scholarly journals Cognitive therapy compared with CBT for social anxiety disorder in adolescents: a feasibility study

2021 ◽  
Vol 25 (20) ◽  
pp. 1-94
Author(s):  
Cathy Creswell ◽  
Eleanor Leigh ◽  
Michael Larkin ◽  
Gareth Stephens ◽  
Mara Violato ◽  
...  
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Young People ◽  
Cognitive Therapy ◽  
Social Anxiety Disorder ◽  
Qualitative Interviews ◽  
Green Paper ◽  
The Mean ◽  
Mean Cost

Background Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective among adults with SAD. Objectives To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive–behavioural therapy that is more commonly used. Design During the training phase of the study, it became clear that the RCT would not be feasible because of high staff turnover and unfilled posts within CAMHS and changes in the nature of referrals, which meant that few young people with primary SAD were accessing some of the participating services. The study design was altered to comprise the following: a training case series of CT-SAD-A delivered in routine CAMHS, an estimate of the cost to the NHS of training therapists to deliver CT-SAD-A and of the mean cost per adolescent treated, and qualitative interviews with participating young people, parents, therapists and service managers/leads. Setting Five CAMHS teams within Berkshire Healthcare and Oxford Health NHS Foundation Trusts. Participants Eight therapists received training in CT-SAD-A. Twelve young people received CT-SAD-A, delivered by six therapists. Six young people, six parents, seven therapists and three managers participated in qualitative interviews. Interventions Cognitive therapy for social anxiety disorder in adolescents (CT-SAD-A). Main outcome measures Measured outcomes included social anxiety symptoms and diagnostic status, comorbid symptoms of anxiety and depression, social and general functioning, concentration in class and treatment acceptability. Patient level utilisation of the intervention was collected using clinicians’ logs. Results Nine out of 12 participants achieved good outcomes across measures (r ≥ 0.60 across social anxiety measures). The estimated cost of delivering CT-SAD-A was £1861 (standard deviation £358) per person. Qualitative interviews indicated that the treatment was acceptable to young people, parents and therapists, but therapists and managers experienced challenges when implementing the training and treatment within the current CAMHS context. Limitations Findings were based on a small, homogeneous sample and there was no comparison arm. Conclusions CT-SAD-A is a promising treatment for young people with SAD, but the current CAMHS context presents challenges for its implementation. Future work Further work is needed to ensure that CAMHS can incorporate and test CT-SAD-A. Alternatively, CT-SAD-A should be delivered and tested in other settings that are better configured to treat young people whose lives are held back by SAD. The new schools Mental Health Support Teams envisaged in the 2017 Children’s Mental Health Green Paper may provide such an opportunity. Funding The National Institute for Health Research (NIHR) Health Technology Assessment programme. Individual funding was also provided for Cathy Creswell, David M Clark and Eleanor Leigh as follows: NIHR Research Professorship (Cathy Creswell); Wellcome Senior Investigator Award (Anke Ehlers and David M Clark); and the Wellcome Clinical Research Training Fellowship (Eleanor Leigh).

scholarly journals Delivering cognitive therapy for adolescent social anxiety disorder in NHS CAMHS: a qualitative analysis of the experiences of young people, their parents and clinicians-in-training

2021 ◽  
pp. 1-15
Author(s):  
Lucy Taylor ◽  
Cathy Creswell ◽  
Samantha Pearcey ◽  
Emma Brooks ◽  
Eleanor Leigh ◽  
...  
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Young People ◽  
Health Services ◽  
Qualitative Analysis ◽  
Social Anxiety Disorder ◽  
Interpretative Phenomenological Analysis ◽  
Phenomenological Analysis ◽  
Qualitative Exploration

Abstract Background: Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents. Aims: The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS). Method: We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment. Results: Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings. Conclusions: The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.

scholarly journals Cognitive Therapy for Social Anxiety Disorder in Adolescents: A Development Case Series

2015 ◽  
Vol 44 (1) ◽  
pp. 1-17 ◽  
Author(s):  
Eleanor Leigh ◽  
David M. Clark
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Young People ◽  
Cognitive Therapy ◽  
Social Anxiety Disorder ◽  
Case Series ◽  
Process Measures ◽  
General Anxiety ◽  
Differential Effectiveness ◽  
End Of Treatment

Background: Social anxiety disorder is common and typically starts in childhood or adolescence. Cognitive Therapy for Social Anxiety Disorder (CT-SAD) in adults is a well-established treatment that shows strong evidence of differential effectiveness when compared to other active treatments. In contrast, CBT approaches to social anxiety in young people have yet to demonstrate differential effectiveness and there is some evidence that young people with social anxiety disorder respond less well than those with other anxiety disorders. Aims: To adapt CT-SAD for use with adolescents and conduct a pilot case series. Method: Five adolescents, aged 11–17 years, with a primary DSM-5 diagnosis of social anxiety disorder received a course of CT-SAD adapted for adolescents. Standardized clinical interview and questionnaire assessments were conducted at pre and posttreatment, and 2 to 3-month follow-up. Results: All five participants reported severe social anxiety at baseline and achieved remission by the end of treatment. Significant improvements were also observed in general anxiety, depression, concentration in the classroom, and putative process measures (social anxiety related thoughts, beliefs and safety behaviours). Conclusions: An adapted form of CT-SAD shows promise as a treatment for adolescents.

scholarly journals Analysis of Default Mode Network in Social Anxiety Disorder: EEG Resting-State Effective Connectivity Study

2021 ◽  
Author(s):  
Abdulhakim Al-Ezzi ◽  
Nidal Kamel ◽  
Ibrahima Faye ◽  
Esther Gunaseli
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Anxiety Disorder ◽  
Default Mode Network ◽  
Resting State ◽  
Effective Connectivity ◽  
Mean Values ◽  
Default Mode ◽  
Severe Group ◽  
The Mean

Several neuroimaging findings by using different modalities (e.g., fMRI and PET) have suggested that social anxiety disorder (SAD) is correlated with alterations in regional or network-level brain function. However, these modalities do not quantify the fast dynamic connectivity of causal information networks due to their poor temporal resolution. In this study, SAD-related changes in brain connections within the default mode network (DMN) was investigated using Electroencephalogram (EEG). Partial directed coherence (PDC) was used to assess the causal influences of DMN regions on each other and indicate the changes in the DMN effective network related to SAD severity. The EEG data were collected from 88 subjects (control, mild, moderate, severe) and used to estimate the effective connectivity between DMN regions at different frequency bands. Among the healthy control (HC) and the three considered levels of severity of SAD, the results indicated a higher level of causal interactions for the mild and moderate SAD groups than for the severe and HC groups. Between the control and the severe SAD groups, the results indicated a higher level of causal connections for the control throughout all the DMN regions. We found significant increases in the mean PDC in the delta and alpha bands between the SAD groups. Among the DMN regions, the precuneus exhibited a higher level of causal influence than other regions. Therefore, it was suggested to be a major source hub that contributes to the mental exploration and emotional content of SAD. In contrast to the severe group, the HC exhibited higher resting-state connectivity at the mesial prefrontal cortex (mPFC), providing evidence for mPFC dysfunction in the severe SAD group. Furthermore, the total Social Interaction Anxiety Scale (SIAS) was positively correlated with the mean values of the PDC of the severe SAD group and negatively correlated with those of the HC group. The reported results may facilitate greater comprehension of the underlying potential SAD neural biomarkers and can be used to characterize possible targets for further medication.

scholarly journals Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: A Development Pilot Series

2013 ◽  
Vol 41 (4) ◽  
pp. 383-397 ◽  
Author(s):  
Richard Stott ◽  
Jennifer Wild ◽  
Nick Grey ◽  
Sheena Liness ◽  
Emma Warnock-Parkes ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Randomized Controlled Trials ◽  
Cognitive Therapy ◽  
Social Anxiety Disorder ◽  
Controlled Trials ◽  
Secure Messaging ◽  
Face To Face ◽  
Randomized Controlled ◽  
The Face

Background: Randomized controlled trials have established that individual cognitive therapy based on the Clark and Wells (1995) model is an effective treatment for social anxiety disorder that is superior to a range of alternative psychological and pharmacological interventions. Normally the treatment involves up to 14 weekly face-to-face therapy sessions. Aim: To develop an internet based version of the treatment that requires less therapist time. Method: An internet-delivered version of cognitive therapy (iCT) for social anxiety disorder is described. The internet-version implements all key features of the face-to-face treatment; including video feedback, attention training, behavioural experiments, and memory focused techniques. Therapist support is via a built-in secure messaging system and by brief telephone calls. A cohort of 11 patients meeting DSM-IV criteria for social anxiety disorder worked through the programme and were assessed at pretreatment and posttreatment. Results: No patients dropped out. Improvements in social anxiety and related process variables were within the range of those observed in randomized controlled trials of face-to-face CT. Nine patients (82%) were classified as treatment responders and seven (64%) achieved remission status. Therapist time per patient was only 20% of that in face-to-face CT. Conclusions: iCT shows promise as a way of reducing therapist time without compromising efficacy. Further evaluation of iCT is ongoing.

scholarly journals Social phobia: relevance and perspectives

2019 ◽  
Vol 4 (1) ◽  
pp. e0401151
Author(s):  
Oleksandr Avramchuk
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Phobia ◽  
Social Functioning ◽  
Social Anxiety Disorder ◽  
Clinical Picture ◽  
Clinical Signs ◽  
Public Mental Health ◽  
The Social

Background Epidemiological studies indicate that social anxiety disorder is one of the most common mental health disorders. However, despite the prevalence of social anxiety disorder, a large amount of information, the possibilities of psychotherapy and medical treatment, many patients for various reasons do not receive or do not seek help. Aim Generalization of actual knowledge and research on the aetiology and pathogenetic mechanisms of social phobias and coverage of the actual issues of low referral of people suffering from social phobia Methods For review, the following databases, such as ScienceDirect, ResearchGate, PubMed and Google Scholar, were used. The search was performed using the keywords: social anxiety disorder, sociophobia, social anxiety, cognitive-behavioral model, neurobiology, mental health. Results The general information about social anxiety disorder, its prevalence and its consequences were covered. The main etiological mechanisms, modern views on the neurobiological and psychological basis of the disorder are considered. In addition, the peculiarities of the clinical picture and its influence on the social functioning of the individual, including the referral of help, were analyzed. The aspects that are useful to consider during the development of recommendations for specialists in general medical practice and centers of public mental health were suggested. Conclusion A social anxiety disorder should be considered as a complex mental health disorder. Recognition of signs of social anxiety disorder in their component often leads to a false interpretation of clinical signs as manifestations of depression or other neurotic disorders among primary care professionals. Informing general practitioners and specialists of public mental health centers about the traits of the clinical picture and the social functioning of patients with this disorder can help to overcome the stigma and improve the referral of qualified assistance.

scholarly journals Social anxiety disorder: relevance and perspectives

2018 ◽  
Vol 3 (3) ◽  
pp. e0303103
Author(s):  
Oleksandr Avramchuk
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Social Functioning ◽  
Social Anxiety Disorder ◽  
Clinical Picture ◽  
Clinical Signs ◽  
Public Mental Health ◽  
Behavioral Model ◽  
The Social

Background Epidemiological studies indicate that social anxiety disorder as one of the most common mental health disorders. However, many patients do not seek or receive help, despite the prevalence of social anxiety disorder, the large amount of information, the possibilities of psychotherapy and medical treatment Aim Generalization of actual knowledge and research on the aetiology and pathogenetic mechanisms of social phobias and coverage of the actual issues of low referral of people suffering from social phobia Methods For review, the following databases, such as ScienceDirect, ResearchGate, PubMed and Google Scholar, were used. The search was performed using the keywords: social anxiety disorder, sociophobia, social anxiety, cognitive-behavioral model, neurobiology, mental health Results The general information about social anxiety disorder, its prevalence and its consequences were covered. The main etiological mechanisms, modern views on the neurobiological and psychological basis of the disorder are considered. In addition, the peculiarities of the clinical picture and its influence on the social functioning of the individual, including the referral of help, were analyzed. The aspects that are useful to consider during the development of recommendations for specialists in general medical practice and centers of public mental health were suggested Conclusions A social anxiety disorder should be considered as a complex mental health disorder. Recognition of signs of social anxiety disorder in their component often leads to a false interpretation of clinical signs as manifestations of depression or other neurotic disorders among primary care professionals. Informing general practitioners and specialists of public mental health centers about the traits of the clinical picture and the social functioning of patients with this disorder can help to overcome the stigma and improve the referral of qualified assistance

scholarly journals Long-Term Effectiveness of Cognitive Therapy for Refractory Social Anxiety Disorder: One-Year Follow-Up of a Randomized Controlled Trial

2019 ◽  
Vol 88 (4) ◽  
pp. 244-246 ◽  
Author(s):  
Naoki Yoshinaga ◽  
Kazumi Kubota ◽  
Kensuke Yoshimura ◽  
Rieko Takanashi ◽  
Yasushi Ishida ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Cognitive Therapy ◽  
Social Anxiety Disorder ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
One Year

The Effectiveness of Mindfulness-based Cognitive Therapy on Sleep Quality of Students with Social Anxiety Disorder

2020 ◽  
Author(s):  
Saeed Mohammadi ◽  
Mahboobeh Maleki ◽  
Mojtaba Tashkeh ◽  
Aliakbar Foroughi ◽  
Golfam Goodarz
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Sleep Quality ◽  
Sleep Disorders ◽  
Cognitive Therapy ◽  
Social Anxiety Disorder ◽  
Sleep Problems ◽  
Sleeping Problems ◽  
Post Test ◽  
Social Interaction Anxiety Scale

Background and Objective: Anxiety disorders are usually accompanied with sleep disorders. Since limited studies have focused on the effectiveness of mindfulness-based cognitive therapy (MBCT) on anxiety-related problems such as sleep disorders, the current research was conducted to investigate the effectiveness of this intervention on sleep problems. Materials and Methods: This study was a clinical trial with control and treatment groups. The sample consisted of 24 university students diagnosed with social anxiety disorder (SAD). Social Interaction Anxiety Scale (SIAS) and Pitts-burgh Sleep Quality Index (PSQI) were used to assess the dependent variables. There were measurements during pre-test, post-test, and follow-up stages. Results: The treatment could significantly improve the anxiety and sleeping problems in patients with social anxiety. Assessing the aspects of sleep quality showed that the intervention could improve the subjective aspects, latency, dis-turbance, and daily dysfunctions of sleep effectively; however, there was no significant effect on the duration of sleep, taking sleep medications, or sleep efficiency. Conclusion: Mindfulness treatment could be used for improving sleep quality in patients with social anxiety. This treatment could also improve the aspects of sleep quality which are related to sleep threshold.

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