JMIR Publications

ABSTRACT

Background:

Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental healthcare. However, this can only be achieved if results of tightly-controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies.

Objective:

To describe and evaluate a programme of therapist training to deliver internet-based Cognitive Therapy for Social Anxiety Disorder (iCT-SAD). As this treatment was developed in the UK, and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series.

Methods:

Three therapists received training in iCT-SAD, which included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating six patients with the iCT-SAD programme. Training progress was evaluated using standardised and self-report measures, and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the programme.

Results:

The training programme was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence suitable for that of a therapist in a clinical trial. The six patients treated by the trainees all completed their treatment and achieved a mean pre- to post-treatment change of 53.8 points (SD = 39.5) on the primary outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohens d) was 2.06 (95%CI 0.66, 3.46). There was evidence to suggest the patients’ clinical outcomes were sustained at three-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet programme. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding.

Conclusions:

The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting, and showed highly promising initial efficacy. A randomised controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further work to develop, describe, and evaluate therapist training procedures is recommended.