Abstract
Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed. Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment? CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training. Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment. This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.
Highlights
Social anxiety disorder (SAD) is common and usually first occurs during adolescence (Kessler et al, 2005; Merikangas, Nakamura, & Kessler, 2009), with almost all cases occurring by early adulthood (Beesdo, Pine, Lieb, & Wittchen, 2010)
The Guideline noted the limited data for psychological interventions in youth social anxiety disorder (SAD), and concluded that cognitive behavioural therapy (CBT) was the most promising intervention, and further that Cognitive therapy for SAD (CT-SAD) should be considered for the treatment of adolescents with social anxiety
Treatment CT-SAD-A, which is the adolescent version of CT-SAD for adults based on the Clark and Wells (1995) model, is a distinctive form of CBT delivered in 14 weekly 1.5 hour sessions provided on a one-to-one basis
Summary
Social anxiety disorder (SAD) is common and usually first occurs during adolescence (Kessler et al, 2005; Merikangas, Nakamura, & Kessler, 2009), with almost all cases occurring by early adulthood (Beesdo, Pine, Lieb, & Wittchen, 2010). Cognitive therapy for SAD (CT-SAD) is a distinctive form of cognitive behavioural therapy (CBT) that is highly effective for adults (Mayo-Wilson et al, 2014). It aims to reverse the processes specified in the cognitive model of social anxiety developed by Clark and Wells (1995). Methods: CAMHS therapists working in two NHS trusts received training in CT-SAD-A They delivered the treatment to adolescents with SAD during a period of supervised practice. Conclusions: This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a two-day training workshop. The cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults
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