Internet treatment for social anxiety in IAPT (OVERCOME-SAD)
Research type
Research Study
Full title
A study of the implementation of Internet-based Cognitive Therapy for Social Anxiety Disorder within NHS Improving Access to Psychological Therapies (IAPT) services.
IRAS ID
286369
Contact name
David M Clark
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
1 years, 6 months, 16 days
Research summary
Social Anxiety Disorder is a common and disabling mental health problem. Cognitive Therapy for Social Anxiety Disorder (CT-SAD), developed by our Oxford group, is recommended by NICE (National Institute for Health and Care Excellence) as the first-line treatment for the condition, with positive findings from randomised controlled trials in the UK, Norway, Germany, Sweden, and Japan. It is the standard treatment for social anxiety disorder in NHS Improving Access to Psychological Therapies (IAPT) services and the outcomes achieved are publicly reported on a monthly and annual basis by NHS Digital.
In its usual format, CT-SAD is delivered in 90-minute in-person sessions once a week over a period of 3 months. However, in two recent studies we were able to show that an internet-based version of the therapy (iCT-SAD), which requires much less therapist time to support patients, is similarly effective. There is now strong interest in having iCT-SAD available in multiple IAPT services with patient support being provided by the therapists in those services. This interest is particularly strong given the impact of COVID-19 and the critical importance of ‘remote’ treatment options.
However, it is important to manage and monitor this implementation carefully. For the initial stage we will therefore make the programme available to a subset of services and will provide their therapists with training in how to use iCT-SAD. This study will examine whether IAPT therapists trained by our group can consistently obtain good results when using iCT-SAD, and that both patients and clinicians find the programme acceptable to use.
Approximately 40 therapists from seven IAPT services will receive a two-day training in how to support patients working through iCT-SAD. They will then treat an average of 15 patients each over the next 18 months while receiving regular clinical supervision from our research team.
Lay summary of study results: Previous research had established that internet cognitive therapy for social anxiety disorder is as effective as face-to-face delivery of the same NICE recommended first line treatment for social anxiety when both are delivered by highly trained, expert therapists (Clark et al, 2023).
The present study aimed to investigate whether similar results can be obtained when iCT-SAD is supported by NHS therapists in routine NHS Talking Therapy (NHS TT) services.
Following a training phase, 26 therapists from 6 NHS TT services offered iCT-SAD to 203 patients whose main problem was social anxiety disorder. Each service included both high intensity CBT therapists (12 in total) and Psychological Well-Being Practitioners (14 in total).
5% of patients did not log-in to the iCT-SAD programme and hence did not start treatment. Outcome data was recorded for all the remaining 193 patients. The primary outcome was recovery as defined in the standard NHS TT data specification. 61% of patients recovered, compared to 35% overall for SAD patients receiving treatment as usual in NHS TT services during the course of the study. The reliable improvement rate was 81%, compared to 67% overall for treatment as usual in NHS TT services. Outcomes were comparable to those obtained with expert therapists in our previous randomised controlled trial (Clark et al, 2023), where the recovery rate was 65%. The outcomes achieved with high intensity therapists ( 60% recovery and 84% reliable improvement) did not differ from those achieved with Psychological Well-Being Practitioners (61% recovery and 79% reliable improvement).
iCT-SAD was highly acceptable to patients as indicated by the high take-up rate, and by high scores on treatment credibility, therapeutic alliance, and patient experience.
REC name
North East - Tyne & Wear South Research Ethics Committee
REC reference
20/NE/0241
Date of REC Opinion
22 Oct 2020
REC opinion
Further Information Favourable Opinion