May 23, 2023

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by Katy Manetta, PhD, A-CBT, representing NSAC Long Beach, California and examines the 2023 article by Leigh and Clark, Internet-delivered therapist-assisted cognitive therapy for adolescent social anxiety disorder (OSCA): a randomised controlled trial addressing preliminary efficacy and mechanisms of action.

Social Anxiety Disorder (SAD) is one of the most common problems facing adolescents. Generic Cognitive Behavior Therapy (CBT) models for treating SAD have been shown to be far less effective than specific models but unfortunately there are not enough therapists skilled in the use of evidence-based therapies specific to SAD to manage the number of clients needing help. This has led researchers to examine alternate applications that would reduce the demand on therapist time while maximizing patient outcomes. The intervention studied in this article was an adaptation of a Cognitive Therapy model specific to the treatment of SAD (CT-SAD) developed by Clark and Wells in 1995.

The version of CT-SAD used in this study was originally shown to be effective for adult populations. Internet-delivered therapist-assisted applications of CT-SAD previously demonstrated equivalent efficacy to traditional in-person treatment, but with a noteworthy 70% reduction in therapist time. This model of CT-SAD was modified for use with adolescents in the current study.

This preliminary study included a relatively small sample size of 43 youth age 14-18 who were recruited through their schools. The teens were then randomly assigned to either a waitlist or to the modified CT-SAD treatment that offered what the authors refer to as, ‘Online Social anxiety Cognitive therapy for Adolescents’ (or OSCA). This treatment was provided over 14 weeks and included online access to secure video conferencing as well as regular check-ins with a therapist.

A number of measures were used to track progress. The primary outcome measures tracked symptoms of social anxiety, which included self-report measures like the Liebowitz Social Anxiety Scale for children and adolescents. Progress was measured for both the treatment group and the waitlist group at consistent intervals throughout the 14-week treatment period as well as at various intervals during the follow up period.

The results of this study demonstrated that OSCA participants fared far better than their waitlisted counterparts. In fact, 77% of the teens who participated in OSCA treatment (compared to 14% of waitlisted participants) were shown to be in remission from their SAD symptoms at the end of the treatment period. At 6 month follow up, this percentage increased to 91% of OSCA participants in remission.

This preliminary study showed that an online application of a cognitive therapy model specific to the treatment of adolescents with SAD when compared to adolescents on a waitlist. The OSCA treatment appears to offer an excellent treatment option that minimizes the demands on therapists’ time. Future research could include comparisons between online versus in-person models as well as head-to-head comparisons between OSCA and other applications specific to the treatment of SAD.

For Clinicians:
How could you implement such a program in your current practice?
What have your experiences been when adding adjunctive online components to current modalities of treatment?

Leigh, Eleanor and Clark, David M. Internet-delivered therapist-assisted cognitive therapy for adolescent social anxiety disorder (OSCA): A randomised controlled trial addressing preliminary efficacy and mechanisms of action. Journal of Child Psychology & Psychiatry, vol. 64, issue 1, pp. 145-155, January 2023.

Katy Manetta, PhD, A-CBT
Representing NSAC Long Beach
(Belmont Psychological Services)