Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder

Abstract

A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9-13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre-to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns. Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach.

Autonomic Dysregulation in Child Social Anxiety Disorder: An Experimental Design Using CBT Treatment

“…Previous studies have shown that CBT is indeed able to change symptoms of anxiety (Chu & Harrison, 2007 ). Most interestingly, findings from the current sample have shown a CBT induced change in social anxiety symptoms (Asbrand et al, 2020 ) and cognitions (Asbrand et al, 2019 ). However, research on effects of CBT aside from core symptoms such as anxiety or cognitions is scarce.…”

“…As the current study was part of a larger research project requiring a larger sample size of at least N = 110, all children were included to increase power. As the current study is part of a larger project of which other results have been published previously, the following method section is based on these reports (Asbrand et al, 2019 , 2020 ).…”

“…As reported previously (Asbrand et al, 2019 , 2020 ), parents of anxious and non-anxious children (9 to 13 years) were approached through advertisements in schools, medical facilities and newspaper articles in two midsized German cities from January 2012 to November 2013 until the targeted sample size had been reached (for an overview see Fig. 1 ).…”

Biased perception of physiological arousal in child social anxiety disorder before and after cognitive behavioral treatment

“…Treatment consisted of an exposure-based CBT treatment that was evaluated simultaneously (Asbrand, Heinrichs, Schmidtendorf, Nitschke, & Tuschen-Caffier, 2020 focus on exposure. Each session consisted of 100 min (including a 10-min break) in groups of five to seven children.…”

Social Anxiety Disorder: Associations with Peer-Liking, Discrimination, and Prejudicial Feelings in Early Adolescent Girls

“…According to the Statistical Manual of Mental Disorders, 5th edition (DSM-5) [ 5 ], a clinical diagnosis of social anxiety disorder (SAD), requires symptoms that cause significant distress and/or impairment to the individual affected [ 6 ]. The core symptom of SAD is a fear of being negatively evaluated by peers, that is often combined with difficulty functioning in social settings [ 7 ]. As such, the association between SAD and peer relationships has been examined in clinical [ 8 ], developmental [ 9 ], and social-cognitive psychological domains [ 10 ].…”