A disorder-specific group cognitive behavior therapy for social anxiety disorder in adolescents: study protocol for a randomized controlled study

Nanna Fensman Lassen, Esben Hougaard, Kristian Bech Arendt, Mikael Thastum, Nanna Fensman Lassen, Esben Hougaard, Kristian Bech Arendt, Mikael Thastum

Abstract

Background: Social anxiety disorder (SAD) is a common disorder in adolescence associated with extensive distress and long-term impairment. Generic cognitive behavior therapy (CBT) programs for anxiety disorders have shown poorer outcomes for adolescents with SAD than for other anxiety disorders.

Aim: The aim of the present study is to investigate the efficacy of a disorder-specific group cognitive behavior therapy (G-CBT) program for youth SAD, the Cool Kids Anxiety Program - Social Enhanced (CK-E), developed at Macquarie University, Sidney, Australia.

Methods: The study is a randomized controlled trial comparing CK-E to a generic G-CBT program for anxiety disorders. Approximately 96 adolescents aged 12 to 17 years are included with data points at pre- and post-treatment, and at 3 months and 1 year follow-ups.

Discussion: The current study will provide more information about the efficacy of diagnosis-specific G-CBT treatment for youth SAD.

Trial registration: ClinicalTrials.gov, NCT03986827. Registered on 14 June 2019.

Keywords: Adolescents; Anxiety; Cognitive behavior therapy; Randomized controlled trial; Social anxiety disorder.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study design
Fig. 2
Fig. 2
SPIRIT diagram showing schedule of enrollment, allocation, interventions, and assessments. –t1 = baseline assessment (before randomization), 0 (t0) = randomization, t1 = after randomization, t2 = during intervention, t3 = post-assessment, t4 = 3 months follow-up, t5 = 1 year follow-up. aOnly the mini-SPIN was administered at sessions 1, 4, 7, and 10. The full SPIN was rated by youth pre- and post-assessment, and at 3 months and 1 year follow-ups. bCEQ is completed after session 1

References

    1. Abbott MJ, Rapee RM. Post-event rumination and negative self-appraisal in social phobia before and after treatment. J Abnorm Psychol. 2004;113(1):136–144. doi: 10.1037/0021-843x.113.1.136.
    1. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176–181. doi: 10.1037/1040-3590.10.2.176.
    1. Antony MM, Coons MJ, McCabe RE, Ashbaugh A, Swinson RP. Psychometric properties of the social phobia inventory: further evaluation. Behav Res Ther. 2006;44(8):1177–1185. doi: 10.1016/j.brat.2005.08.013.
    1. Arendt Kristian, Hougaard Esben, Thastum Mikael. Psychometric properties of the child and parent versions of Spence Children's Anxiety Scale in a Danish community and clinical sample. Journal of Anxiety Disorders. 2014;28(8):947–956. doi: 10.1016/j.janxdis.2014.09.021.
    1. Arendt K., Thastum M., Hougaard E. Efficacy of a Danish version of the Cool Kids program: a randomized wait-list controlled trial. Acta Psychiatrica Scandinavica. 2015;133(2):109–121. doi: 10.1111/acps.12448.
    1. Attride-Stirling J. Development of methods to capture users’ views of child and adolescent mental health services in clinical governance reviews [updated 2002]. . Accessed on 1 Sep 2018.
    1. Beesdo-Baum K, Knappe S, Fehm L, Hofler M, Lieb R, Hofmann SG, Wittchen HU. The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatr Scand. 2012;126(6):411–425. doi: 10.1111/j.1600-0447.2012.01886.x.
    1. Beesdo K, Bittner A, Pine DS, Stein MB, Höfler M, Lieb R, Wittchen H-U. Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry. 2007;64(8):903–912. doi: 10.1001/archpsyc.64.8.903.
    1. Beidel DC, Turner SM, Morris TL. Behavioral treatment of childhood social phobia. J Consult Clin Psychol. 2000;68(6):1072–1080. doi: 10.1037/0022-006X.68.6.1072.
    1. Burstein M, He JP, Kattan G, Albano AM, Avenevoli S, Merikangas KR. Social phobia and subtypes in the national comorbidity survey-adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry. 2011;50(9):870–880. doi: 10.1016/j.jaac.2011.06.005.
    1. Canaway AG, Frew EJ. Measuring preference-based quality of life in children aged 6–7 years: a comparison of the performance of the CHU-9D and EQ-5D-Y—the WAVES pilot study. Qual Life Res. 2013;22(1):173–183. doi: 10.1007/s11136-012-0119-5.
    1. Canino G, Shrout PE, Rubio-Stipec M, Bird HR, Bravo M, Ramírez R, et al. The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Arch Gen Psychiatry. 2004;61(1):85–93. doi: 10.1001/archpsyc.61.1.85.
    1. Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg R, Liebowitz M, Hope DA, Schneier FR, editors. Social phobia: diagnosis, assessment and treatment. New York: Guilford Press; 1995.
    1. Connor KM, Davidson JR, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. Br J Psychiatry. 2000;176:379–386. doi: 10.1192/bjp.176.4.379.
    1. Connor KM, Kobak KA, Churchill LE, Katzelnick D, Davidson JR. Mini-SPIN: a brief screening assessment for generalized social anxiety disorder. Depress Anxiety. 2001;14(2):137–140. doi: 10.1002/da.1055.
    1. Costello EJ, Egger HL, Angold A. The developmental epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2005;14(4):631–648. doi: 10.1016/j.chc.2005.06.003.
    1. Cuming S, Rapee RM, Kemp N, Abbott MJ, Peters L, Gaston JE. A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: development and psychometric properties. J Anxiety Disord. 2009;23(7):879–883. doi: 10.1016/j.janxdis.2009.05.002.
    1. Curran PJ, Bauer DJ. The disaggregation of within-person and between-person effects in longitudinal models of change. Annu Rev Psychol. 2011;62:583–619. doi: 10.1146/annurev.psych.093008.100356.
    1. Daviss WB, Birmaher B, Melhem NA, Axelson DA, Michaels SM, Brent DA. Criterion validity of the Mood and Feelings Questionnaire for depressive episodes in clinic and non-clinic subjects. J Child Psychol Psychiatry. 2006;47(9):927–934. doi: 10.1111/j.1469-7610.2006.01646.x.
    1. Devilly GJ, Borkovec TD. Psychometric properties of the Credibility/Expectancy Questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Edwards SL, Rapee RM, Franklin J. Postevent rumination and recall bias for a social performance event in high and low socially anxious individuals. Cogn Ther Res. 2003;27(6):603–617. doi: 10.1023/a:1026395526858.
    1. Eg J, Bilenberg N, Costello EJ, Wesselhoeft R. Self- and parent-reported depressive symptoms rated by the Mood and Feelings Questionnaire. Psychiatry Res. 2018;268:419–425. doi: 10.1016/j.psychres.2018.07.016.
    1. Furber G, Segal L. The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services. Health Qual Life Outcomes. 2015;13:22. doi: 10.1186/s12955-015-0218-4.
    1. Hayward C, Varady S, Albano AM, Thienemann M, Henderson L, Schatzberg AF. Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study. J Am Acad Child Adolesc Psychiatry. 2000;39(6):721–726. doi: 10.1097/00004583-200006000-00010.
    1. Herbert JD, Gaudiano BA, Rheingold AA, Moitra E, Myers VH, Dalrymple KL, Brandsma LL. Cognitive behavior therapy for generalized social anxiety disorder in adolescents: a randomized controlled trial. J Anxiety Disord. 2009;23(2):167–177. doi: 10.1016/j.janxdis.2008.06.004.
    1. Hudson JL, Keers R, Roberts S, Coleman JR, Breen G, Arendt K, et al. Clinical predictors of response to cognitive-behavioral therapy in pediatric anxiety disorders: the Genes for Treatment (GxT) study. J Am Acad Child Adolesc Psychiatry. 2015;54(6):454–463. doi: 10.1016/j.jaac.2015.03.018.
    1. Ingul JM, Aune T, Nordahl HM. A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. Psychother Psychosom. 2014;83(1):54–61. doi: 10.1159/000354672.
    1. James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2013;6:CD004690. doi: 10.1002/14651858.CD004690.pub3.
    1. Kessler RC, Avenevoli S, Costello EJ, Georgiades K, Green JG, Gruber MJ, et al. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent SupplementPrevalence of DSM-IV Disorders in the NCS-A. Arch Gen Psychiatry. 2012;69(4):372–380. doi: 10.1001/archgenpsychiatry.2011.160.
    1. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry. 2003;60(7):709–717. doi: 10.1001/archpsyc.60.7.709.
    1. Kodal A, Fjermestad K, Bjelland I, Gjestad R, Ost LG, Bjaastad JF, et al. Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. J Anxiety Disord. 2018;53:58–67. doi: 10.1016/j.janxdis.2017.11.003.
    1. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation of Australia; 1995.
    1. Lundkvist-Houndoumadi I, Thastum M. Anxious children and adolescents non-responding to CBT: clinical predictors and families' experiences of therapy. Clin Psychol Psychother. 2017;24(1):82–93. doi: 10.1002/cpp.1982.
    1. Lyneham HJ, Sburlati ES, Abbott MJ, Rapee RM, Hudson JL, Tolin DF, Carlson SE. Psychometric properties of the Child Anxiety Life Interference Scale (CALIS) J Anxiety Disord. 2013;27(7):711–719. doi: 10.1016/j.janxdis.2013.09.008.
    1. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002;7(1):83–104. doi: 10.1037/1082-989X.7.1.83.
    1. Mayo-Wilson E. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2014;1(5):368–376. doi: 10.1016/S2215-0366(14)70329-3.
    1. Melfsen S, Kuhnemund M, Schwieger J, Warnke A, Stadler C, Poustka F, Stangier U. Cognitive behavioral therapy of socially phobic children focusing on cognition: a randomised wait-list control study. Child Adolesc Psychiatry Ment Health. 2011;5(1):5. doi: 10.1186/1753-2000-5-5.
    1. Micco JA, Ehrenreich JT. Validity and specificity of the Children’s Automatic Thoughts Scale in clinically anxious and non-clinical children. Cogn Ther Res. 2009;33(5):532–536. doi: 10.1007/s10608-009-9230-5.
    1. National Institute for Health and Care Excellence (NICE) Social anxiety disorder: recognition, assessment and treatment. London: NICE; 2013.
    1. Perini SJ, Abbott MJ, Rapee RM. Perception of performance as a mediator in the relationship between social anxiety and negative post-event rumination. Cogn Ther Res. 2006;30(5):645–659. doi: 10.1007/s10608-006-9023-z.
    1. Ranta K, Kaltiala-Heino R, Koivisto AM, Tuomisto MT, Pelkonen M, Marttunen M. Age and gender differences in social anxiety symptoms during adolescence: the Social Phobia Inventory (SPIN) as a measure. Psychiatry Res. 2007;153(3):261–270. doi: 10.1016/j.psychres.2006.12.006.
    1. Ranta K, Kaltiala-Heino R, Rantanen P, Marttunen M. The Mini-Social Phobia Inventory: psychometric properties in an adolescent general population sample. Compr Psychiatry. 2012;53(5):630–637. doi: 10.1016/j.comppsych.2011.07.007.
    1. Ranta K, Kaltiala-Heino R, Rantanen P, Tuomisto MT, Marttunen M. Screening social phobia in adolescents from general population: the validity of the Social Phobia Inventory (SPIN) against a clinical interview. Eur Psychiatry. 2007;22(4):244–251. doi: 10.1016/j.eurpsy.2006.12.002.
    1. Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741–756. doi: 10.1016/s0005-7967(97)00022-3.
    1. Rapee RM, Lyneham HJ, Schniering C, Wuthrich V, Abbott M, Hudson J, et al. The cool kids child and adolescents anxiety program - therapist manual. Sydney: Centre for Emotional Health, Macquarie University; 2006.
    1. Reynolds S, Wilson C, Austin J, Hooper L. Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2012;32(4):251–262. doi: 10.1016/j.cpr.2012.01.005.
    1. Roza SJ. Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood. Am J Psychiatry. 2003;160(12):2116–2121. doi: 10.1176/appi.ajp.160.12.2116.
    1. Rozental A, Kottorp A, Forsstrom D, Mansson K, Boettcher J, Andersson G, et al. The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments. Behav Cogn Psychother. 2019;47(5):559–572. doi: 10.1017/s1352465819000018.
    1. Schniering CA, Lyneham HJ. The Children's Automatic Thoughts Scale in a clinical sample: psychometric properties and clinical utility. Behav Res Ther. 2007;45(8):1931–1940. doi: 10.1016/j.brat.2006.09.009.
    1. Schniering CA, Rapee RM. Development and validation of a measure of children's automatic thoughts: the Children's Automatic Thoughts Scale. Behav Res Ther. 2002;40(9):1091–1109. doi: 10.1016/S0005-7967(02)00022-0.
    1. Seeley-Wait E, Abbott MJ, Rapee RM. Psychometric properties of the mini-social phobia inventory. Prim Care Companion J Clin Psychiatry. 2009;11(5):231–236. doi: 10.4088/PCC.07m00576.
    1. Silverman WK, Nelles WB. The Anxiety Disorders Interview Schedule for Children. J Am Acad Child Adolesc Psychiatry. 1988;27(6):772–778. doi: 10.1097/00004583-198811000-00019.
    1. Silverman WK, Saavedra LM, Pina AA. Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry. 2001;40(8):937–944. doi: 10.1097/00004583-200108000-00016.
    1. Smeets RJ, Beelen S, Goossens ME, Schouten EG, Knottnerus JA, Vlaeyen JW. Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Clin J Pain. 2008;24(4):305–315. doi: 10.1097/AJP.0b013e318164aa75.
    1. Spence SH. A measure of anxiety symptoms among children. Behav Res Ther. 1998;36(5):545–566. doi: 10.1016/S0005-7967(98)00034-5.
    1. Spence SH, Rapee RM. The etiology of social anxiety disorder: an evidence-based model. Behav Res Ther. 2016;86:50–67. doi: 10.1016/j.brat.2016.06.007.
    1. Stevens K. Valuation of the Child Health Utility 9D Index. PharmacoEconomics. 2012;30(8):729–747. doi: 10.2165/11599120-000000000-00000.
    1. Thomas SA, Daruwala SE, Goepel KA, De Los Reyes A. Using the Subtle Avoidance Frequency Examination in adolescent social anxiety assessments. Child Youth Care Forum. 2012;41(6):547–559. doi: 10.1007/s10566-012-9181-y.
    1. Tsai CF, Wang SJ, Juang KD, Fuh JL. Use of the Chinese (Taiwan) version of the Social Phobia Inventory (SPIN) among early adolescents in rural areas: reliability and validity study. J Chin Med Assoc. 2009;72(8):422–429. doi: 10.1016/s1726-4901(09)70399-5.
    1. Wong QJJ, Gregory B, McLellan LF, Kangas M, Abbott MJ, Carpenter L, et al. Anticipatory processing, maladaptive attentional focus, and postevent processing for interactional and performance situations: treatment response and relationships with symptom change for individuals with social anxiety disorder. Behav Ther. 2017;48(5):651–663. doi: 10.1016/j.beth.2017.03.004.
    1. Wood JJ, Piacentini JC, Bergman RL, McCracken J, Barrios V. Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Clin Child Adolesc Psychol. 2002;31(3):335–342. doi: 10.1207/s15374424jccp3103_05.
    1. Woody SR. Effects of focus of attention on anxiety levels and social performance of individuals with social phobia. J Abnorm Psychol. 1996;105(1):61–69. doi: 10.1037/0021-843X.105.1.61.
    1. Woody SR, Chambless DL, Glass CR. Self-focused attention in the treatment of social phobia. Behav Res Ther. 1997;35(2):117–129. doi: 10.1016/S0005-7967(96)00084-8.
    1. Yang L, Zhou X, Pu J, Liu L, Cuijpers P, Zhang Y, et al. Efficacy and acceptability of psychological interventions for social anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials. Eur Child Adolesc Psychiatry. 2019;28(1):79–89. doi: 10.1007/s00787-018-1189-x.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir