Treatment
attention on external stimuli., anxiety, SAD
WELLS
The app offers an adaptation of scientifically proven techniques in the treatment of SAD based on Clark and Wells [Clark and Wells’ model [Module 1—Learning and Understanding: The goal of this module of the app is to provide the user with key information about SAD and to create an individualized model based on Clark and Wells’ approach. The information used to derive the model is based on patients’ self-reports of anxiety-provoking situations. The model is developed in a stepwise manner, prompted by feedback from the app.Module 2—Attention Training: The goal of the second module is to change self-focused attention. The training uses recorded audio exercises that train the ability to focus attention on external stimuli.Module 3—Behavioral experiments: This key module of the app consists of four phases. Each phase includes specific types of behavioral experiments, as well as various forms and questions for planning the experiments and recording the results and key findings.The first phase provides an experiment on how increasing or decreasing safety behaviors and self-focused attention affects anxiety. The experiment is supplemented by video feedback, in which patients are asked to record themselves in a simulated social situation (e.g., a presentation) and subsequently correct dysfunctional beliefs about their appearance or behavior.The second phase involves testing the dysfunctional beliefs that emerge in real social situations while simultaneously reducing safety behaviors and directing their attention outward.The third phase focuses on testing beliefs about the assumed negative impact of supposedly embarrassing behaviors on how they are evaluated by others (e.g., “If I pause during a presentation, I will appear awkward, and others will think I am an idiot”). Patients are instructed to explicitly demonstrate certain critical behaviors (e.g., pausing during a presentation) and to question the validity of their (possibly erroneous) beliefs.The fourth phase involves integrating behavioral experiments into daily life by continually testing SAD-related beliefs that interfere with personal goals.In the therapist-guided app condition (TG-APP), use of the app is accompanied by eight therapist-guided video sessions. Based on the manual by Stangier et al. [First session: establishing a therapeutic alliance, exploring the symptoms and giving an introduction to the appSecond session: answering questions based on the individualized model of the app, deriving a second cognitive model by exploring safety behaviors and establishing motivation for changeThird session: performing a video recorded behavioral experiment to modify safety behaviors and self-focused attentionFourth session: analyzing the recorded video to test dysfunctional self-evaluation (video feedback)Fifth session: conducting a therapist-guided behavioral experiment testing a dysfunctional beliefSixth session: conducting a therapist-guided behavioral experiment deliberately showing critical behavior and testing the evaluation by othersSeventh session: motivating the patient to implement behavioral experiments into the everyday life and debriefing of previous behavioral experimentsEighth session: relapse prevention (summary of helpful techniques, pursuing personal goals, cognitive interventions for strengthening the self-esteem)