same psychological problems

Primary diagnosis of major depression

Psychotic disorder

Subtype of social phobia: Specific social phobia: 29 participants (37.7%)

Non generalized social phobia: 31 participants (40.3%)

Generalized social phobia: 17 participants (22.1%)

Method: Sample

Between-group design

Participants were randomly assigned to one of the following experimental conditions:

1. Therapist Administered (N=22)

2. Self-administered (N=30)

3. Waiting List (N=25)

Experimental Conditions

Method: Design

Anxiety Disorders Interview Schedule for Social Phobia (ADIS-IV; Brown, DiNardo, & Barlow, 1994)

Target behaviours: Fear, Avoidance, and Belief in the negative thought

Brief version of the Fear of Negative Evaluation Scale (BFNE; Leary, 1983)

Social Avoidance and Distress Scale (SAD; Watson & Friend, 1969)

Fear of Public Speaking Questionnaire (FPSQ; Bados, 1986).

Method: Measures

“Talk to Me”: a CBT Program Treatment

Psychoeducation

Cognitive restructuring

Exposure:

Scenarios

• The oral presentation in front of a class

• The oral test

• The job interview

• The oral presentation at work

• The conference

• The wedding

Modulators: gender, number of people

Relapse prevention

Method: system description

Trust and rapport

“Talk to Me” introduces itself and states that its role is to

assess, guide and offer help

The program has an assistant: Dr. Net


Assessment



Treatment components:

1.-Psychoeducation



Treatment components:

2.-Cognitive Therapy


Treatment components: Exposure “The class”


Treatment components: Exposure “The Conference”


Treatment components: Exposure “The oral test”


Treatment components: Exposure “Project Presentation”


The program has “barriers” between different parts of the

treatment: It is allowed to progress to the next task “only” if

the present task has been overcome.

“Talk to Me” assesses the patient at pre-treatment, during

the treatment and after the treatment.


0

2

4

6

8

10

pre post 12-month

follow-up

Therapist Self-applied Waiting List

0123456789

pre post 12-month

follow-up


FEAR

F(2,76)=30.73 p<0.001

Talk to Me

AVOIDANCE

F(2,76)= 30.02 p<0.001

0123456789

pre post 12-month

follow-up


BELIEF IN CATASTROPHIC THOUGHT

F(2,76)= 28.69

p<0.001

Target Behaviours

0

10

20

30

40

50

pre post 12 months

follow-up


Social Avoidance and Distress

Scale

F(2,76)= 4.63

p<0.05

0

10

20

30

40

50

60

pre post follow up 12

months


Fear of Public Speaking

Questionnaire

F(2,76)= 7.23

p<0.01

Talk to Me Self-report questionnaires

0

2

4

6

8

10

12

14

pre post follow up 12

months


Brief version of the Fear of Negative Evaluation Scale

F(2,76)= 1.35

p=0.267

Talk to Me Self-report questionnaires

• Results offer support of the effectiveness of the Internet-administered self-help program for the treatment of social phobia.

• “Talk to me” was as effective as the same program applied by a therapist.

• The treatment conditions were more effective than a waiting list control group.

• The treatment program was effective not only at short-term (post-test), but also at long-term (12-month follow-up).

Conclusions

Counseling/motivation

3D environments

Self-help therapy

Multimedia stimuli

Conclusions

TELEPSYCHOLOGY AND MENTAL HEALTH:

Reduction of costs

Feared situations more available

Higher control over feared context

Possibility of overlearning

Confidentiality and privacy

A less aversive experience than in vivo exposure

New technologies, in this case the Internet, can allow a higher number of people to have access to health programs and resources:

- at home- choosing the moment they prefer- at their own pace

The future

CAN ICTs HELP TO IMPROVE QUALITY

OF LIFE AND WELLBEING?

The future

Assistance and care

Social inclusion

Therapy

Leisure

The Butler project

A CONSOLIDER action project

Virtual Reality

Environments

-Induction of joyful mood state

-Relaxation

Book of life

My memories:– Images

–Sounds

The Butler project: Tools included

THERAPEUTIC APPLICATION

“Going to a relaxing place”

“Going to a joyful place”

They allow to induce positive

mood states (relax, joy)

The individual can learn useful

techniques to reduce negative

emotional mood states

(relaxation, mindfulness…)

Therapeutic benefits

Relaxing sun rise

THERAPEUTIC APPLICATION

2 Virtual environments to induce positive mood:

LUDIC APPLICATION

“Write a letter” “Talk to someone” “Meet new people”

The access to communication using ICTs helps to::

- Promote social support, by helping to maintain the already present relationships (family,

friends, grandchildren…)

- Promote new relationships with other users of the Butler net.

Butler: Tools included

ETIOBE: A CIBER action

• According to the International

Obesity TaskForce (EASO,

2002) governments should act

against childhood obesity ,

improving the evidence for

treatments.

• ETIOBE is an intelligent e-

therapy system (e-TI) for the

treatment of obesity,

ETIOBE is composed by 3 applications:

• Clinical support system (CSS)

• Home support system (HSS)

• Mobile support system (MSS)

Home support

system

Mobile support

system

Clinical support

system

ETIOBE

OPTIMI: Online Predictive Tools

for Intervention in Mental Illness

- Challenge 5: Towards Sustainable and Personalised Healthcare

- Objective ICT-2009.5.1: Personal Health Systems

Mental Health care represents a third of the health care to all EU nations.

Depression and Stress related disorders are the most common mental illnesses.

The OPTIMI project

Prevention of Depression and suicide is one of the five points central focus points in the European Pact for Mental Health and Wellbeing.

OPTIMI: prediction, prevention

• is based on a PROACTIVE approach to mental health and pretends lower costs and higher levels of life quality

The OPTIMI concept

CCBT Treatment

Beating the Blues

• Existing commercial software

approved by NICE

• Will be modified code and

content with OPTIMI

ETIOBE

• Existing e-therapy

treatment under trials in

Spain (schools, pediatric

services hospital , eating

disorder clinics)

• Will be modified code and

content with OPTIMI

The OPTIMI project

The OPTIMI project

This is the beginning of a new era in the

psychological treatments field: the evidence-

based CBT programs delivered using the

Internet.

At the present moment it is possible to

conclude that Internet-delivered CBT is useful

for the treatment of different disorders (at least

for some patients

FUTURE PERSPECTIVES

The prediction seems to be that the

Internet has come, and is going to stay,

and grow, and improve, more and

more in the coming years, helping us

to improve health care.

FUTURE PERSPECTIVES

“talk to me”: a self-applied telepsychology programme for treatment of fear of public speaking

Health & Medicine