Development of a graphic medicine-enabled social media-based intervention for youth social anxiety

ABSTRACT

Objective

The objective of the Entourage project was to develop an innovative digital mental health intervention addressing key barriers experienced by young people in accessing evidence‐based therapy for social anxiety. In particular, Entourage takes a specific focus on reaching young men, given their lower rates of service engagement.

Method

This article discusses the theoretical underpinnings, therapeutic mechanisms, persuasive technology elements, and development process of a novel approach incorporating graphic medicine, clinical and peer support, and social networking.

Results

Based on an integrated cognitive model of social anxiety disorder and consistent with the principles of cognitive behavioural therapy (CBT), a novel digital intervention for social anxiety was developed (Entourage). Using the moderated online social therapy (MOST) model, Entourage provides young people with a digital strengths‐based platform to overcome social anxiety symptoms. Designed in close partnership with young people with a lived experience of mental ill‐health, and overseen by a steering group of young men, Entourage applies graphic medicine through bespoke therapy comics to help users understand and overcome symptoms. Program e‐mentors (expert clinicians and trained peer workers) work in tandem to maintain engagement, support participant skill acquisition, and promote opportunities for social connectedness. Behavioural experiments and in‐vivo exposure activities facilitate restructuring of maladaptive social anxiety‐focussed cognitions.

Conclusions

Entourage represents an innovative approach to managing social anxiety in young people. Intervention elements seek to ensure longer‐term engagement of users, in particular young men, who have unmet service needs. Results of a single‐group clinical trial of Entourage are forthcoming.

KEY POINTS

(1) Young people experiencing problematic levels of social anxiety also face a range of barriers in accessing traditional face‐to‐face therapy, particularly as the nature of the disorder involves avoidance of interpersonal interaction.

(2) Digital interventions applying CBT for social anxiety have shown promise, however new approaches are needed that provide therapeutic content alongside opportunities for behavioural application of therapy.

(3) Entourage represents an innovative application of an integrated cognitive model of social anxiety. Combined with strengths based approaches to accessible online treatment for young people, it involves graphic medicine, clinical and peer support, and social networking.

KEYWORDS:

• Cognitive behaviour therapy
• graphic medicine
• online psychosocial interventions
• peer support
• social anxiety

Acknowledgements

The study was funded by a grant from Movember and Beyond Blue. Mario Álvarez‐Jiménez is supported by a Career Development Fellowship (APP1082934) from the National Health and Medical Research Council. Carla McEnery is funded by an Australian Government Research Training Program Scholarship. Simon Rice is supported by a Career Development Fellowship (APP115888) from the National Health and Medical Research Council. Lee Valentine is supported by the Mental Illness Research Fund from the State Government of Victoria.

Conflict of interest

None.

Data availability statement

No original data are available.

Additional information

Funding

beyondblue; Movember Foundation; Mental Illness Research Fund from the State Government of Victoria; Australian Government Research Training Program Scholarship; National Health and Medical Research Council; Career Development Fellowship, Grant/Award Numbers: APP115888, APP1082934.