Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial

Abstract

We designed and pilot-tested a group-based, work-related cognitive-behavioral therapy (WCBT) for unemployed individuals with social anxiety disorder (SAD). WCBT, delivered in a vocational service setting by vocational service professionals, aims to reduce social anxiety and enable individuals to seek, obtain, and retain employment. We compared WCBT to a vocational services as usual control condition (VSAU). Participants were unemployed, homeless, largely African American, vocational service-seeking adults with SAD (N=58), randomized to receive either eight sessions of WCBT plus VSAU or VSAU alone and followed three months post-treatment. Multilevel modeling revealed significantly greater reductions in social anxiety, general anxiety, depression, and functional impairment for WCBT compared to VSAU. Coefficients for job search activity and self-efficacy indicated greater increases for WCBT. Hours worked per week in the follow-up period did not differ between the groups, but small sample size and challenges associated with measuring work hours may have contributed to this finding. Overall, the results of this study suggest that unemployed persons with SAD can be effectively treated with specialized work-related CBT administered by vocational service professionals. Future testing of WCBT with a larger sample, a longer follow-up period, and adequate power to assess employment outcomes is warranted.

Effect on return to work or education of Individual Placement and Support modified for people with mood and anxiety disorders: results of a randomised clinical trial

“…Since Sherpa, who provided the IPS-MA method, already cooperated with mental health services and job centres, we chose to let Sherpa coordinate services; this deviation from IPS may have impacted our results. In accordance with our trial, the three recently published randomised trials30–32 with similar patient groups compared adjuvant occupational therapy,31 collaborative care aimed at return to work32 or work-related CBT30 with usual care and did not find enhanced clinical or vocational care separately to be superior concerning return to work 30 32. They, too, did not integrate treatment with vocational support 30–32.…”

Employment Barriers, Skills, and Aspirations Among Unemployed Job Seekers With and Without Social Anxiety Disorder

“…Unfortunately, attending school or other training programs presents a range of challenges for many persons with social anxiety (e.g., interacting with fellow students and instructors, asking questions in class, being observed while working, taking tests, giving presentations). Substantial improvement in these important domains for a socially anxious person likely requires specialized psychosocial and/or pharmacotherapies that could be provided either at a vocational service center (26) or a mental health clinic.…”

Systematic review and meta‐analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults

“…Two studies (Garland et al, ; Himle et al, ) used CBT. Garland et al () had two intervention groups, one where participants received a mindfulness‐oriented recovery enhancement program including mindfulness training, reappraisal training, training in savouring pleasant events and emotions and the other where participants received CBT.…”

“…The mindfulness‐oriented recovery enhancement program was administered by a clinical social worker and the CBT was administered by clinicians. Himle et al () also used CBT including psychoeducation for work‐related social anxiety, cognitive restructuring, exposure therapy, and social skills training. Participants received eight group sessions of 2 hr per session for 4 weeks delivered by three vocational service professionals.…”

“…Five studies reported an adequate method of blinding of participants and personnel and six studies clearly stated blinding of outcome assessors. Attrition bias was low in 13 studies for the following reasons: six studies reported results of intention‐to‐treat analyses (Chang et al, ; Garland et al, ; Guo et al, ; Krabbenborg et al, ; Reback et al, ; Shern et al, ); four studies reported that missing outcome data were unlikely to be related to true outcomes (Himle et al, ; Malte et al, ; Medalia et al, ; Salem et al, ); two studies imputed missing data using appropriate statistical methods (Lester et al, ; Toro et al, ) and missing outcome data were balanced in numbers across groups in one study (Upshur et al, ). Low risk of bias in selective reporting was observed in 11 studies, which reported all expected outcomes.…”