Internet-Based Cognitive Behavioral Therapy with Community Health Worker Support for Adults with Social Anxiety

Social anxiety is a common experience ranging from transient discomfort in social situations to excessive fear causing serious functional impairment. Some individuals with social anxiety seek psychological treatment aiming to reduce symptoms and improve quality of life. There is strong empirical support for cognitive-behavioral therapy (CBT) as an effective intervention for social anxiety. However, many individuals are unable to access CBT due to practical, financial, and cultural barriers. Bibliotherapies, telehealth services, and other internet-based services have been developed to help reduce this mental health disparity. The present study examined the acceptability, efficacy, and feasibility of a self-guided, internet-based CBT (ICBT) with support from a “coach”. Participants were 35 undergraduate students who responded to print-based advertisements for a treatment study. Participants were randomized to an immediate treatment (IT) condition or a wait list (WL) control. Participants in the IT condition (n = 20) completed a six-week ICBT program while meeting with their coach in between each lesson. Coaches were undergraduate students who had received training about the ICBT program and supportive listening skills. Participants in the WL condition (n = 15) waited for six weeks and then began the ICBT program. All participants completed surveys at the beginning, middle, and end of the six-week period. Participants in the IT condition reported a reduction in social interaction anxiety while those on the wait list did not. IT participants also reported a significant increase in self-esteem and satisfaction with work/school while the WL participants did not. No other measures of functional impairment showed significant change for either group. Treatment retention was high, and participants in the IT condition reported a high level of satisfaction with both the ICBT program and their coach, which demonstrates the acceptability of this treatment modality. Although further study is needed, this finding may suggest that lay health workers are a valuable resource for helping individuals with social anxiety to engage with and complete self-guided treatments. Overall, the present study serves as an early step in establishing the acceptability, efficacy, and feasibility of ICBT with lay support