Online therapy works for social anxiety in teens

Online CBT offers many advantages to patients with SAD, including removing the need for them to go to the therapist’s office, which is a social situation that can trigger their symptoms. — TNS

Social anxiety disorder (SAD) can cause considerable suffering in children and adolescents.

In addition, access to effective treatment is limited for many with the disorder, which was previously known as social phobia.

Researchers at the Centre for Psychiatry Research at Karolinska Institutet and the Child and Adolescent Mental Health Services at Region Stockholm in Sweden, have now shown that internet-delivered cognitive behavioural therapy (CBT) is an efficacious and cost-effective treatment option.

SAD has a typical onset during childhood and is characterised by an intense and persistent fear of being scrutinised and negatively evaluated in social or performance situations.

The fear typically leads to avoidance of such anxiety-triggering situations or are endured under great distress, resulting in an impaired ability to function in everyday life.

The disability can lead to underperformance in school, social isolation from peers and an inability to partake in leisure activities.

As one of the most common anxiety disorders among youth, the disorder affects 5% to 10% of the youth population.

Without effective treatment, it has been linked to long-term psychosocial adversity and persistence into adulthood.

Despite known evidence-based treatments for SAD, such as CBT, the access to effective treatment is very limited.

As a means to increase access, the researchers developed and evaluated a 10-week internet-delivered CBT (ICBT) programme for young people with SAD.

The study, published in the journal JAMA Psychiatry, was conducted between 2017 and 2020, and included 103 youths aged 10 to 17, along with their parents.

Participants were randomly assigned to either ICBT or an active control group, which provided internet-delivered supportive therapy.

Both interventions included 10 online treatment modules with weekly therapist support and three video sessions with the therapist.

Parents received five online modules in parallel with therapist support.

The results showed that ICBT was significantly more effective than supportive therapy in reducing social anxiety and concurrent psychiatric symptoms, as well as in increasing the level of overall functioning.

The superiority of ICBT was shown in evaluations of participants’ symptoms made by assessors who were unaware of which treatment group the participants were in, as well as in ratings by participants themselves and their parents.

According to the researchers, the digital format can also increase access to evidence-based treatment for children and adolescents with SAD.

“Offering treatment digitally means that children and parents don’t have to take time off school and work to travel to a healthcare facility,” says psychologist and study first author Martina Nordh.

“We also believe it may lower the threshold to seeking treatment, as young people with SAD can find it too challenging to meet with unfamiliar people and to be in a new setting.”

The total time spent by the therapists on ICBT was about a quarter of the time normally required by face-to-face CBT for SAD.

“Shorter therapist time enables each therapist to treat more patients and may lead to reduction of waiting times,” says child and adolescent psychiatrist and study principal investigator Dr Eva Serlachius.

“This also makes digital CBT less costly for healthcare services and resources can be redistributed to those with greater need of more intensive treatment.”

The researchers are now working on a joint project with Region Stockholm’s Internet treatment unit within the Child and Adolescent Mental Health Services to plan for the implementation and dissemination of the programme via a Swedish national platform.

The study was supported by grants from the Swedish Research Council for Health, Working Life and Welfare, and Region Stockholm.