This single-cohort pilot study measured social anxiety symptoms weekly using the self-reported Liebowitz Social Anxiety Scale (LSAS) [7].

iCT-SAD includes core modules on key SAD treatment principles and a range of optional modules for tailoring treatment to patients’ specific concerns [2,3]. Support is provided via telephone, messaging, and SMS texts. Four calls are scheduled over the first 2 weeks, then weekly thereafter until week 14. Three monthly booster calls are then scheduled to monitor and consolidate progress. Behavioral experiments, constituting practical exercises to test fearful beliefs in anxiety-provoking situations [8], are used throughout treatment. The English-language program was translated into Chinese following a similar process for a Japanese translation [9].

We significantly modified 3 of 27 iCT-SAD modules for coach support by replacing or removing elements requiring expert therapist support. Typically, therapists support patients in completing exercises speaking to a stranger via webcam, demonstrating experientially the disadvantages of self-focused attention and safety behaviors [10], with subsequent video feedback [11]. These two modules were replaced with a demonstration video and guidance on implementing this experiment independently. The module addressing past socially traumatic memories was edited to focus solely on stimulus discrimination, removing imagery rescripting, which typically requires closer therapist guidance. We added new videos (reducing safety behaviors, generating experiment ideas, behavioral experiment tips) and made minor text changes to reflect the coach role (removing mention of the therapist administering surveys, which was not within the coach role). The frequency and length of coach phone calls were identical to therapist calls in previous studies.

Five psychology graduates with no professional qualifications in mental health care (2 female, 3 male; mean age 25.0, SD 1.22 years) were recruited as coaches. Training consisted of a 1-day in-person workshop, followed by two 2-hour online training sessions given by GRT. These were adapted from previous iCT-SAD training [4] and covered key principles of SAD and cognitive therapy, the treatment procedure, the website, and patient communication methods. The training summarized each module, focusing on how coaches support patients within their role. It emphasized taking queries to their supervisor and fidelity to the treatment content and training.

Coaches then received weekly group supervision with CLYMP (a clinical psychologist) as they saw initial cases. Each saw 2 to 3 cases between September 2023 and July 2024.

Twelve participants received treatment (10 female, 2 male; mean age 26.3, SD 4.1 years). All were referred from clinical services and experienced SAD as their main concern, confirmed at assessment by a clinical psychologist. All had sufficient literacy, time, and technology to undertake treatment.

The Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee approved this study (2022.086-T). All participants provided informed consent, which included anonymized reporting of outcomes.