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

Thea Nørregaard Agersnap
Thea Nørregaard Agersnap
, 
Esben Hougaard
Esben Hougaard
, 
Morten Berg Jensen
Morten Berg Jensen
 and 
Mikael Thastum
Mikael Thastum
   | Aug 30, 2022
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology's Cover Image
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Article Category: Research Article
Published Online: Aug 30, 2022
Page range: 89 - 101
DOI: https://doi.org/10.2478/sjcapp-2022-0010
Keywords
© 2022 Thea Nørregaard Agersnap, Esben Hougaard, Morten Berg Jensen, Mikael Thastum, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Flow Diagram of Response and Completion Rate
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
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
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