Mediators and moderators of treatment effects in social anxiety disorder and post-traumatic stress disorder.

Anxiety Disorder PhD Scholarship 2016: Department of Experimental Psychology, University of Oxford

Supervisor: Professor Anke Ehlers

Summary:
Cognitive-behaviour therapies are effective in anxiety disorders. Less is known about why these treatments work and who responds to them. The project will investigate these questions in two common and disabling conditions, posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD). The supervisor's team have developed highly effective cognitive therapy programmes for these conditions. More recently, they have developed therapist-assisted internet-based versions of these treatments that allow very precise investigation of the relationship between patient and therapist behaviours and symptom changes.

In investigate how the treatments work, the project will closely monitor changes in variables that are thought to drive symptom change according to cognitive theories of SAD and PTSD (such as negative beliefs, patterns of attention and memory, and behavioural and cognitive responses to threat), as well as changes in symptom severity and the therapeutic relationship. Statistical analyses will identify which changes in cognitive and behavioural variables lead to subsequent clinical improvement. Furthermore, the internet-based programmes automatically record variables of interest that characterise patients’ behaviour in a more detailed way than previously possible in face-to-face therapy. This will allow us to study in detail which components of the treatments are linked to substantial improvement.

The project will also test whether there are patient characteristics that predict poorer treatment response such as gender, concurrent depression, educational background, and type of social fear/ trauma.

The results of the project will help improve the treatments further and help identify people who may benefit from adaptations of the treatment programmes or additional interventions.

Research Student: Milan Wiedemann
Hi, my name is Milan.  My DPhil is due to start in October 2016 at the Oxford Centre for Anxiety Disorders and Trauma, University of Oxford. 

I'm delighted to have been awarded this studentship by MHRUK and to be given this great opportunity to develop my research skills and clinical knowledge. My work will focus on the mechanisms for therapeutic change and recovery in cognitive therapy for two common mental health problems. Understanding the ways in which targeted treatments work will allow us to enhance and refine their therapeutic utility. 

I will be supervised by Professor Anke Ehlers and Professor David M Clark, whose research has not only influenced our understanding of how anxiety disorders emerge and are maintained but also, how we use psychological therapies to effectively treat these conditions. 

My project aims to investigate mechanisms of treatment effects in cognitive therapy for SAD and PTSD. In particular, how we achieve good therapeutic outcome when a highly successful treatment program for PTSD is delivered via the internet rather than face to face. I’m looking forward to this next step in my career and all the valuable experiences and challenges it will bring.

Start Date: September 2016

Scientific goal: 
Mediators and moderators of treatment effects in social anxiety disorder and post-traumatic stress disorder.

2017 Report

I am trying to understand more about how patients who receive cognitive therapy for posttraumatic stress disorder (PTSD) get better by looking at the change processes during therapy. Specifically, I am looking at how change in symptoms occur and how certain patient characteristics might predict treatment outcome. These factors will be important in order to test whether the treatment works for the reasons suggested by the underpinning cognitive model.

During my first year I focussed on analysing sudden gains in cognitive therapy for PTSD. Sudden gains are sudden and drastic improvements in symptoms experienced by patients in between-session intervals. My findings show that patients with sudden gains do better in treatment overall compared to patients who did not experience a sudden gain. Further analyses will test whether cognitive changes and changes in depression symptoms help to understand the occurrence of these sudden gains. I will also look at session notes and treatment videos to see if specific therapeutic techniques lead to sudden gains.

To complement self-ratings from patients, I am using voice stress analysis to measure changes in emotional arousal during therapy sessions. So far I have been training in the analysis and ideas behind this relatively new approach in psychotherapy research.

In my next year I will finish my sudden gains analyses and start looking in more detail at the mechanisms of change in cognitive therapy for PTSD using structural equation modeling approaches.