Accepted for/Published in: JMIR Mental Health
Date Submitted: Aug 7, 2019
Date Accepted: Feb 22, 2020
Date Submitted to PubMed: Apr 29, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The effect of exposure and engagement on shame in an online intervention for social anxiety in China
ABSTRACT
Background:
Prior research has shown the efficiency of Internet-based cognitive behavioral therapy (ICBT) on social anxiety disorder (SAD). However, it is unclear how shame influences this treatment effect.
Objective:
The primary aim of the study was to investigate what role did shame play in the ICBT treatment process of SAD participants.
Methods:
A total of 138 Chinese participants (98 females, mean ages: 27.18 years, SD 7.62) were divided into self-help ICBT, guided ICBT or waiting list (WL). Participants were assessed prior to, and immediately following the intervention using Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), and Experience of Shame Scale (ESS).
Results:
The participants’ social anxiety symptoms (Self-help: SIAS = −12.76; Cohen d = 1.10; 95% CI −15.62 to −9.90, P < .001; SPS = −10.18; Cohen d = 0.72; 95% CI −13.65 to −6.71, P < .001; Guided: SIAS=−19.45; Cohen d = 1.44; 95% CI −24.24 to −14.67, P < .001; SPS=−13.45; Cohen d = 0.92; 95% CI −18.64 to −8.26, P <.001) and shame-proneness (Self-help: ESS = −8.92; Cohen d = 0.75; 95% CI −11.86 to −5.99, P <.001; Guided: ESS = −9.97; Cohen d = 0.77; 95% CI −14.58 to −5.36, P <.001) in both self-help and guided group reduced significantly after treatment, with no significant differences between the two intervention groups. Additionally, among all the ICBT sessions, the only significant predictors of decrease in shame-proneness were the average number of words participants wrote in the exposure module (beta = .222, SE = .175, t(96) = 2.317, P = .023), and gender (beta = -.276, SE = .002, t(96) = 12.888, P = .005). We also found a mediation effect: the decrease in shame can fully mediate the relationship between the average number of words participants wrote in the exposure module and the decrease of social anxiety (for SIAS: β= -.0035, SE = .0014, 95% CI [-.0068, -.0012]; for SPS: β= -.0028, SE = .0012, 95% CI [-.0057, -.0010] ).
Conclusions:
These results suggest that participants’ engagegment in the exposure module in ICBT could alleviate social anxiety symptoms through reducing the level of shame. Our study provides a new perspective for understanding the role of shame in treatment of social anxiety. The possible mechanisms of the mediation effect and clinical implications are discussed. Clinical Trial: ChiCTR1900021952
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