社交焦虑障碍(SAD)是最普遍的心理障碍之一,通常与升高的羞耻水平同时发生。先前针对羞耻的干预措施可以显着改善社交焦虑治疗的结果。最近的评论表明,整合更直接的羞耻干预可能会提高认知行为疗法的有效性。基于网络的认知行为疗法(WCBT)已经证明了疗效,持续受益6个月至4年。先前的证据表明,羞耻可以预测社交焦虑的减少,并在WCBT期间参与暴露和社交焦虑变化之间起中介作用。
■本研究旨在通过一项纵向研究设计一种羞耻干预成分,并进行一项随机对照试验,以研究羞耻干预成分在减少社交焦虑症状和羞耻体验方面的有效性。SAD患者的临床样本。
■羞耻干预组件的发展是由认知行为原理和来自测量羞耻经历量表(ESS)的纵向数据的见解提供的,应对方式问卷,和153名参与者的社交互动焦虑量表(SIAS)。心理教育,认知建构,和曝光部分被定制为更多地关注与羞耻相关的问题解决和自责。总共招募了1220名参与者来完成问卷,包括ESS,SIAS,社交恐惧症量表(SPS),诊断性访谈经过两轮筛选,201名SAD参与者被随机分配到一个耻辱WCBT组,正常的WCBT组,一个等待的小组。在为期8周的WCBT干预后,参与者被要求完成后测评估,包括ESS,SIAS和SPS。
■WCBT组的参与者在干预后的羞耻水平显着降低(ESS:P<.001;ηp2=0.22),与正常WCBT相比,羞耻干预组的下降幅度更大(P<.001;平均偏差-12.50)。与干预后的等待组相比,羞耻WCBT和正常WCBT组的参与者社交焦虑症状显着降低(SIAS:P<.001;ηp2=0.32;SPS:P<.001;ηp2=0.19)。此外,在社交互动焦虑(SIAS)的经验中,与正常WCBT组相比,羞耻WCBT组显示出更高的降低(P<.001;平均偏差-9.58)。问题解决(SE0.049,95%CI0.025-0.217)和自责(SE0.082,95%CI0.024-0.339)介导了ESS和SIAS之间的作用。
■这是第一项在WCBT中设计并纳入羞耻干预成分并通过随机对照试验验证其有效性的研究。与正常WCBT和等待组相比,羞耻WCBT组治疗后的羞耻和社交焦虑显着降低。问题解决和自责介导了羞耻对社交焦虑的影响。总之,这项研究支持了先前的发现,即直接的羞耻特异性干预成分可以增强WCBT的疗效.
UNASSIGNED: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous
shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct
shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT.
UNASSIGNED: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD.
UNASSIGNED: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS.
UNASSIGNED: Participants in the
shame WCBT group experienced significant reductions in
shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation -12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation -9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS.
UNASSIGNED: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The
shame WCBT group showed a significant reduction in both
shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of
shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT.