Study rational Social anxiety disorder (SAD) is one of the most prevalent anxiety
disorders, with lifetime and past-year prevalence estimates reaching 12% and 7% in
Canada. In the absence of treatment SAD is a chronic disorder with significant impairment
in functioning associated with reduced school performance, loss of productivity, and
decreased quality of life. During COVID-19, studies highlight increased mental health
needs, but barriers to mental health service access due inpart to limited resources
available. Viable therapy options for the treatment of SAD include CBT being delivered
virtually, with effectiveness being shown in youth and adults. The Clinical Research Unit
for Anxiety and Depression (CRUfAD) in Australia has developed, implemented, and
demonstrated the effectiveness of an innovative guided and unguided internet delivered
cognitive-behavioural therapy (iCBT) program for social anxiety. To make available
high-quality and real-time evidence in response to the current COVID-19 mental health
crisis and crucially needed access to psychological services to meet population mental
health needs including for high risk populations (including individuals with pre-existing
psychiatric conditions, youth and young adults, self identifying as belonging to a
visible minority group (including from linguistic minority groups), we propose to conduct
a Canadian adaptation of Australia's Shyness Program and to examine the adapted program's
effectiveness, and implementation in two Canadian provinces (Quebec and Ontario).
Objectives
- to translate and adapt iCBT Shyness Program to the Canadian context; 2) to examine
the completion and effectiveness of the Canadian-adapted, including the French
translated and English iCBT Shyness Program, in improving SAD symptoms; 3) to
explore barriers and facilitating factors to the program's implementation.
Methods
The overall study design is a hybrid effectiveness-implementation study of a
quasi-experimental parallel group trial reflecting real world pathways (recommended and
self-referrals). The project will be conducted in two Canadian provinces: Quebec
(Montérégie) and Ontario.
To build on the current knowledge regarding the effectiveness of guided and unguided iCBT
for SAD and inform on generalizability, we will evaluate the outcomes associated with the
implementation of the program in a three-pathway parallel trial. The iCBT Shyness Program
includes six online lessons based on CBT strategies with homework assignments to be
completed within 90 days. The study will be carried out in Quebec and Ontario.
Phase 1:
Prior to implementing the iCBT Shyness Program, it will undergo an initial adaptation to
the Canadian context. Focus groups in each province will be conducted with key actor
groups (patients-partners, community leaders, service providers, i.e.,
consultant-partners to the research team) to discuss the adaptations to the graphics,
narration of the modules, and this to better reflect varying sociocultural context (e.g.,
socioeconomically disadvantaged environment; cultural backgrounds) among Canadian French-
and English-speaking populations.
Phase 2:
Then, individuals with social anxiety will either: 1) self-refer to the adapted
intervention (self referral, undirected iCBT); 2) be recommended the adapted intervention
by a registered health professional and will complete the program without guidance
(recommended, undirected iCBT); or 3) be recommended the adapted intervention by a
registered health professional, with low intensity guidance throughout the program
(recommended, directed iCBT). The program will be implemented via the virtual clinic at
Université de Sherbrooke (www.equilia.ca), as we have acquired and implemented a license
for the virtual clinic in Canada. Data collection will be integrated into the virtual
clinic web platform and the REDCap platform and carried out at baseline, at the beginning
of each lesson, 12-week and 6-month follow-up. Individual-level outcomes measured will
include anxiety and depressive symptoms, psychological distress, disability,
health-related quality of life as well as health service utilization and satisfaction.
Phase 3:
As a last step to this trial, semi-structured interviews will be conducted with study
participants and health care providers to explore facilitating factors and barriers to
the implementation of the iCBT adapted program, and this to inform implementation
strategies for wider use across Canada.
Anticipated results
This study will provide evidence on the effectiveness, barriers and facilitating factors
to implementing a low-intensity iCBT in the Canadian context for SAD, which will bridge
an important care gap for undeserved populations in Canada with SAD. Findings will inform
the eventual scaling up of the program in community-based primary health care across
Canada. This would improve equity of the health care system by helping a large number of
Canadians including those from visible, socio-cultural, and linguistic minority groups
timely access to mental health services post-pandemic.