The Entourage Project: A single-group pilot study of an interactive e-mentoring program for young people with social anxiety symptoms attending headspace

Entourage is a pilot, single-group pre-post trial of an interactive e-mentoring program. The trial involves moderated online social therapy (MOST), developed by eOrygen, the digital mental health division of Orygen, the National Centre of Excellence in Youth Mental Health (Orygen). The intervention is being piloted among a group of 89 young people attending headspace centres, who experience symptoms of social anxiety, representing an adjunct to treatment as usual provided by headspace. The online platform consists of: peer-to-peer online social networking; individually-tailored interactive psychosocial interventions; and involvement of expert mental health and peer moderators to ensure intervention safety. The primary objective is to evaluate whether the Entourage intervention demonstrates acceptability, feasibility and safety. A secondary objective is to investigate whether the Entourage intervention demonstrates potential social benefit (i.e., improvement to loneliness, isolation, social connectedness and symptoms of social anxiety). The intervention consists of evidence-based cognitive approaches to the treatment of social anxiety, delivered online via purpose-developed therapeutic comics. The Entourage therapy comics have been developed through an iterative process of scripting, professional illustration and inter-disciplinary feedback from expert youth mental health clinicians and end-users (i.e., young people). Each comic is approximately 15-25 panels in length, requiring around 5-minutes to read. Entourage includes 7 “Pathways”, covering various therapeutic themes (Communication; Mindfulness; Self compassion; Depression; Anxiety; Social anxiety). Each Pathway contains a series of “Steps”, and each Step has its own unique therapy comic which covers a different aspect of the theme of the Pathway. For example, the Social Anxiety Pathway has 12 Steps, covering a range domains of social anxiety: psychoeducation regarding social anxiety; physiological symptoms of social anxiety; the role of cognition & fear of negative evaluation; safety behaviours associated with social anxiety; building on positive social experiences; etc. All therapy modules in Entourage contain therapeutic comics and a set of associated Actions. Entourage e-mentors (clinical psychologists) also support participants to complete therapy "Actions", which serve as behavioural experiments within Entourage. Each Step has a set of associate Actions which are designed to help participants apply their learning from reading the Step. For example, the Social Anxiety Pathway contains Actions which encourage participants to work with clinical moderators to develop a set of behavioural experiments, where participants are supported in the process of identifying feared social situations within a graded hierarchy. Participation in the therapy Actions is monitored by the clinical moderation team, who contact participants successively over the course of the 12-week study period to support their progress. Participants are also encouraged to record their completion of Actions in the Entourage system. Entourage also allows participants to interact anonymously with each other via a peer-to-peer online social networking section. This section is moderated by Entourage peer workers (young people with a lived experience of mental health service access, who have been specially-trained to support others). Whilst all participants have unlimited access to all therapy modules during the study period, the intervention is tailored insofar as the clinical moderation team can suggest particular therapy modules to young people based on presenting concerns. Following an in-person baseline assessment and induction to the Entourage platform, participants are free to use the system for a 12-week study intervention period. During this time participants receive online clinical moderation and peer support, and can access the therapy modules in their own time. No expectation for duration of use is communicated to participants, however the moderation team encourage participants to complete successive therapy modules (called “steps”) as part of “pathways” throughout the study period. Data analytics regarding participants’ use of the system are automatically recorded online. These will be monitored by the clinical moderation team, alongside communication with participants throughout the study period to monitor adherence to the intervention. This is a pilot study aiming to gauge participants’ experience of Entourage, and as such their level of engagement might vary. Additional assessments involve a 6-week midpoint questionnaire administered online, and 12-week in-person follow-up assessment involving questionnaire measures and a semi-structured feedback interview, designed to capture participants' perspectives on the acceptability, feasibility and safety of the Entourage intervention.