Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta-analysis.

Rachel Evans,Eleanor Leigh,David M Clark

doi:10.1017/s135246582000079x

Rachel Evans, Eleanor Leigh + Show 1 more

Open Access

https://doi.org/10.1017/s135246582000079x

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Abstract

Social anxiety disorder (SoAD) in youth is often treated with a generic form of cognitive behavioural therapy (CBT). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. This systematic review and meta-analysis investigated recovery rates following generic CBT for youth with primary SoAD versus other primary anxiety disorders. Five databases (PsycINFO, Web of Science, PubMed, Embase, Medline) were searched for randomised controlled trials of generic CBT for child and/or adolescent anxiety. Ten trials met criteria for inclusion in the systematic review, six of which presented sufficient data for inclusion in the meta-analysis. Sixty-seven did not report data on recovery rates relative to primary diagnosis. While most individual studies included in the systematic review were not sufficiently powered to detect a difference in recovery rates between diagnoses, there was a pattern of lower recovery rates for youth with primary SoAD. Across the trials included in the meta-analysis, the post-CBT recovery rate from primary SoAD (35%) was significantly lower than the recovery rate from other primary anxiety disorders (54%). Recovery from primary SoAD is significantly less likely than recovery from any other primary anxiety disorder following generic CBT in youth. This suggests a need for research to enhance the efficacy of CBT for youth SoAD.

Highlights

Social anxiety disorder (SoAD) is characterised by an intense fear of embarrassment or negative evaluation by others which causes significant distress and functional impairment
Adolescent SoAD is associated with development of subsequent depression (Stein et al, 2001), which itself is predictive of a range of a range of functional impairments (McKnight and Kashdan, 2009)
These randomised controlled trial (RCT) evaluated a range of formats of cognitive behavioural therapy (CBT), including three of individual CBT (Barrett et al, 1996; Silk et al, 2018; Suveg et al, 2018), two of group CBT (Arendt et al, 2016; Shortt et al, 2001), two of individual or group CBT (Villabo et al, 2018; Wergeland et al, 2014; Wergeland et al, 2016), two of parent-delivered CBT (Creswell et al, 2017; Thirlwall et al, 2013; Thirlwall et al, 2017), and one of internetdelivered CBT (Stjerneklar et al, 2019)

Summary

Introduction

Social anxiety disorder (SoAD) is characterised by an intense fear of embarrassment or negative evaluation by others which causes significant distress and functional impairment. It is common, with a lifetime prevalence of 12% (Kessler et al, 2005). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. Aims: This systematic review and meta-analysis investigated recovery rates following generic CBT for youth with primary SoAD versus other primary anxiety disorders. Across the trials included in the meta-analysis, the post-CBT recovery rate from primary SoAD (35%) was significantly lower than the recovery rate from other primary anxiety disorders (54%). This suggests a need for research to enhance the efficacy of CBT for youth SoAD

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