Social Anxiety
Conditions
Keywords
social anxiety, unemployment, cognitive behavioral therapy, group therapy, work, vocation
Brief summary
Social anxiety disorder is a highly prevalent condition that interferes with employment. Prior research indicates that social anxiety disorder interferes with work attainment. This project involves a two-site randomized trial of a community-based cognitive-behavioral intervention to reduce social anxiety and improve employment outcomes among unemployed persons with social anxiety disorder.
Detailed description
The goal of the proposed research is to conduct a multi-site trial of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose job attainment efforts have been undermined by social anxiety disorder. Social anxiety disorder is a very common and impairing condition, with negative impacts on occupational functioning. Work-related impairments include turning down job offers and promotions, reduced productivity and job performance, lowered educational attainment, increased unemployment, financial dependence, and reduced income. The investigators have shown that social anxiety disorder was the strongest psychiatric predictor of sustained reliance on welfare for support. In response to these documented employment-related impairments, the investigators produced an eight-session work-related group cognitive behavioral therapy (WCBT) that, when coupled with standard vocational rehabilitation services, significantly improved social anxiety, depression, job search behaviors and job search self-confidence compared to a control group of socially anxious jobs seekers who received only vocational services as usual (VAU). Participants in this pilot R34 study were all homeless, primarily African American, urban-based job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. WCBT is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. The current collaborative RO1 will involve two academic, investigative teams and the staff of two community-based employment service agencies to further evaluate WCBT compared to VAU. This two-region study will address whether WCBT enhances job placement and retention assessed over a one-year interval. In addition, this trial will test the implementation of WCBT in a new vocational service agency that was not involved in the development of WCBT, and whether the effects of WCBT generalize to a new population of urban-based, racially diverse job-seekers with educational and educational histories that differ from the original WCBT study site. The investigators will also investigate the system effects of WCBT in the new site that will be informative for broad implementation of WCBT nationwide. Finally, as an innovative extension from the R34, this project will incorporate implementation tools of technology-assisted provider training and delivery of WCBT.
Interventions
BEHAVIORALVocational Services as usual plus Cognitive Behavioral Therapy (CBT)
Teaches thought restructuring and exposure therapy to socially anxious job seekers delivered by vocational service professionals
BEHAVIORALUsual Vocational Services
Vocational services delivered by vocational professionals at vocational service center (e.g., resume assistance, job leads)
Sponsors
University of California, Los Angeles
National Institutes of Health (NIH)
National Institute of Mental Health (NIMH)
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Participants will be: * JVS service-seeking adults who are unemployed * Screen positive for social anxiety, and * Meet diagnostic criteria for social anxiety. * Potential Participant taking psychotropic medications will be offered participation without restriction.
Exclusion criteria
* Presence of any of the following: * Substance dependence; current opiates or freebase cocaine; schizophrenia, other psychotic symptoms and/or manic symptoms that would interfere with study participation * Current anorexia nervosa * Prior course of cognitive behavioral therapy for social anxiety (at least 8 sessions) * Prominent suicidal/homicidal ideation with imminent risk * Persons meeting diagnostic criteria for substance abuse if they are unable to attend sessions while not under the influence, except for those abusing opiates or freebase cocaine who will be excluded * Persons who score below 6th grade reading level * Non-English speaking participants
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Liebowitz Social Anxiety Scale | Mean scores across all timepoints: baseline, post treatment, 3 month, 6 month and 12 month follow up. | Measure of social anxiety and avoidance. This first set of questions asks how anxious or fearful an individual feels in the situation. Ratings range from 0-3(0=none, 1=mild, 2=moderate, 3=severe). The second set of questions asks how often an individual would avoid the situation. Ratings range from 0-3(0=never, 1=occasionally, 2=often, 3=usually). Sums of each subscale(fear/anxiety and avoidance) are added together to create the total score. The severity scale for this measure is 0-54=subclinical, 55-64=moderate, 65-79=marked, 80-94=severe, 95-144(maximum score)=very severe. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Health Questionnaire | Mean scores across all timepoints(baseline, post treatment, 3 month, 6 month and 12 month follow up). | Rating scale for depression. Participants are asked how often they have been bothered by specific symptoms within the last two weeks. They are asked about 8 different symptoms on a rating scale from 0-3(0=not at all, 1=several days, 2=more than half the days, 3=nearly everyday). Participants are asked how difficult problems made for them do work, take care of things at home, and get along with others. This item is rated from 0-3(0=not difficult at all, 1=somewhat difficult, 2=very difficult, 3=extremely difficult). The final score is the total of all eight responses. Ranges include 0-4= minimal depression, 5-9=mild depression, 10-14 moderate depression, 15-19 moderately severe depression, 20-24\*=severe depression. Note: The study switched from using the PHQ-9 to the PHQ-8 midway throughout. |
| Hours Worked Per Week | Mean scores across all timepoints(3 month, 6 month and 12 month follow up), to show change across time. | How many hours per week worked during follow up period. Participants were asked to report weekly work hours starting at 3 month follow up. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Usual Vocational Services + CBT This is the experimental intervention - Usual vocational services at a vocational services center plus additional cognitive behavioral therapy at vocational service center.
Vocational Services as usual plus Cognitive Behavioral Therapy (CBT): Teaches thought restructuring and exposure therapy to socially anxious job seekers delivered by vocational service professionals
Usual Vocational Services: Vocational services delivered by vocational professionals at vocational service center (e.g., resume assistance, job leads) | 120 |
| Usual Vocational Services This is the care as usual intervention - Vocational services as usually delivered to service seeking clients
Usual Vocational Services: Vocational services delivered by vocational professionals at vocational service center (e.g., resume assistance, job leads) | 130 |
| Total | 250 |
Baseline characteristics
| Characteristic | Usual Vocational Services + CBT | Usual Vocational Services | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 120 Participants | 130 Participants | 250 Participants |
| Age, Continuous | 46.25 years STANDARD_DEVIATION 10.84 | 43 years STANDARD_DEVIATION 10.99 | 44.63 years STANDARD_DEVIATION 10.92 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 3 Participants | 1 Participants | 4 Participants |
| Race/Ethnicity, Customized Asian American | 3 Participants | 4 Participants | 7 Participants |
| Race/Ethnicity, Customized Black or African American | 47 Participants | 55 Participants | 102 Participants |
| Race/Ethnicity, Customized I identify in another way | 12 Participants | 12 Participants | 24 Participants |
| Race/Ethnicity, Customized More than one race | 16 Participants | 7 Participants | 23 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Unknown or not reported | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 38 Participants | 51 Participants | 89 Participants |
| Region of Enrollment United States | 120 participants | 130 participants | 250 participants |
| Sex/Gender, Customized Sex/Gender, Customized Female | 73 Participants | 75 Participants | 148 Participants |
| Sex/Gender, Customized Sex/Gender, Customized Identify in another way | 3 Participants | 1 Participants | 4 Participants |
| Sex/Gender, Customized Sex/Gender, Customized Male | 44 Participants | 54 Participants | 98 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 120 | 0 / 130 |
| other Total, other adverse events | 0 / 120 | 0 / 130 |
| serious Total, serious adverse events | 0 / 120 | 0 / 130 |
Outcome results
Primary
Liebowitz Social Anxiety Scale
Measure of social anxiety and avoidance. This first set of questions asks how anxious or fearful an individual feels in the situation. Ratings range from 0-3(0=none, 1=mild, 2=moderate, 3=severe). The second set of questions asks how often an individual would avoid the situation. Ratings range from 0-3(0=never, 1=occasionally, 2=often, 3=usually). Sums of each subscale(fear/anxiety and avoidance) are added together to create the total score. The severity scale for this measure is 0-54=subclinical, 55-64=moderate, 65-79=marked, 80-94=severe, 95-144(maximum score)=very severe.
Time frame: Mean scores across all timepoints: baseline, post treatment, 3 month, 6 month and 12 month follow up.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Usual Vocational Services + CBT | Liebowitz Social Anxiety Scale | Baseline | 81.05 score on a scale | Standard Deviation 2.47 |
| Usual Vocational Services + CBT | Liebowitz Social Anxiety Scale | 3 months | 57.78 score on a scale | Standard Deviation 3.94 |
| Usual Vocational Services + CBT | Liebowitz Social Anxiety Scale | 6 months | 50.13 score on a scale | Standard Deviation 3.79 |
| Usual Vocational Services + CBT | Liebowitz Social Anxiety Scale | 12 months | 40.97 score on a scale | Standard Deviation 3.74 |
| Usual Vocational Services + CBT | Liebowitz Social Anxiety Scale | Post | 64.11 score on a scale | Standard Deviation 3.24 |
| Usual Vocational Services | Liebowitz Social Anxiety Scale | 12 months | 46.58 score on a scale | Standard Deviation 3.78 |
| Usual Vocational Services | Liebowitz Social Anxiety Scale | Baseline | 82.74 score on a scale | Standard Deviation 2.34 |
| Usual Vocational Services | Liebowitz Social Anxiety Scale | Post | 73.05 score on a scale | Standard Deviation 3.02 |
| Usual Vocational Services | Liebowitz Social Anxiety Scale | 6 months | 58.77 score on a scale | Standard Deviation 3.65 |
| Usual Vocational Services | Liebowitz Social Anxiety Scale | 3 months | 65.82 score on a scale | Standard Deviation 3.85 |
Secondary
Hours Worked Per Week
How many hours per week worked during follow up period. Participants were asked to report weekly work hours starting at 3 month follow up.
Time frame: Mean scores across all timepoints(3 month, 6 month and 12 month follow up), to show change across time.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Usual Vocational Services + CBT | Hours Worked Per Week | 3 month follow up | 14.2 hours per week | Standard Deviation 1.5 |
| Usual Vocational Services + CBT | Hours Worked Per Week | 6 month follow up | 16.57 hours per week | Standard Deviation 1.67 |
| Usual Vocational Services + CBT | Hours Worked Per Week | 12 month follow up | 18.92 hours per week | Standard Deviation 1.98 |
| Usual Vocational Services | Hours Worked Per Week | 3 month follow up | 15.39 hours per week | Standard Deviation 1.37 |
| Usual Vocational Services | Hours Worked Per Week | 6 month follow up | 17.94 hours per week | Standard Deviation 1.46 |
| Usual Vocational Services | Hours Worked Per Week | 12 month follow up | 20.44 hours per week | Standard Deviation 1.74 |
Secondary
Patient Health Questionnaire
Rating scale for depression. Participants are asked how often they have been bothered by specific symptoms within the last two weeks. They are asked about 8 different symptoms on a rating scale from 0-3(0=not at all, 1=several days, 2=more than half the days, 3=nearly everyday). Participants are asked how difficult problems made for them do work, take care of things at home, and get along with others. This item is rated from 0-3(0=not difficult at all, 1=somewhat difficult, 2=very difficult, 3=extremely difficult). The final score is the total of all eight responses. Ranges include 0-4= minimal depression, 5-9=mild depression, 10-14 moderate depression, 15-19 moderately severe depression, 20-24\*=severe depression. Note: The study switched from using the PHQ-9 to the PHQ-8 midway throughout.
Time frame: Mean scores across all timepoints(baseline, post treatment, 3 month, 6 month and 12 month follow up).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Usual Vocational Services + CBT | Patient Health Questionnaire | Post treatment | 7.79 score on a scale | Standard Deviation 6.07 |
| Usual Vocational Services + CBT | Patient Health Questionnaire | 6 month follow up | 7.15 score on a scale | Standard Deviation 6.25 |
| Usual Vocational Services + CBT | Patient Health Questionnaire | 3 month follow up | 7.70 score on a scale | Standard Deviation 6.97 |
| Usual Vocational Services + CBT | Patient Health Questionnaire | 12 month follow up | 6.78 score on a scale | Standard Deviation 6.13 |
| Usual Vocational Services + CBT | Patient Health Questionnaire | Baseline | 10.99 score on a scale | Standard Deviation 6.27 |
| Usual Vocational Services | Patient Health Questionnaire | 12 month follow up | 6.30 score on a scale | Standard Deviation 6.06 |
| Usual Vocational Services | Patient Health Questionnaire | Baseline | 11.52 score on a scale | Standard Deviation 7.01 |
| Usual Vocational Services | Patient Health Questionnaire | Post treatment | 9.26 score on a scale | Standard Deviation 6.72 |
| Usual Vocational Services | Patient Health Questionnaire | 3 month follow up | 8.17 score on a scale | Standard Deviation 6.61 |
| Usual Vocational Services | Patient Health Questionnaire | 6 month follow up | 7.44 score on a scale | Standard Deviation 6.75 |