Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery

Abstract

The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8-17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition.

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

“…These rates are higher than those reported by Herbert et al [10] with 26% for individual CBT, 27% for group CBT, and 17% for psychoeducational-supportive therapy in these patients. The same concerns the study by Spence et al [12], they reported that 29% dropped out in a generic CBT condition, 21% in CBT specifically tailored to SAD, and 10% in a WL condition. However, Sportel et al [13] found comparable or even higher dropout rates: 32% in the CBT group, who did not receive the allocated intervention, compared to 65% in the internet-based cognitive bias modification group, and 17% in the control group.…”

“…Importantly, several working groups already noted that longer and/or more intensive treatments (i.e., treatment dosage) than the usually examined CBT programs are needed to achieve remission in adolescent SAD [12, 39-41]. Here are some of their most relevant findings: the authors highlight the adolescents’ deficits in social skills, their strong behavioral inhibition, and a high resistance to changes in SAD.…”

“…A direct comparison with existing RCT on CBT for SAD in adolescents can best be made based on the SPAI/SPAI-C. Here, we found within-group pre-post effect sizes of d = 1.19 (CBT) and d = 1.11 (PDT) compared to d = 0.60 for individual CBT [10], d = 0.77 for a generic CBT online program [12], or d = 2.96 for individual CBT [11]. However, Ingul et al [11] only conducted a completer analysis and no ITT analysis from pre to post.…”

“…However, the moderate baseline severity also indicates the difficulties to reach adolescents with severe SAD symptoms in treatment studies where they are confronted with face-to-face contacts. Maybe online interventions [12] would be a smaller obstacle and, therefore, a useful alternative for severely impaired patients, at least at treatment initiation.…”

“…Furthermore, 2 recently conducted RCT also demonstrated the efficacy of internet-delivered CBT interventions in these patients [12, 13]. …”