Category: Cultural Diversity / Vulnerable Populations

Symposium

An Examination of Therapist Support and Other Predictors of Treatment Engagement in an Online Intervention in China

Sunday, November 19
10:15 AM - 11:45 AM
Location: Indigo 202, Level 2, Indigo Level

Keywords: Technology / Mobile Health | Cross Cultural / Cultural Differences | Social Anxiety
Presentation Type: Symposium

Background: Although initial findings provide evidence for the efficacy of self-guided, Internet-based Cognitive Behavioral Therapy (iCBT), most studies report low rates of treatment engagement (high attrition, low adherence). More research is needed to evaluate feasible and culturally-sensitive approaches to not only enhance treatment efficacy, but also treatment engagement. The aim of the present study is (1) to identify demographic and clinical factors associated with treatment engagement in an online intervention for social anxiety (SAD) in China, and (2) to explore whether therapist support results in improved treatment engagement or outcomes. Method: Adults with high levels of social anxiety (Social Interaction Anxiety Scale [SIAS] > 31) were interviewed and assigned into the Chinese version of an 8-week, self-guided iCBT (N=183; Berger et al., 2011) or to the intervention plus therapist support (iCBT+; N=72), which included an adjunctive, text-based support provided by masters-level clinicians on an as-needed basis. Results: Both groups reported significant reductions in SAD symptoms. Women and participants who completed more modules (i.e., adherence) reported greater reductions in symptoms. Older participants and those with a SAD diagnosis were more adherent. However, there were no significant group differences for rates of adherence (iCBT=4.0 modules [SD=3.2] vs. iCBT+=4.4 modules [SD=3.5]) or attrition (i.e., failure to complete post-treatment assessments; iCBT=54.2% vs. iCBT+=59.6%). Further analyses using different measures of engagement as well as mediation models were tested. Discussion: These results add to a growing body of literature suggesting that self-guided, online interventions are effective, and that adjunctive paraprofessional support does not necessarily impact treatment engagement or outcomes. However, more standardized definitions of attrition and adherence are needed. Future trials should include a broader range of diagnoses, populations (children, older adults), and geographic regions (other LMICs). Furthermore, qualitative methods should be employed to elicit participants’ reasons for engaging with or quitting an iCBT program.

Marcus Rodriguez

PhD candidate
Duke University

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