title: Starting to develop self-help for social anxiety associated with vitiligo: using clinical significance to measure the potential effectiveness of enhanced psychological self-help.
abstract: BACKGROUND
  Vitiligo can be associated with high levels of distress, yet there are currently no self-help interventions available.
  
  
  OBJECTIVE
  To describe the initial development of a psychosocial self-help intervention designed to reduce social anxiety associated with vitiligo. Also to examine whether including a planning exercise, aimed at increasing use of the intervention (termed implementation intentions), has the potential to achieve a clinically significant reduction in distress.
  
  
  METHODS
  Participants (n = 75) were randomized to one of three groups: cognitive behavioural self-help (CBSH), CBSH augmented with implementation intentions (CBSH+), or no intervention. Participants were assessed at baseline and after 8 weeks on measures of social anxiety, anxiety and depression, and appearance-related concern. The two intervention groups also completed a questionnaire evaluating their use of, and satisfaction with, the intervention.
  
  
  RESULTS
  High levels of social anxiety and concern over appearance were reported. Twenty-four per cent of participants in the CBSH+ group experienced clinically significant change on the measure of social anxiety compared with 8% in the CBSH group and 0% in the control group. In addition, 58% of the control group deteriorated during the study period. There were no significant differences between the conditions on the other outcome measures. Participants reported that the self-help leaflets were helpful.
  
  
  CONCLUSIONS
  The findings demonstrate that augmented CBSH provides a relatively simple and accessible intervention that can result in a clinically significant reduction in social anxiety. The augmented intervention has potential and might be further developed and evaluated in subsequent trials.
authors.affiliation: Department of Dermatology, Whipps Cross University Hospital, London, E11 1NR, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.forename: J
authors.initials: J
authors.lastname: Hunt
authors.forename: T L
authors.initials: TL
authors.lastname: Webb
authors.forename: A R
authors.initials: AR
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000209:etiology / Q000517:prevention & control*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012657:Self-Help Groups; D016896:Treatment Outcome; D014820:Vitiligo / Q000523:psychology*; D055815:Young Adult