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

Abstract

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.

Publication DOI: https://doi.org/10.3310/hta25200
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Applied Health Research Group
College of Health & Life Sciences
Additional Information: © Queen’s Printer and Controller of HMSO 2021. This work was produced by Creswell et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Uncontrolled Keywords: ADOLESCENT,ANXIETY,ANXIETY DISORDERS,COGNITIVE THERAPY,MENTAL HEALTH SERVICES,PHOBIA, SOCIAL,SOCIAL ANXIETY DISORDER,Health Policy
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://www.jou ... 25200#/abstract (Publisher URL)
PURE Output Type: Article
Published Date: 2021-03-01
Accepted Date: 2021-03-01
Authors: Creswell, Cathy
Leigh, Eleanor
Larkin, Michael (ORCID Profile 0000-0003-3304-7000)
Stephens, Gareth
Violato, Mara
Brooks, Emma
Pearcey, Samantha
Taylor, Lucy
Stallard, Paul
Waite, Polly
Reynolds, Shirley
Taylor, Gordon
Warnock-Parkes, Emma
Clark, David M

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