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| Name | Class |
|---|---|
| Umeå University | OTHER |
| Uppsala University | OTHER |
| Stockholm University | OTHER |
| Karolinska Institutet |
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This study evaluates underlying psychological and biological mediators in Internet-delivered cognitive behavior therapy for adults with social anxiety disorder.
Internet-delivered cognitive behavior therapy for social anxiety disorder has previously demonstrated to target and affect the brain´s fear network, typically neural response in the amygdala ameliorate after effective psychological treatment. Commonly, neuroimaging studies have performed brain imaging at pre- and post-intervention, yet, longitudinal study designs including several repeated measures of neural response over the course of treatment are currently missing in anxiety disorder. In the current study the participants will undergo magnetic resonance imaging (MRI) at four occasion. a) Twice before treatment initiation (9 weeks apart), b) at week 4 (during treatment), c) and directly after treatment termination.
Biological aging can be quantified at the individual cell level by measuring telomere length in peripheral immune cells (leukocytes). Telomeres are located at the end of each chromosome and protect the genetic material during cell division. Telomerase is an enzyme that can lengthen telomeres, and have in this way a protective function against accelerated cellular aging. Variations in these bodily processes have been associated with psychiatric manifestations such as anxiety and depression. In the current study the participant´s telomere length and telomerase activity will be assessed at three occasion. a) Twice before treatment initiation (9 weeks apart), and b) directly after treatment termination.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Psychological treatment | Experimental | Psychological treatment during 9 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Internet-delivered cognitive behavior therapy | Behavioral | Internet-delivered cognitive behavior therapy for social anxiety disorder. Similar to previous studies in our research group, the treatment will be delivered during 9 weeks. Each week the participant will be introduced to a module containing text material and homework assignments. The participants will receive feedback via text by a clinical psychologist once a week. |
| Measure | Description | Time Frame |
|---|---|---|
| Clinically Global Impression-Improvement scale (CGI-I; Change from baseline) | Clinician administrated telephone-interview to determine the participant´s treatment response rates (very much worse to very much improved) | At week 20 (post-treatment), and at 6, 12, and 60 months |
| Liebowitz Social Anxiety Scale, Self-report version (LSAS-SR; Change from baseline) | Self reported social anxiety symptoms on fear (scoring 0-3) and avoidance (scoring 0-3) in 24 social situations. | Screening, Baseline 1 (week 0), Baseline 2 (week 9), weekly during treatment (week 10-19), week 20 (post-treatment), and at 6, 12, and 60 months |
| Measure | Description | Time Frame |
|---|---|---|
| Clinically Global Impression-Severity scale (CGI-S) | Clinician administrated telephone-interview to determine the participant´s severity of illness | Screening, week 20 (post-treatment), and at 6, 12, and 60 months |
| Social Phobia Screening Questionnaire (SPSQ) |
| Measure | Description | Time Frame |
|---|---|---|
| Resting-state fMRI 6 minutes | Salami et al., 2014, PNAS | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| Self-referential criticism | Blair et al., 2008, Arch Gen Psych |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kristoffer NT Månsson, PhD | Stockholm University, Karolinska Institutet | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Umeå university | Umeå | 90187 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24064198 | Background | Mansson KN, Carlbring P, Frick A, Engman J, Olsson CJ, Bodlund O, Furmark T, Andersson G. Altered neural correlates of affective processing after internet-delivered cognitive behavior therapy for social anxiety disorder. Psychiatry Res. 2013 Dec 30;214(3):229-37. doi: 10.1016/j.pscychresns.2013.08.012. Epub 2013 Sep 21. | |
| 25781229 |
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| ID | Term |
|---|---|
| D001008 | Anxiety Disorders |
| D000072861 | Phobia, Social |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
| D010698 | Phobic Disorders |
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| OTHER |
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Self reported social anxiety symptoms on distress (scoring 0-4) in 24 social situations. |
| Screening, week 20 (post-treatment), and at 6, 12, and 60 months |
| Beck Anxiety Inventory (BAI) | Self reported anxiety symptoms | Screening, week 20 (post-treatment), and at 6, 12, and 60 months |
| Social Interaction Anxiety Scale (SIAS) | Self reported social anxiety symptoms on distress (scoring 0-4) in 21 social situations. | Screening, week 20 (post-treatment), and at 6, 12, and 60 months |
| Social Phobia Scale (SPS) | Self reported social anxiety symptoms on distress (scoring 0-4) in 20 social situations. | Screening, week 20 (post-treatment), and at 6, 12, and 60 months |
| Montgomery Åsberg Depression Rating Scale, Self-report version (MADRS-S) | Self reported depressive symptoms (scoring 0-6). | Screening, Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment), and at 6, 12, and 60 months |
| Subjective unit of discomfort on fear and distress (SUD) | Self reported scoring 0-100 on fear and distress separately | Before experimental tasks while undergoing MRI, at Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| Social Probability/Cost Questionnaire | 40 items scoring 0 to 8. Foa et al., 1996, J Abnormal Psychology | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment), and at 6, 12, and 60 months |
| Quality of Life (QOLI) | Screening, week 20 (post-treatment), and at 6, 12, and 60 months |
| Social Network Index (SNI) | Bickart et al., 2010, Nat Neurosci | Baseline 1 (week 0) |
| Brown Attention-Deficit Disorder Scales (Brown ADD) | Baseline 1 (week 0) |
| Difficulties in Emotion Regulation Scale (DERS) | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment), and at 6, 12, and 60 months |
| Treatment Credibility Scale (TCS) | Baseline 2 (week 9), week 13 during treatment |
| Revised NEO Personality Inventory (NEO-PI-R) | Baseline 1 (week 0) |
| Insomnia Severity Index (ISI) | Baseline 1 (week 0) |
| Karolinska Sleep Questionnaire (KSQ) | Baseline 1 (week 0) |
| State-Trait Anxiety Inventory (STAI-T) | Baseline 1 (week 0) |
| State-Trait Anxiety Inventory (STAI-S) | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| MINI International Neuropsychiatric Interview | Swedish version 7.0.0 | Screening |
| Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| Hariri´s Hammer (emotional face perception) | Hariri et al., 2002, Science | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| Brain habituation during face perception | Fischer et al., 2003, Brain Research Bulletin | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| Diffusion Tensor Imaging (DTI) | Salami et al., 2012, Biochim Biophys Acta | Baseline 1 (week 0), Baseline 2 (week 9), week 13 during treatment, week 20 (post-treatment) |
| Leukocyte telomere length | Lindqvist et al., 2015, Neurosci Biobehav Rev | Baseline 1 (week 0), Baseline 2 (week 9), week 20 (post-treatment) |
| Telomere terminal transferase (telomerase) | Wolkowitz et al., 2012, Mol Psychiatry | Baseline 1 (week 0), Baseline 2 (week 9), week 20 (post-treatment) |
| Mansson KN, Frick A, Boraxbekk CJ, Marquand AF, Williams SC, Carlbring P, Andersson G, Furmark T. Predicting long-term outcome of Internet-delivered cognitive behavior therapy for social anxiety disorder using fMRI and support vector machine learning. Transl Psychiatry. 2015 Mar 17;5(3):e530. doi: 10.1038/tp.2015.22. |
| 25999120 | Background | Lindqvist D, Epel ES, Mellon SH, Penninx BW, Revesz D, Verhoeven JE, Reus VI, Lin J, Mahan L, Hough CM, Rosser R, Bersani FS, Blackburn EH, Wolkowitz OM. Psychiatric disorders and leukocyte telomere length: Underlying mechanisms linking mental illness with cellular aging. Neurosci Biobehav Rev. 2015 Aug;55:333-64. doi: 10.1016/j.neubiorev.2015.05.007. Epub 2015 May 18. |
| 11982446 | Background | Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Langstrom B, Fredrikson M. Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry. 2002 May;59(5):425-33. doi: 10.1001/archpsyc.59.5.425. |