A novel CBT informed intervention for social anxiety in people recovering from psychosis. Ruth Turner, Richard White, Rebecca Lower, Lina Gega, David Fowler

Acknowledgements Everyone who has helped to make the Social Anxiety Research Clinic successful: Tony Reilly,Timothy Clarke, Felicity Waite, Evelina Medin, Kevin Lloyd, Rose Christopher, Emily Drake all of our participants,and the case managers within Central Norfolk Early Intervention Team

Social Anxiety Research Clinic Describe participants Brief description of intervention Describe findings Discussion of use of virtual environments

Background Up to 70% of people recovering from psychosis experience social anxiety. This is a significant barrier to social recovery. Social anxiety appears to be independent of the experience of positive symptoms

Description of sample at baseline Demographics: ; 17 male, 5 female; Average age = 26 (S.D. 6) PANSS (data for 13 participants) average score on positive sub-scale = 10.9 (S.D. = 3.0). 46% (n = 6) of participants scored 4 or more on one or more items of the sub-scale. BDI average score = 26.6 (S.D. 15.8) SIAS: SIAS M (S.D.) SARC55.6 (10.7) Social Phobia Comparison34.6 (16.4) Non-Clinical Comparison18.8 (11.8)

Description of sample at baseline BCSS Positive SelfNegative Self Positive Other Negative Other M (S.D.) SARC 6.8 (6.4)9.2 (7.0) 8.6 (6.5)9.0 (7.7) Psychosis Comparison10.3 (6.4)7.2 (5.9)10.3 (6.0)9.1 (6.8) Non-clinical10.2 (4.2)3.5 (3.5)10.4 (4.5)4.0 (4) SSI SASSI PSSI AESSI total M (S.D.) SARC17.4 (4.7)11.5 (7.6)8.4 (5.5)37.2 (15.0) Psychosis Comparison 8.6 (6.7) 6.0 (6.4)4.1 (5.7)18.7 (15.7) Non-Clinical 4.4 (5.1) 2.9 (3.6)2.3 (3.4)9.5 (9.2) SSI

Formulation Based on Clarke and Wells model

Intervention The intervention is an assisted self-help intervention which follows four stages: –first stage included an assessment of social anxiety, goal setting and psycho-education about social anxiety. –Stage two helped patients develop an individualised CBT formulation. Patients identified their own idiosyncratic safety behaviours. –Stage three involved repeated exposure to anxiety provoking social situations in the format of behavioural experiments –The final stage focussed on maximising patients’ gains by planning further exposure-based behavioural experiments which were done either independently by the patient or with support from the care team. Additional interventions were piloted using computerised cognitive bias modification and virtual environments.

Outcomes - SIAS Baseline SIAS scores were compared to those at the 12, 18 and 24 week follow up points. Baseline12 weeks18 weeks24 weeks Therapy60.2 (11.19)49.7 (12.23)42.9 (8.15)40.4 (10.95) Waitlist52.4 (9.19)52.1 (13.69)52.1 (12.76)50.6 (13.09)

Outcome - SIAS 12 week18 week24 week TherapyN1078 Mean change score (SD) (8.90) (4.86) (13.75) Reliable improvement (n)676 Reliable deterioration (n)000 Clinically significant reliable change (n) 214 WaitlistN1198 Mean change score (SD)-.27 (11.34)-.56 (7.45)-1.0 (10.52) Reliable improvement (n)313 Reliable deterioration (n)313 Clinically significant reliable change (n) 211

Additional pilot interventions Preliminary evidence that CBM-I sentence completion task can be used to train a more positive interpretation bias in this group. Virtual environments are being used to provide additional situations in which behavioural experiments can be conducted.

CAFÉ “sitting down waiting to order”

Conclusions Preliminary evidence that an assisted self- help intervention may help to reduce the level of social anxiety in people recovering from psychosis. Psychoeducation about social anxiety and the active engagement in behavioural experiments seems to be key.

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