Most people have feelings of shyness or nervousness in social situations. Many feel apprehensive before oral exams, feel shy and tongue-tied on a first date, or are nervous when asking their supervisor for a raise. They feel anxious because the outcome of these situations is important to them, to their academic or occupational career, to their relationships, or to their image of themselves.
However, individuals differ in their degree of shyness. Some people feel self-confident and optimistic in most social situations, whereas others experience intense anxiety in almost all social encounters. For those, social anxiety becomes a massive burden and can lead to major impairments in their lives.
Social Anxiety Disorder (SAD) is characterized by an intense fear of embarrassment and humiliation in social situations. Individuals with SAD are afraid of the judgment and critique of others and avoid relevant situations. Social Anxiety Disorder is one of the most common mental disorders. Data from the U.S. show that up to 12% of the population are afflicted by symptoms of SAD.
There are effective treatments for SAD, with psychotherapy and Cognitive Behavior Therapy, in particular, being the top treatments of choice. However, many individuals with SAD do not enroll in treatment. Among others, the fear of negative judgment is one important barrier for seeking help. How do we overcome this barrier? In the current study, we tested whether using an app may help patients to feel more confident in social situations. The app is called Challenger and it invites users to challenge their social fears. The app is constructed like a game and users progress on a game board (see picture one).
Credit: Johanna Böttcher
Within the app, users can choose among a list of skills that they would like to practice. For example, one may choose to practice “talking to strangers” or “being assertive” or “speaking in public.” Users can define their individual level for a skill and choose people with whom and locations where they want to practice. The app then suggests challenges, starting with more easy tasks and gradually moving up to tasks that are more difficult. The app also uses GPS to tailor challenges to the users’ surroundings. For example, for the skill “talking to strangers,” the app may suggest: “Go to the [near to your place] park and say hello to one of the people taking out their dogs. Ask him/her what kind of a dog it is.”
Users can receive positive feedback for their challenges from other users in the form of a “message in a bottle” (see picture 2). In “parachute packages,” users receive important information on how to practice certain skills (see picture 2).
Credit: Johanna Böttcher
In our study, patients with Social Anxiety Disorder used the app in addition to an online self-help program. Our results showed that working with the app and receiving additional information and exercises within the online self-help program led to good benefits for the patients. Through our study, we learned two things. First, our app works. People like it and use it. But we also learned that conducting difficult challenges on your own is hard. Many users did not complete as many challenges as we would have wanted.
This was the first study on this app, and there are still many things that we do not know. We do not know how patients would fare if they only used the app. We studied the app in combination with an online self-help program. Also, we do not know whether the app can help people with “mild” symptoms of social anxiety. We only tested it with patients diagnosed with SAD.
Using smartphone apps in the treatment of mental health problems is a promising new field of research. Already, there is a wealth of mental health apps available in app stores. However, the large majority of these apps have not been tested in a scientific study. With our study, we provided some evidence for the potential benefit of using apps for mental health problems.
The Challenger app is currently not available in the AppStore. For inquiries regarding the app, please contact its developer Arvid Marklund (arvid@arvidmarklund.com).
These findings are described in the article entitled Adding smartphone app to internet-based self-help for social anxiety: A randomized controlled trial, recently published in the journal Computers in Human Behavior. This work was conducted by Johanna Boettcher and Daniel Sommer from the Freie Universitaet Berlin, Kristoffer Magnusson from the Karolinska Institutet, Arvid Marklund, Ellinor Berglund, Rikard Blomdahl, Ulrike Braun, Charlotte Lundén, and Kaspar von Weber from Stockholm University, Lovisa Delin and Katja Sjöblom from Uppsala University, Gerhard Andersson from the Karolinska Institutet and Linköping University, and Per Carlbring from Stockholm University and the University of Southern Denmark.