The Development and Evaluation of an Ecological Momentary Intervention for Social Anxiety

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.