The Development and Evaluation of an Ecological Momentary Intervention for Social Anxiety
Date
2018
Authors
Loo Gee, Brendan Djin Goh
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Abstract
Social anxiety is a common mental health problem. Many people do
not seek help due to barriers to accessing services. Novel
methods have been explored that enhance existing assessments and
treatments to be more accessible to people outside a clinic.
Ecological Momentary Assessments (EMA) are real-time approaches
that allow a person to self-assess their anxiety while they
engage in daily activities. Ecological Momentary Interventions
(EMI) are approaches that extend EMA to deliver psychological
treatment to people in their natural environment. EMIs can be
used as an adjunct to existing therapies, or as a standalone
intervention.
The current thesis examines the development and evaluation of
EMIs for social anxiety through four related studies. The first
study is a meta-review of observational and evaluation studies
using EMA to assess or target various mental disorders. The study
found 14 reviews that examined general psychopathology, mood
disorders, borderline personality disorder, smoking addiction,
and psychosis. The study concluded that there is a need for
higher quality reviews on anxiety and stress and more reviews of
studies that evaluate EMI effects. The second study is a
systematic review of EMIs for stress and anxiety, which includes
a meta-analysis on the EMI effects on generalised anxiety. This
study suggests that EMIs may be effective but indicates a
research gap in EMIs for social anxiety.
The third study is a case study on the design and development of
an EMI for social anxiety. This study demonstrated the use of
three software development approaches and discussed the
implications of those approaches on the iterative design process,
the development of software components, and the challenges of
engagement and communication with stakeholders, documentation and
time management. The fourth study presents the protocol for a
Randomised Controlled Trial (RCT) for the evaluation of an EMI
for social anxiety. The RCT protocol was a two-arm study design
that examined the EMI effects against a waitlist control group.
The final study presents
the RCT outcomes in an adult sample (n = 55) testing the
effectiveness of the EMI for reducing social anxiety symptoms.
This study found the EMI was not associated with significant
improvements in social anxiety relative to the control. Nor the
EMI was associated with a significant improvement in anxiety
sensitivity, psychological distress, generalised anxiety and
depression, or help-seeking. While the participants who used the
mobile app reported being satisfied, the study suffered from
significant drop out with 83% of the participants not completing
the study.
Overall, the current thesis found that EMIs are promising, but
more research is needed to address the challenges in developing
an EMI for social anxiety that incorporates an iterative and
reflexive development process. Furthermore, the RCT on the
resulting EMI faced challenges with recruitment and retention,
suggesting that alternative methods may be required for
increasing the engagement of individuals in self-guided EMIs.
Nevertheless, with further technological and methodological
developments, EMIs may offer an opportunity to deliver
personalised therapy for people experiencing anxiety.
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Keywords
telemedicine, mobile health, anxiety, anxiety disorders, psychological stress, social anxiety, ecological momentary assessment, just-in-time interventions, human-computer interaction
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Thesis (PhD)
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