Background: Increasing access to treatment via smartphone apps is an important topic in Social Anxiety Disorder (SAD). ‘Challenger’ is an app promoting exposure exercises in daily life. The present study evaluated the additional benefit of using the app as adjunct to Internet-based unguided self-help for SAD. In a second step, we also tested how the app and the self-help programme (SH) should best be combined.

Method: 209 patients diagnosed with SAD were randomly allocated to three groups. Group 1 received the app and the self-help programme for six weeks (parallel treatment), group 2 first received SH for six weeks and then the app for six weeks (sequential treatment). Group 3 was a wait-list group. Comparisons were made at week 7 evaluating the potential add-on effect of the app (SH plus app versus SH only) and at week 14 comparing the parallel to the sequential treatment. Participants filled in questionnaires prior, during, and post treatment, and at 4- and 12- months follow-up.

Results: Intention-to-treat analyses showed no significant effect of adding the app to Internet-based self-help. However, among participants actively using the app, adding Challenger to self-help resulted in significantly less social anxiety (d = 0.30). At week 14, decreases in social anxiety were large for both the parallel and the sequential group with no differences between the active groups (dwithin = 1.12–1.19). Changes were maintained throughout the follow-up period.

Conclusion: Results of the current study cautiously support the notion of adding a smartphone app to unguided self-help for SAD. Future studies should investigate how patients can be motivated to use the app more frequently.

The efficacy of Internet-based treatments and bibliotherapy for Social Anxiety Disorder is well established. The next step is to evaluate smartphone supported interventions. ‘Challenger’ is a recently developed facilitating the implementation of exposure exercises in daily life. The present study evaluates the efficacy of the combination of Challenger and bibliotherapy for Social Anxiety Disorder. A total of 209 patients with Social Anxiety Disorder were randomly allocated to three groups. The first group received app and bibliotherapy for six weeks (parallel design) and the second group received first bibliotherapy for six weeks and then the app for another six weeks (sequential design). The third group was a wait-list control group. Participants filled in questionnaires on primary and secondary outcomes post treatment as well as at 4 and 12 months follow-up. Participants using both app and bibliotherapy showed somewhat larger reductions in social fears after six weeks of treatment compared to participants using only bibliotherapy (d=0.25). Decreases in social anxiety were large for both groups after 12 weeks of treatment (d= 1.11-1.20) and were maintained throughout the follow-up period. Results of the current study support the notion of adding a smartphone app to bibliotherapy for Social Anxiety Disorder. Future study should investigate the potential of the app in different treatment settings.

Hintergrund: Online-Behandlungen für soziale Angststörungen (SAS) sind bereits gut untersucht. Ein nächster Schritt ist die Erprobung von Smartphone Anwendungen. Diese bieten zahlreiche Möglichkeiten, die Umsetzung einzelner Behandlungselemente im Alltag zu vereinfachen. „Challenger“ ist eine jüngst entwickelte App, die die Durchführung von Expositionsübungen unterstützt. Spielerisch bietet sie den Nutzer*innen Übungen an, die auf die individuellen Bedürfnisse der Betroffenen, sowie auf aktuelle räumliche und situationale Merkmale abgestimmt sind. Die vorliegende Studie untersucht, welchen zusätzlichen Nutzen Challenger zur internet-basierten Behandlung sozialer Ängste beiträgt.Methode: 209 Patient*innen mit SAS wurden zufällig drei Gruppen zugeteilt. Die erste Gruppe erhielt ein unbegleitetes Selbsthilfeprogramm mit zusätzlichem Zugang zur App, die zweite Gruppe erhielt ausschließlich das Selbsthilfeprogramm und die dritte Gruppe war eine Warteliste-Kontrollgruppe. Die Teilnehmer*innen füllten vor, nach und 12 Monate nach Ende der Behandlung Fragebögen zu sozialen Ängsten und sekundären Maßen aus.Ergebnisse: Beide aktive Gruppen zeigten bedeutsame Verbesserungen der sozialen Ängste. Patient*innen, die zusätzlich mit der App trainierten, waren der aktiven Vergleichsgruppe leicht überlegen (kontrolliertes d=0,25). Die Therapieerfolge waren über 12 Monate stabil. Diskussion: Die untersuchte Kombination der Challenger App mit internet-basierter Selbsthilfe war für Patient*innen mit SAS wirksam. Da die ungeleitete App keine personellen Ressourcen fordert und gleichzeitig einen neuartigen, spielerischen Zugang zu Expositionsübungen bietet, empfiehlt sich ihre weitere Erforschung in anderen Behandlungskontexten.

Hintergrund: Die Behandlung der sozialen Angststörung (SAS) durch internetbasierte kognitive Verhaltenstherapie (iKVT) verfügt bereits über breite Evidenz. Angesichts zunehmender Fokussierung auf internetfähige mobile Endgeräte für psychologische Interventionen überrascht es daher, dass bislang keine wissenschaftlich evaluierte Smartphone-Anwendung (App) für SAS in App-Stores erhältlich ist. Wir präsentieren Ergebnisse einer ersten randomisiert-kontrollierten Evaluierung der deutschen Version von „Challenger“ – einer speziell für Menschen mit sozialen Ängsten konzipierten, frei zugänglichen App. Ergänzend zu KVT- und Achtsamkeitselementen, generiert Challenger auf User zugeschnittene „Challenges“ - Expositionsübungen, Gedanken- und Verhaltensexperimente sowie Psychoedukation. Interaktive (peer-support) und innovative (Echtzeitanpassung an User-Umwelt mittels GPS) Elemente werden durch ein auf „Gamification“-Prinzipien beruhendes Konzept miteinander verknüpft. Methode: 77 sozial ängstliche Studierende wurden zwei Gruppen (6-wöchiger Zugang zur App oder Warteliste) randomisiert zugeteilt. Daten zu Nutzungsverhalten sowie Benutzerfreundlichkeit wurden erhoben. Soziale Ängstlichkeit wurde mit dem Social Phobia Inventory gemessen, sekundäre Maße umfassten allgemeine Ängstlichkeit, depressive und globale Symptombelastung. Ergebnisse: Die Auswertung der Nutzungsdaten ergab eine klare Präferenz für nicht-konfrontative Challenges, die ohne Beteiligung Dritter absolviert werden konnten. Zufriedenheits- und Benutzerfreundlichkeitsratings der App fielen gemischt aus. Analysen der Completer-Stichprobe zeigten eine signifikante Reduktion sozialer Ängste (Effektstärke PRÄ-POST innerhalb der Interventionsgruppe: d = - 0.94; zwischen Gruppen: d = 0.61), jedoch nicht-signifikante Verbesserungen auf sekundären Ergebnismaßen. Analysen nach Multipler Imputation fehlender Werte ergaben keine signifikanten Unterschiede. Diskussion: Zukünftige Herausforderungen in der Weiterentwicklung der App bestehen in einer Erhöhung der Nutzungsintensität wirksamer Elemente. Aufgrund des hohen Dropouts und Besonderheiten von Studiendesign und Stichprobe, erscheinen endgültige Schlüsse hinsichtlich der Wirksamkeit von Challenger verfrüht.

Social anxiety disorder (SAD) is a common debilitating mental illness with large negative effects on quality of life and economic productivity. Modern psychotherapy treatments utilizing cognitive–behavioral theory are increasingly delivered over the Internet and more recently using smartphone applications. The Challenger App written natively for the Apple iPhone was developed at the Stockholm University Department of Psychology for the treatment of SAD and uses a number of advanced features not previously seen in past mental health applications; these include real-time location awareness, notifications, anonymous social interaction between users, a high-degree of personalization and use of gamification techniques. This paper explores design considerations for the various components of the app, their theoretical and evidence base, and research opportunities that exist for apps making use of these novel features.

Background: Randomized controlled trials have yielded promising results for internet-delivered cognitive behavior therapy (iCBT) for patients with social anxiety disorder (SAD). Smartphone assisted treatment is potentially cost effective and could also bring the treatment closer to the patient’s real life environment than desktop application delivered iCBT.

The newly developed smartphone application “Challenger” is generating exercises that are customized to the user’s environment, involving places and people in their vicinity. Based on what skills the user wants to improve, appropriate challenges are randomly selected and created by the app. The user can follow their progress and history on a board game, where they move forward for each challenge they complete. They can also fill their own board with rewards that they find appealing and motivating. After a challenge completion, the user is prompted to write a note reflecting on the experience and to report their anxiety level during the challenge. If the user so chooses, the note can then be sent anonymously, much like a message in a bottle, to another randomly selected user to provide supportive feedback. That feedback is sent back to the challangee which can then choose to “like”, be indifferent to, or dislike (report abuse) the feedback.In summary, “Challenger” generates customized behavioral experiments, as well as exposure exercises that are performed in the patients vicinity and provides the means to reflect on the experience and to receive anonymous social community support.

Objective: The present study aims to evaluate the feasibility and acceptance of the newly developed smartphone application “Challenger” for treating social anxiety disorder (SAD) and to report on the preliminary data regarding how the anonymous social community support function is being used. It also aims to assess significant changes in the self-reported social anxiety symptoms and ecological momentary assessments over time.

Methods: A set of valid and commonly used questionnaires were used in the study. Level of social anxiety symptoms was assessed using MINI-SPIN every other day. In addition, once a week PHQ9 and GAD7 were administered in the smartphone application in order to get a general level of depression and anxiety respectively.

Result: At the present date 92 participants have enrolled in the treatment program. The MINI-SPIN scores (M=6.75, SD=3.62) indicate that this is a sample of participants with primarily social anxiety problems. The PHQ9 (n=85, M=3.38, SD=2.43) and GAD-7 (n=84, M=4.07, SD=2.60) scores suggests that the group is well-functioning with low levels of depression and general anxiety. Concerning the social feedback system we can report that 62% (n=161) of the notes being sent have been liked. About 10% has received the opinion “indifferent”, while 13% were given feedback but not yet rated. 15% was not given feedback yet and 0 comments has been reported as abusive.

Conclusions: Preliminary results indicate that using Challenger could decrease social anxiety and depressive symptoms, but data collection is still at an early stage and we will know much more at the time of the conference.

Challenger, a newly developed smartphone application from Stockholm University, provides users with customized challenges. Based on the goals the user chooses, and the answers to questions regarding that goal, an appropriate challenge is created by the app. The user can follow their progress and history on a board game, where they move forward for each challenge they complete. They can also fill their own board with rewards that they find appealing and motivating. After a challenge completion, the user is prompted to write a note reflecting on the experience, and to report their anxiety level during the challenge. If the user so chooses, the note can then be sent anonymously, much like a message in a bottle, to another randomly selected user to provide supportive feedback. That feedback is sent back to the challangee which can then choose to "like", be indifferent to, or dislike (report abuse) the feedback. 

In summary, "Challenger" generates customized behavioral experiments, and exposure exercises which are performed in the patients vicinity, and provides the means to reflect on the experience and to also receive anonymous social community support. 

A set of valid and commonly used questionnaires were used in the study. Level of social anxiety symptoms was assessed using MINI-SPIN every other day. In addition, once a week PHQ9 and GAD7 were administered in the smartphone application in order to get a general level of depression and anxiety respectively. 

Preliminary results indicate that using Challenger decreases social anxiety and depressive symptoms, but data collection is still at an early stage, and we will know much more at the time of the conference. The app can be found at www.mobilKBT.se