A computer-based self-treatment for social phobia [Elektronische Ressource] : development, evaluation and a controlled treatment study / Martina Wolf

User3

Sujets

• Psychologie

Informations

• Publié par: eberhard_karls_universitat_tubingen
• Publié le: 01 janvier 2003
• Nombre de lectures: 12
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Martina Wolf



A computer-based self-treatment for social phobia:

Development, evaluation and a controlled treatment study




















Dissertation
Zur
Erlangung des akademischen Grades
Doktor der Sozialwissenschaften
in der Fakultät
für Sozial- und Verhaltenswissenschaften
der Eberhard-Karls-Universität Tübingen



2003 Gedruckt mit Genehmigung der
Fakultät für Sozial- und Verhaltenswissenschaften
Der Universität Tübingen












Hauptberichterstatter: Prof. Dr. M. Hautzinger

Mitberichterstatter: Prof. Dr. D. Revenstorf

Dekan: Prof. Dr. A. Boeckh

Tag der mündlichen Prüfung: 31.03.2003




























Maier & App Computer, Oberndorf am Neckar










































In loving memory of my parents... ABSTRACT

Social phobia is one of the most prevalent and debilitating anxiety disorders. The
main purpose of the present thesis was to develop and evaluate a computer-
based self-treatment for social phobia within the framework of cognitive behavior
therapy.
In the formative evaluation, the focus was to create a comprehensible program
that could support the learning process. Multimedia and interactive features were
applied according to recommendations from leading researchers, as well as
feedback from participants (Ps). In the pilot study, it was demonstrated that the
self-treatment could reduce social anxiety.
In the summative evaluation, a controlled treatment study generated a final
judgement, showing that the self-treatment could lead to a clinically significant
improvement in about 35% of the Ps working at the university with the self-
treatment. In particular, the results indicated that older Ps with an onset age in
the mid and the late adolescence were more likely to be successful, whereas Ps
with severe forms of social phobia and depression were not. Aspects important to
the learning process were investigate, showing that the use of external resources
and high levels of intrinsic, rather than extrinsic motivation, were important to
treatment outcome.
Results from an impromptu speech task showed that thoughts after the speech
were associated with the level of social anxiety, rather than thoughts in
anticipation of the speech or behavioral variables. Thus, the results lend support
to the assumption that cognitive aspects play a crucial role in social phobia. In
particular, post-event processing should be further investigated. Social support
was also suggested to be further investigated, as well as the learning process
during computer-based self-treatments.

Key words: self-treatments, social phobia, cognitive behavior therapy, computer-
based learning, evaluation.



i
CONTENT

Tables iii
Figures iv
Abbreviations v
Acknowledgements vi

1. INTRODUCTION...................................................................................................................... 0 1

1.1. Social phobia and cognitive behavior therapy......................................................... 0 1
1.1.1. Introduction........................................................................................................... 0 1
1.1.2. Symptomatology................................................................................................... 0 2
1.1.2.1. A closer look at the cognitive component.................................................. 0 2
1.1.2.2. A closer look at the behavioral component................................................ 0 4
1.1.3. Diagnostic issues................................................................................................. 0 5
1.1.4. Prevalence, age of onset, gender and comorbidity........................................... 0 7
1.1.5. Cognitive behavior therapy for social phobia.................................................... 0 8
1.1.5.1. Social skills training.................................................................................... 0 8
1.1.5.2. Exposure training....................................................................................... 08
1.1.5.3. Anxiety-reduction strategies....................................................................... 10
1.1.5.4. Cognitive techniques.................................................................................. 10
1.1.5.5. Multi-component treatment packages........................................................ 11
1.1.5.6. Matching.................................................................................................... 14
1.1.5.7. Summary.................................................................................................... 15

1.2. Self-treatments............................................................................................................ 15
1.2.1. From manuals to self-treatments........................................................................ 15
1.2.2. Important concepts............................................................................................... 16
1.2.3. Self-treatments for phobias................................................................................. 18
1.2.4. Current issues....................................................................................................... 20
1.2.4.1. Issues to be tackled in research on self-treatments................................... 20
1.2.4.2. Advantages with self-treatments................................................................ 23
1.2.4.3. Criticism of and disadvantages with self-treatments.................................. 25
1.2.5. New trends............................................................................................................. 27
1.2.5.1. The technological development and its implications.................................. 27
1.2.5.2. A closer look at multimedia and interactive computers.............................. 28
1.2.5.3. Potential advantages with interactive multimedia programs...................... 32
1.2.5.4. Criticism and potential disadvantages with interactive multimedia............ 37
1.2.6. Factors influencing users when working with a self-treatment....................... 41
1.2.7. The development of computer-based self-treatments...................................... 44
1.2.8. The evaluation of computer--.......................................... 45
1.3. Conclusion.................................................................................................................. 51

2. GENERAL AIM OF THE STUDY............................................................................................. 52

3. THE DEVELOPMENT AND THE FORMATIVE EVALUATION OF A SELF-TREATMENT:
THE FIRST PHASE................................................................................................................. 52

3.1. Introduction and aim................................................................................................... 52
3.2. Method.......................................................................................................................... 52
3.2.1. Participants........................................................................................................... 52
3.2.2. Assessments......................................................................................................... 53
3.2.2.1. The screening interview............................................................................. 53
3.2.2.2. The unstructured interview......................................................................... 53
3.2.3. Design and procedure.......................................................................................... 53
3.3. Results......................................................................................................................... 54
3.4. Discussion................................................................................................................... 55



ii

4. THE DEVELOPMENT AND THE FORMATIVE EVALUATION OF A SELF-TREATMENT:
THE SECOND PHASE............................................................................................................ 56

4.1. Introduction and aim................................................................................................... 56
4.2. Method.......................................................................................................................... 57
4.2.1. Participants 57
4.2.2. Assessmen