Efficacy Of Online Cognitive Behavioral Therapy For Social Anxiety Disorder Comorbid With Depression

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Dr. Mehwish Mursaleen


To evaluate the effectiveness of online cognitive behavior therapy, treatment of a 20-year-old girl was executed through Skype over 9-months including 22 Psychotherapy sessions. According to DSM-5 she was diagnosed with “Social Anxiety Disorder, Performance Only” and “Major Depressive Disorder, Moderate”. Pre-test assessment through Liebowitz Social Anxiety Scale, Brief Fear of Negative Evaluation Scale, Self-Statements during Public Speaking Scale, and Beck Depression Inventory indicated prominent social phobia, clinically significant social anxiety, frequent negative self-statements, and severe depression respectively. Cognitive behavioral techniques were applied including identifying cognitive distortions and cognitive restructuring, belief change through Socratic dialogues, systematic desensitization, problem solving, and developing communication skills. The post-treatment assessments showed no social phobia/ anxiety and depression and more positive self-statements while rare negative self-statements were found till 1-month follow-up that completely faded over 3-months, 6-months, 2.5 years, and 5 years follow-ups. To evaluate progress over time, separate client and clinician ratings were recorded in every session through Subjective Units of Distress Scale and Clinical Global Impressions Scale respectively. Before the start of treatment, client rating indicated a distress level near to freak-out and alienate which coincided with clinician rating showing markedly ill level with no change from baseline. Gradual reduction in distress and improvement was observed throughout treatment while both client and clinician rating at the end of treatment indicated a normal level, improved state, peace, serenity, and total relief suggesting no more anxiety of any kind. Further, the Credibility/Expectancy Questionnaire showed that at beginning client rated on average 85% credibility and positive expectancy of treatment outcomes which improved to 95% on average at the end of treatment. Overall, objective and subjective measures were found to demonstrate stable outcomes over 5 years suggesting that online cognitive behavioral therapy stands as effective treatment for social anxiety disorder and depression. The efficacious outcomes are especially significant in relevance to the pre and post covid technological advancements in the field of clinical psychology.

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