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Cognitive therapy for social anxiety disorder (CT-SAD) is recommended by NICE (2013) as a first-line intervention. Take up in routine services is limited by the need for up to 14 ninety-min face-to-face sessions, some of which are out of the office. An internet-based version of the treatment (iCT-SAD) with remote therapist support may achieve similar outcomes with less therapist time.
102 patients with social anxiety disorder were randomised to iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients were randomised to the treatments after wait. Assessments were at pre-treatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12 months after treatment. The pre-registered (ISRCTN 95 458 747) primary outcome was the social anxiety disorder composite, which combines 6 independent assessor and patient self-report scales of social anxiety. Secondary outcomes included disability, general anxiety, depression and a behaviour test.
CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or follow-up. Total therapist time in iCT-SAD was 6.45 h. CT-SAD required 15.8 h for the same reduction in social anxiety. Mediation analysis indicated that change in process variables specified in cognitive models accounted for 60% of the improvements associated with either treatment. Unlike the primary outcome, there was a significant but small difference in favour of CT-SAD on the behaviour test.
When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.
Online peer support platforms have been shown to provide a supportive space that can enhance social connectedness and personal empowerment. Some studies have analysed forum messages, showing that users describe a range of advantages, and some disadvantages to their use. However, the direct examination of users’ experiences of such platforms is rare and may be particularly informative for enhancing their helpfulness. This study aimed to understand users’ experiences of the Support, Hope and Recovery Online Network (SHaRON), an online cognitive behavioural therapy-based peer support platform for adults with mild to moderate anxiety or depression. Platform users (n = 88) completed a survey on their use of different platform features, feelings about using the platform, and overall experience. Responses were analysed descriptively and using thematic analysis. Results indicated that most features were generally well used, with the exception of private messaging. Many participants described feeling well supported and finding the information and resources helpful; the majority of recent users (81%) rated it as helpful overall. However, some participants described feeling uncomfortable about posting messages, and others did not find the platform helpful and gave suggestions for improvements. Around half had not used the platform in the past 3 months, for different reasons including feeling better or forgetting about it. Some described that simply knowing it was there was helpful, even without regular use. The findings highlight what is arguably a broader range of user experiences than observed in previous studies, which may have important implications for the enhancement of SHaRON and other platforms.
Key learning aims
(1) To understand what an online peer support platform is and how this can be used to support users’ mental health.
(2) To learn how users described their experience of the SHaRON platform.
(3) To understand the benefits that online peer support may provide.
(4) To consider what users found helpful and unhelpful, and how this might inform the further development of these platforms.
This chapter opens with a summary of advice on interviewing people with intellectual disabilities. Then the need rating algorithm is provided, as it applies to CANDID-S and Section 1 of CANDID-R. Need ratings of met (M), unmet (U) and no need (N) represent a change from the numerical ratings of CANDID 1st edition. Furthermore, a set of frequently asked questions and comprehensive answers is provided. The questions are applicable to both CANDID-S and CANDID-R.
A comprehensive training programme for completing the CANDID is described. It covers both versions of CANDID and provides all training slides and notes for the trainer. Learning points covered are the background to the CAN approach, the policy background to needs assessment in intellectual disabilities services, the concept of need, research using CANDID thus far, CANDID domains, need rating (no need, met need, unmet need), CANDID rating algorithm, structure of the CANDID (including trigger questions, anchor points, perceptions of help of interventions, and the differences between staff, service user and informal carers assessment of needs. Two case vignettes are provided along with expected ratings. A role play is suggested in order to give participants the opportunity to learn, practice or consolidate needs assessment using CANDID. A discussion focusses on the rationale behind each rating,
The development and psychometric evaluation of the CANDID is reported. It was developed by modification of the Camberwell Assessment of Need (CAN). The four principles that informed the development of the CAN and the CANDID are 1. people with intellectual disabilities and mental health problems have basic needs like everybody else along with specific needs associated with their conditions
2. the primary aim is to identify rather than describe in detail each need; once a need is identified more specialist assessment can be conducted in those domains
3. needs assessment should be possible to be conducted by a wide range of people, so that it can be applied in routine clinical practice
4. there may be differences of opinion about the existence of need amongst people involved and therefore different points of view should be recorded separately.
The reliability and validity of CAN have been investigated and found to be acceptable. Research studies using CANDID are summarised here.
The policy background is provided that underpins the assessment of needs in intellectual disabilities mental health services. Developments since the publication of the 1st edition of the CANDID are provided along with an updated list of measures and instruments used to assess needs in this population.
Step by step description of using the CANDID-R as a needs assessment tool is provided. This includes suggestions on what CANDID-S can be used for (as an audit and research tool, as well as as an aid for a CANDID-S user to familiarise themselves with the approach) and who can use CANDID-R (no formal training is required and can be used by any person with experience in working with adults with intellectual disabilities and mental health problems). Then, the question of who should be interviewed is addressed, whilst highlighting the importance of assessing needs of the person from three perspectives: that of the person being assessed, their informal carer and the staff involved in their care. A description is provided as to how the instrument is used by way of a semi-structured interview using trigger questions in each domain, to initiate discussion. As with CANDID-S, a timeframe of 4 weeks is used. In addition, the rating of informal and formal help and satisfaction with the latter is described. Thus, the interview with each respondent takes typically 20–30 minutes. Finally, the approach to recording the need ratings and summary scores is descibed: one recording sheet for each interview or record ratings on CANDID-R.
The Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) is introduced. It was developed at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London in 1999, and published in book form in 2003. It was developed by modification of the Camberwell Assessment of Need (CAN), the most widely used needs assessment approach for people with severe mental health problems. In addition to CANDID, a number of other variants of CAN have been developed including needs assessment for forensic patients, for mothers and pregnant women, for older adults and for people in disaster and relief situations. In this 2nd edition, the need rating for the presence or absence of need and met or unmet needs is discussed. In addition, a need rating algorithm has been introduced. Both changes are in line with changes in the 2nd edition CAN. Moreover, the terminology in this 2nd edition has changed to reflect terminology used in contemporary intellectual disabilities services.