Diagnosis-Specific Group CBT Treating Social Anxiety in Adolescents: A Feasibility Study

Agersnap, Thea Nørregaard; Hougaard, Esben; Jensen, Morten Berg; Thastum, Mikael

doi:10.2478/sjcapp-2022-0010

Figures & Tables

Flow Diagram of Response and Completion Rate

Overview of the Cool Kids Social Enhanced Program

Session number	Participants	Session content	Homework practice tasks
S-1	T, Y, P	- Rapport building- Psychoeducation- Worry scale- SMART goals	- Complete “Getting to know anxiety”
S-2	T, Y, P	- Continue rapport building- Introduce link between thoughts & feelings- Introduce attention training- Review parent goals	- Attention training- Linking thoughts and feelings
S-3	T, Y, P	- Introduce cognitive restructuring (detective thinking)- Introduce rewards	- Attention training continued- Detective thinking- Rewards menu
S-4	T, Y, P	- Detective thinking to cost- Introduce avoidance- Introduce behavioral experiments- Conduct in session experiment	- Detective thinking incl. cost- 2-4 planned experiments should be implemented- Attention training continued
S-5	T, P	- Parenting an adolescent with SAD	- Changing my response as a parent- Continue detective thinking- Continue experiment practice- Attention training continued
S-6	T, Y, P	- Introduce safety traps- Review experiments- Introduce experiments to reduce safety behaviors- Conduct in session experiment- Introduce task focused attention	- Conduct 2-4 planned experiments that focus on undoing safety traps- Continue detective thinking- Task attention practice
S-7	T, Y, P	- Review safety trap experiments and task-focused attention - Conduct the video-feedback experiment - Introduce the importance of obtaining an accurate self-perception - Obtaining accurate self-perception using feedback - Conduct additional in session experiments	- Implement min. 2-4 planned experiments using feedback in the recording form - Daily experiment practice - Use detective evidence sheet as supplement to the experiments - Continue task-focus attention training
S-8	T, Y, P	- Review and revise experiments that utilize feedback- Introduce post-event processing (detective thinking AFTER a situation)- Introduce cost experiments- Conduct in-session exposure (including an extra challenge experiment)	- Daily experiment practice (incl. min. 2-4 planned extra challenge experiments)- Post-event detective thinking- Continue task-focus attention training
S-9	T, Y, P	- Review and revise extra challenge experiments and post-event detective thinking- In session experiments- Troubleshooting experiments [PARENT ONLY]- Optional MODULE: Dealing with teasing and bullying	- Daily experiments (including large experiments)- Continue task-focus attention training- Parent task: complete the reviewing foals worksheet- Optional module: Role play new ways of interacting with bullies
S-10	T, Y, P	- Review of goals- Maintenance of gains/setbacks- Future plans	- Continue to practice skills
Booster	T, Y,P	- Focusing on maintaining and continuing the progress.- Advise possible further help.	- Continue to practice skills

Estimated Slopes (Change) from Baseline- to Post Intervention and Post Intervention to 1-Year Follow-Up

Outcome	Respondent	Baseline to post intervention β [95% CI]	Post intervention to 1-year follow-up β [95% CI]
SCAS total	Youth	-1.44 [-1.78, -1.10]***	0.08 [-0.15, 0.30]
	Mother	-1.18 [-1.59, -0.77]***	0.02 [-0.13, 0.17]
	Father	-0.82 [-1.41, -0.23]**	0.04 [-0.16, 0.24]
SCAS social phobia subscale	Youth	-0.29 [-0.41, -0.17]***	0.02 [-0.04, 0.08]
	Mother	-0.21 [-0.33, -0.09]***	-0.01 [-0.05, 0.03]
	Father	-0.14 [-0.28, -0.00]*	-0.02 [-0.06, 0.02]
CALIS total	Youth	-0.44 [-0.60, -0.27]***	0.06 [-0.06, 0.18]
	Mother	-0.71 [-1.12, -0.31]***	-0.05 [-0.19, 0.09]
	Father	-0.54 [-1.00, -0.08]*	-0.05 [-0.25, 0.16]
MFQ	Youth	-0.28 [-0.45, -0.10]**	0.07 [-0.01, 0.14]
	Mother	-0.12 [-0.33, 0.09]	0.00 [-0.06, 0.06]
	Father	-0.11 [-0.27, 0.05]	-0.02 [-0.07, 0.03]
SEQ total	Youth	0.74 [0.42, 1.05]***	-0.07 [-0.24, 0.09]
SAFE	Youth	-1.07 [-1.50, -0.64]***	-0.09 [-0.25, 0.06]
CATS total	Youth	-1.02 [-1.39, -0.65]***	0.11 [-0.06, 0.27]
FAQ - self focus	Youth	-0.30 [-0.42, -0.17]***	0.01 [-0.07, 0.08]
FAQ - external focus	Youth	-0.08 [-0.18, 0.02]	0.01 [-0.04, 0.06]
PTQ	Youth	-0.76 [-1.18, -0.34]***	-0.05 [-0.18, 0.09]
DASS anxiety	Mother	-0.08 [-0.23, 0.06]	0.04 [0.00, 0.08]
DASS depression	Mother	-0.16 [-0.41, 0.09]	0.05 [-0.02, 0.12]
DASS stress	Mother	-0.01 [-0.26, 0.25]	0.02 [-0.07, 0.10]
DASS anxiety	Father	-	-
DASS depression	Father	0.10 [-0.10, 0.30]	-0.02 [-0.11, 0.07]
DASS stress	Father	0.05 [-0.14, 0.24]	-0.04 [-0.10, 0.02]

Treatment Satisfaction at Post-Intervention

Item	Respondent	Response categories
Item	Respondent	Not True	Partly True	Certainly True
The treatment helped me/my child	Youth	0	3 (25%)	9 (75%)
	Mother	0	4 (31%)	9 (69%)
	Father	0	3 (33%)	7 (67%)
We feel better in the family now than before treatment	Youth	3 (25%)	6 (50%)	3 (25%)
	Mother	0	4 (31%)	9 (69%)
	Father	0	2 (20%)	8 (80%)
If a friend needed similar help, I would recommend the	Youth	0	11 (92%)	1 (8%)
treatment	Mother	0	0	13 (100%)
	Father	0	1 (10%)	9 (90%)
I trusted the therapist	Youth	0	2 (17%)	10 (83%)
	Mother	0	0	13 (100%)
	Father	0	1 (10%)	9 (90%)
The therapist had an understanding of my worries and issues	Youth	0	3 (25%)	9 (75%)
After treatment I felt like being with my friends more	Youth	2 (16%)	5 (42%)	5 (42%)
The treatment helped me (the parent)	Mother	0	2 (15%)	11 (85%)
	Father	1 (10%)	2 (20 %)	7 (70%)
I have been given enough information about the purpose	Mother	0	1 (8%)	12 (92%)
and course of treatment prior to the start	Father	0	2 (20%)	8 (80%)
During the treatment I managed to change my behavior	Mother	0	3 (23%)	10 (77%)
towards my child in a positive way	Father	0	1 (10%)	9 (90%)
During the treatment I got a better understanding of my	Mother	0	0	13 (100%)
child’s psychological well-being	Father	0	1 (10%)	9 (90%)
The treatment made me/my child feel worse	Youth	11 (92%)	1 (8%)	0
	Mother	13 (100%)	0	0
	Father	10 (100%)	0	0
The treatment made me (the parent) feel worse	Mother	13 (100%)	0	0
	Father	10 (100%)	0	0

Mean Scores, Standard Deviations and Effect-Sizes

Outcome	Respondent	Baseline	Post intervention	3 month follow-up	1 year follow-up	Baseline - post intervention: effect size	Post - 1 year follow-up: effect size
ADIS-IV: CSR on SAD	CSR rating*	6.23 (0.44)n = 13	5.58 (0.79)n = 12	4.77 (1.83)n = 13	-	d = 1.02	d = 0.59
SCAS total	Youth	53 (16.81)n = 13	35.33 (13.74)n = 12	37.22 (13.09)n = 9	39 (22.09)n = 8	d = 1.15	d = -0.21
	Mother	48.46 (15.03)n = 13	34.85 (16.09)n = 13	30.08 (13.92)n = 12	33.83 (21.32)n = 12	d = 0.87	d = 0.05
	Father	43.09 (10.27)n = 11	34.7 (16.57)n = 10	25.5 (7.93)n = 8	29.71 (15.51)n = 7	d = 0.62	d = 0.31
SCAS social phobia	Youth	12.77 (3.24)n = 13	8.75 (3.44)n = 12	9.44 (3.09)n = 9	9.63 (4.34)n = 8	d = 1.2	d = -0.23
subscale	Mother	14.23 (2.52)n = 13	11.77 (3.52)n = 13	10.92 (4.14)n = 12	10.75 (4.29)n = 12	d = 0.80	d = 0.26
	Father	13.36 (2.01)n = 11	11.6 (3.06)n = 10	10.88 (3.44)n = 8	10.43 (1.72)n = 7	d = 0.69	d = 0.45
CALIS total	Youth	19.46 (5.64)n =13	13.67 (6.75)n = 12	14.56 (5.46)n = 9	16.88 (10.09)n = 8	d = 0.93	d = -0.39
	Mother	37.69 (8.45)n = 13	30 (10.65)n = 13	25.17 (13.13)n = 12	26.08 (13.21)n = 12	d = 0.80	d = 0.33
	Father	35.27 (9.26)n = 11	31.4 (9.72)n = 10	22.75 (7.05)n = 8	27.29 (13.59)n = 7	d = 0.41	d = 0.36
MFQ	Youth	12.62 (7.18)n = 13	9.67 (7.29)n = 12	9.22 (7.16)n = 9	12.5 (9.15)n = 8	d = 0.41	d = -0.35
	Mother	9.62 (6.45)n =13	8.23 (7.01)n = 13	7.08 (8.34)n = 12	7.33 (6.96)n = 12	d = 0.21	d = 0.13
	Father	6.55 (3.56)n = 11	4.8 (3.39)n = 10	4.63 (4.60)n = 8	3.29 (2.36)n = 7	d = 0.50	d = 0.50
SEQ total	Youth	59.62 (11.33)n = 13	69.25 (14.45)n = 12	69.11 (14.08)n = 9	63.88 (20.29)n = 8	d = 0.75	d = -0.32
SAFE	Youth	91.62 (16.19)n = 13	78.5 (12.99)n = 12	75.33 (18.70)n = 9	73.63 (16.13)n = 8	d = 0.89	d = 0.34
CATS total	Youth	34.46 (20.56)n = 13	22.08 (17.07)n = 12	22.44 (20.30)n = 9	26.13 (23.53)n = 8	d = 0.65	d = -0.20
FAQ self-focus	Youth	17.38 (4.05)n = 13	13.92 (3.70)n = 12	13.89 (5.09)n = 9	14.75 (6.23)n = 8	d = 0.89	d = -0.17
FAQ external focus	Youth	14.38 (2.47)n =13	13.67 (1.67)n = 12	13 (3.16)n = 9	14.25 (3.65)n = 8	d = 0.34	d = -0.22
PTQ	Youth	36.92 (11.94)n =13	27.75 (13.46)n = 12	23.67 (16.48)n = 9	23.75 (17.38)n = 8	d = 0.72	d = 0.26
DASS anxiety	Mother	3.38 (5.20)n = 13	1.69 (2.78)n = 13	2.92 (3.68)n = 12	3.17 (3.97)n = 12	d = 0.41	d = -0.43
DASS depression	Mother	6.08 (10.77)n = 13	2.92 (3.88)n = 13	4.67 (7.34)n = 12	4.25 (6.22)n = 12	d = 0.39	d = -0.26
DASS stress	Mother	8.38 (7.7)n =13	8.38 (6.97)n = 13	7.67 (8.05)n = 12	8.5 (7.70)n = 12	d = 0.0	d = -0.02
DASS anxiety	Father	1.64 (3.56)n = 11	1.6 (2.76)n = 10	0.38 (0.74)n = 8	0.14 (0.38)n = 7	d = 0.01	d = 0.68
DASS depression	Father	3.27 (8.66)n = 11	4.4 (6.88)n = 10	5.75 (8.53)n = 8	2.86 (2.85)n = 7	d = -0.14	d = 0.27
DASS stress	Father	4.09 (4.74)n = 11	4.7 (4.37)n = 10	4.25 (3.11)n = 8	2.29 (2.63)n = 7	d = -0.13	d = 0.64

Diagnosis-Specific Group CBT Treating Social Anxiety in Adolescents: A Feasibility Study

Figures & Tables

Figure 1

Overview of the Cool Kids Social Enhanced Program

Estimated Slopes (Change) from Baseline- to Post Intervention and Post Intervention to 1-Year Follow-Up

Treatment Satisfaction at Post-Intervention

Mean Scores, Standard Deviations and Effect-Sizes

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