Brief, developmentally oriented cognitive therapy for adolescents with social anxiety disorder: A case series from a pilot evaluation

Background: Social anxiety disorder (SAD) is one of the key mental health disorders of adolescence. Due to the mental health challenge across the globe in this age group, a growing acknowledgement of the need to effectively identify and treat incipient SAD at an early stage has been presented in many countries. Aim: The aim of this study was to examine the accuracy of detection of SAD in schools, using a detection toolkit and a professional operating model in which school psychologists acted in a consultant/coordinator role. The second aim was to gain initial data on usefulness and feasibility of brief, developmentally oriented cognitive therapy (DOCT-SAD) for adolescents with SAD. Methods: Ten adolescents, identified from upper secondary schools with a mean age of 13.8 years, participated in DOCT-SAD. Accuracy rate of detection in the school was calculated as the proportion of adolescents who had interview-confirmed SAD and completed the treatment out of those altogether referred from schools. Usefulness of DOCT-SAD was assessed with pre- post-treatment changes in symptoms of SAD (SPIN), mood (PHQ-9) and in adolescents’ wellbeing (YP-CORE), and by evaluating change in DSM-5 diagnostic status. Feasibility was evaluated by semi-structured interviews of adolescents and their parents. Results: Use of the SAD detection toolkit and the professional operating model yielded a 71% accuracy rate for schoolbased identification of adolescents who had SAD, and who eventually completed treatment. DOCT-SAD showed promise as treatment of SAD: adolescents’ symptoms of SAD and depression decreased markedly pre-post effect sizes being 1.6 and 1.4 respectively, adolescents’ wellbeing improved, and a 60% rate of diagnostic remission, comparable to established treatments, was found. Feasibility of DOCT-SAD appeared good or excellent for adolescents and parents. Discussion: As incidence of SAD is high in adolescence, methods for detection and treatment are needed. The 10-session DOCT-SAD shows promise for further development as a treatment for adolescent SAD. Conclusion: This case series found support for using a structured detection model, and for treatment of SAD using a brief cognitive therapy program among adolescents identified in the school.