JMIR Publications

ABSTRACT

Background:

Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular online treatment, has shown strong efficacy in English-language randomized controlled trials in the UK and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following the translation and cultural adaptation of treatment contents.

Objective:

This study aimed to examine the feasibility, acceptability, and initial efficacy of culturally-adapted iCT-SAD in Japanese clinical settings.

Methods:

This multi-center, single-arm pilot study recruited 15 participants with SAD. Participants accessed iCT-SAD for 14 weeks (treatment phase), and for a subsequent 3-month follow-up phase that included up to three booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale (LSAS). Secondary outcome measures examined social anxiety-related psychological processes, taijin-kyofusho, depression, generalized anxiety, and general functioning.

Results:

Of the 15 participants who started iCT-SAD, 14 completed the treatment phase, and 13 completed the follow-up phase. iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (Cohen’s d = 3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for secondary outcome measures. At the end of the treatment phase, 12 participants (80%) demonstrated reliable improvement, and nine (60%) demonstrated remission from social anxiety. No serious adverse events occurred. Participant feedback was positive and highlighted areas of strength in treatment, and further suggestions to improve suitability for Japanese settings.

Conclusions:

Translated and culturally adapted iCT-SAD appeared feasible and acceptable in Japanese clinical settings and demonstrated highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly.