Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys (original) (raw)
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BMC Psychiatry
Background Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. Methods Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment bei...
Treatment adequacy for social anxiety disorder in primary care patients
PLOS ONE, 2018
Objectives There is a gap between clinical practice guidelines for social anxiety disorder and clinical practice that needs to be addressed to ensure the delivery of evidence-based treatments. The objectives of this study were: 1) to describe mental health service utilization in a cohort of primary care patients with social anxiety disorder; 2) to examine treatment adequacy for pharmacotherapy and psychotherapy according to indicators based on clinical practice guidelines; and 3) to explore correlates of treatment adequacy. Method The "Dialogue" project (Quebec, Canada) is a large study conducted in 67 primary care clinics. After a mental health screening in primary care (n = 14 833), participants with anxiety or depressive symptoms took part in a telephone/web structured interview on mental health symptoms and service utilization (n = 1956). This study included 289 participants meeting DSM-IV criteria for social anxiety disorder. Results Overall, 86.2% of participants reported consulting for mental health reasons over the past 12 months. Only 23.6% of our sample reported the detection of social anxiety disorder by a healthcare professional in the past 12 months. Approximately 2 in 5 respondents with social anxiety disorder reported receiving pharmacotherapy or psychotherapy meeting our treatment adequacy indicators. Antidepressant medication was the most common treatment. Logistic regression models showed that the detection of major depression (OR = 4.651; 95% CI: 2.559-8.453) or other anxiety disorder(s) (OR = 2.957; 95% CI: 1.555-5.625) were associated with receiving any adequate treatment, but the detection of social anxiety disorder itself was not (OR = 1.420; 95% CI: 0.696-2.899).
A review on predictors of treatment outcome in social anxiety disorder
Revista Brasileira de Psiquiatria, 2012
Objective: This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD). Methods: A systematic review of trials identified through databases of ISI, Medline, PsycInfo, Cochrane, LILACS, Current Controlled Trials, and in references of previously selected articles published in English up to December 2010. In our literature search, we used the words prediction/predictors and social anxiety disorder or social phobia. Results: Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD. Conclusions: Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.
Journal of Anxiety Disorders, 2004
Efficacious treatments for social anxiety disorder have become increasingly available, with approximately three-quarters of treatment completers showing significant improvement [Arch. Gen. Psychiatry 55 (1998) 1133. However, very few individuals with social anxiety disorder access these services. The present study reports on the path to initiation of treatment for social anxiety disorder among individuals contacting an anxiety disorder specialty clinic. Of 395 initial telephone inquiries, only 60 individuals (15%) started treatment. Three ''critical points'' associated with high pretreatment attrition were identified: scheduling an initial interview, attending a scheduled initial interview, and initiating a treatment program after receiving a principal diagnosis of social anxiety disorder. Several demographic variables (e.g., level of education, race) were related to attendance at the initial interview. However, no differences were found between those who did and did not initiate treatment on demographic variables, symptom severity, or quality of life. Given that most individuals who complete treatment for social phobia experience significant benefit, results of the current study suggest Anxiety Disorders 18 (2004) that future efforts should be devoted to increasing number of patients who access these services. #
BMC medicine, 2017
There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis. Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, ...
Depression and anxiety, 2018
Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use o...
Behavioral Psychology/Psicología Conductual, 2021
Social anxiety disorder (SAD) is one of the most prevalent disorders worldwide. The goal of this study was to test the effectiveness of the new program “Multidimensional Intervention for Social Anxiety” (MISA) for the treatment of SAD. Sixty-seven people diagnosed with SAD, according to the DSM-5, participated in this study, and they were assessed by means of a semi-structured interview (Salazar & Caballo, 2018) and two self-report measures for social anxiety, the SAQ (Caballo, Salazar, Arias, et al., 2010) and the LSAS-SR (Liebowitz, 1987). Different therapists delivered the treatment in Ecuador, Spain, Paraguay, and Puerto Rico. The results showed significant improvements from pre-treatment to post-treatment, which were maintained at six months. The effect size was between 1 and 2 and, on many occasions, was greater than 2. Although it was compared with a cognitive behavioral therapy group and a pharmacological treatment group, with favorable results for the MISA program, the low ...
Behavioral Psychology/Psicología Conductual
In a previous work (Caballo et al., 2021) we tested the effectiveness of the Multidimensional Intervention for Social Anxiety (MISA) program in reducing social anxiety symptoms. In this quasi-experimental study, with pre/post-treatment and follow-up measures, we examined the impact of the MISA program on other problems related to social anxiety. 57 people diagnosed with social anxiety disorder (SAD), according to DSM-5, were assessed with a diagnostic interview and questionnaires measuring social skills, depression, avoidant personality disorder symptoms, alcoholism, self-esteem, personal sensitivity, worries, and quality of life. Different therapists carried out the treatment in Ecuador, Spain, and Paraguay. The results showed significant improvements at post-treatment in virtually all measures assessing the above variables, improvements that were maintained at six months. Effect sizes on treatment effectiveness ranged from medium to large. The MISA program was also compared with i...
Outcome predictors in guided and unguided self-help for social anxiety disorder
Behaviour Research and Therapy, 2012
Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.