JMIR Publications

ABSTRACT

Background:

Social anxiety disorder (SAD), also known as social phobia, is one of the most common mental disorders worldwide. In Hong Kong, there is a high prevalence but low treatment rate for SAD. SAD has immense impact on academic/work performance, social life, career development and quality of life. One of the most effective treatments for SAD is cognitive behavioral therapy (CBT) with internet-based CBT (iCBT) and virtual reality exposure therapy (VRET) showing promise in treating SAD. However, internet intervention has been underdeveloped in Chinese communities, such as Hong Kong.

Objective:

The objective of this study is to develop an iCBT program that includes VRET called “Ease Anxiety in Social Event Online” (Ease Online), for Hong Kong adults with SAD in a randomized controlled trial (RCT) study.

Methods:

The 14-week Ease Online program is a guided self-help iCBT program which adopts a blended mode of service delivery. The program consists of 9 online modules and 5 individual counseling sessions (including 2 VRET sessions). Other components of the program include therapist feedback on assignment, internal message, forum, client portfolio, online questionnaire, reminder, and online booking. The program can be accessed either through a mobile app or program website through a PC with internet connection. The participants are openly recruited, and screened by using a questionnaire, and through an intake interview. Eligible participants are randomized by placing them into a web-based iCBT group, app-based iCBT group or a waitlist control group. Participants in the waitlist control group are assigned to the app-based program upon completion of the service of the two experimental groups. Measurements of social anxiety, depression and anxiety symptoms, psychological distress, automatic thoughts and quality of life are administered at pre-test, post-test, and 3- and 6-month follow-ups. Linear mixed effect modeling is performed to determine the intervention effectiveness on the continuous variables over time.

Results:

Participant recruitment commenced in January 2021. As of February 2023, a total of 1811 individuals applied for the EASE Online program. A total of 401 intake interviews have been completed and 329 eligible participants have joined the program, among whom 166 have completed the service. Data collection is still ongoing, which is expected to be completed in March 2024.

Conclusions:

This study is the first of its kind in combining iCBT and VRET for the treatment of SAD in Hong Kong. At the theoretical level, this study contributes to the development and evaluation of internet psychological intervention in Hong Kong. At the practical level, the Ease Online program may serve as an alternative service option for SAD clients in Hong Kong if proven effective. Clinical Trial: This study is registered at https://clinicaltrials.gov/ (Identifier: NCT04995913).