Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19

Abstract

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.

Effects of mask-wearing on social anxiety: an exploratory review

“…However, recent self-report surveys have suggested that the COVID-19 pandemic has increased people's levels of SA and fears of negative evaluation overall, even despite the increases in physical distancing (Hawes et al, 2021;Ho & Moscovitch, 2021). In line with previous recommendations for continued exposure exercises to mitigate SA during the coronavirus pandemic (e.g., Khan et al, 2021), clinicians should encourage clients with SAD to work hard to confront their fears by adopting creative methods of exposure via video-chat platforms and in-person social interactions that can be conducted safely and in compliance with COVID-related restrictions (see Warnock-Parkes et al, 2020).…”

“…For example, many have cautioned about the potentially deleterious effects that preventative measures such as social distancing can have on interpersonal connection, sense of cohesion, and mental health generally (e.g., Sikali, 2020). In their review of the potential effects of coronavirus lockdown measures on youth with SA, Khan et al (2021) suggest that coronavirus-related restrictions on socialization might initially reduce SA but, left untreated, have the potential to increase SA in the long run. They aptly note that social distancing precautions necessarily limit opportunities for exposure exercises for people with SA to face their fears by engaging in social interaction, thereby learning that such fears are often exaggerated.…”

Brief, parent-led, transdiagnostic cognitive-behavioral teletherapy for youth with emotional problems related to the COVID-19 pandemic

“…This has challenged cognitive-behavioral therapists to think creatively about designing exercises that will promote corrective learning during exposure or contact with positive reinforcers during behavioral activation. For example, parents in the Coping with COVID Program may have coached their children in showing their face or speaking during virtual school or walk around their neighborhood wearing something “embarrassing” for social exposures ( Khan et al, 2021 ), or identified contamination-based exposures to challenge behaviors that go far beyond public health recommendations and/or target non-COVID-19-related fears ( Palo and D'Souza, 2021 ). While youth are more isolated than they were before the pandemic, parents were still encouraged to maintain social contact with peers through outdoor, socially distant gatherings with friends, arranging time with extended family, or finding “quarantine pods.” Indeed, loneliness was the most frequently cited COVID-19-related problem for youth in this sample, underscoring the importance of thinking creatively about socially focused behavioral activation during the pandemic.…”

Descriptive review of internet-based cognitive behavior therapy on anxiety-related problems in children under the circumstances of COVID-19

“…Additionally, in the case of ICBT through the Internet, it is also necessary to confirm in advance the emergency measures to be taken in case of sudden physical or mental disorders. In addition, one review discusses the application of SAD exposure for youth in teletherapy [ 31 ]. In this review, they argued that managing their embarrassment, leaning into the challenges, and creatively identifying unique and relevant exposures that elicit the same core fears as the more “tried and-true” social exposures, are essential skills to the successful treatment of social anxiety in youth.…”