Bridging the gap in internet treatments for mental health: A fully automated online cognitive behaviour therapy for social anxiety for those who stutter.

Introduction: CBTpsych.com is a fully functional intervention that aims at bridging the gap between Eliza (Weizenbaum, 1966) and modern internet treatments for anxiety disorders (Helgadottir, Menzies, Onslow, Packman & O‟Brien, 2009a). A Phase I trial demonstrated that two participants no longer met the diagnosis of social phobia on the DSM-IV and ICD-10 after being treated by CBTpsych.com. The quality of the interaction appeared to be similar to face-to-face therapy. The automated techniques were successful in engaging the participants and in encouraging them to log on regularly and complete the treatment (Helgadottir, Menzies, Onslow, Packman & O‟Brien, 2009b). The current study is a phase II trial targeting social anxiety in stuttering. Method: File audit data were gathered from 10 years of experience in the psychological management of social anxiety and stuttering (St Clare et al., 2008). This data was used to create a fully automated human-like intervention using algorithms alone. CBTpsych.com creates cognitive restructuring exercises, behavioural experiments, and negative thoughts checklists for the automated treatment program. Furthermore, other features such as imagery rescripting were incorporated to adhere to the Clark D. M. and Wells (1995) model of social anxiety treatment. 18 participants presenting for treatment of stuttering with social anxiety at the Australian Stuttering Research Centre (ASRC) were offered 5 months access to the “computer psychologist”. 16 participants started using the computer program. The treatment did not involve any contact with clinical psychologists at the ASRC. Results: Post-treatment analysis revealed that of the 16 participants who started using the program, 78% no longer met the criteria for social phobia. Furthermore, none of the 10 participants who completed all 7 sections of the computer program within 5 months had social phobia diagnosis at post-treatment. Consequently, in this study the “computer psychologist” was able to identify the specific problem areas participants reported and to design individualized formulations and tailored treatment components with corrective feedback. Furthermore, participants were able to engage in highly specific cognitive restructuring exercises, and with the help of the computer psychologist managed to build behavioural experiments to test out unhelpful cognitions. Data from this Phase II trial suggest that the computerised treatment protocol can lead to substantial reductions in anxiety and avoidance, and improve mood and quality of life as measured by the FNE, SPAI, BDI-II, UTBAS, SASS and OASES. Conclusions: The computer psychologist motivated people both to log on regularly (with use of an automated email process) and to complete the program. It engaged clients in detailed cognitive restructuring work, creating successful behavioural experiments for exposure, and producing promising preliminary results. However, these results need to be tested in a randomized controlled trial to establish efficacy. A RCT is currently under way. The preliminary findings presented here suggest that it would be viable to develop this type of treatment intervention for other anxiety disorders. Limitations of this approach and suggestions for future research are discussed

Supplementing stuttering treatment with online cognitive behavior therapy: An experimental trial

Purpose: It is now well established that adults who present to speech clinics for help with stuttering will have an increased risk of having an anxiety disorder, particularly social anxiety disorder. Concomitant psychological problems are known to interfere with the maintenance of the benefits of behavioral speech treatments for stuttering. The current team has developed and trialed a cognitive behavior therapy (CBT) program designed specifically to reduce anxiety in adults who stutter, and trials have shown promise for both an in-clinic version and a standalone internet-based version. The aim of the present study is to determine whether iGlebe, the internet-based version of the team's internet CBT treatment (previously known as CBTPsych), enhances the benefits of behavioral stuttering treatment. Method: Participants were 32 adults seeking treatment for stuttering. The design was a two-arm randomized experimental trial with blinded outcome assessments at 6 and 12 months post-randomization. Both arms received basic speech-restructuring training to reduce stuttering, without any anxiolytic (anxiety reducing) components. The experimental arm also received 5 months access to iGlebe. Results: There was evidence that, at 12 months post-randomization, iGlebe added clinically significant improvements to self-reported stuttering severity and quality of life. The present experimental trial provides the first evidence that the addition of CBT to speech restructuring improves speech outcomes. Conclusions: The present results will be the basis for the development of a comprehensive, internet-based treatment program for anxiety associated with stuttering. Ultimately, it may be possible for such an economical, scalable, and translatable comprehensive treatment model to supplement standard speech-language pathology treatment practices for those who stutter