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

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.