Telman et al. (2020). Modular CBT for youth social anxiety disorder: A case series examining initial effectiveness.” – Article summary

Social anxiety disorder (SAD) refers to a persistent, intense fear of social situations in which the individual may be negatively evaluated by others. This fear must occur in peer settings and not just in adult settings for children. The prevalence rate is 10% in adolescence and first incidence after the age of 21 is very low.

Not treating SAD is associated with impairments in interpersonal functioning (1), loneliness (2), school refusal (3), drop-out (4), lower educational level (5), subsequent anxiety (6), subsequent depressive disorders (7) and subsequent substance use disorders (8). It typically persists into adulthood when it is left untreated.

Cognitive behavioural therapy (CBT) is the most efficacious treatment for anxiety disorders in children and adolescents. About 50-70% of the children with an anxiety disorder are free of it after treatment. CBT for childhood anxiety disorders typically consists of skill-building (1), psychoeducation (2), cognitive restructuring (3), coping (4) and exposure (5). However, general CBT is less effective for SAD than for other anxiety disorders.

Modular treatment may allow for the therapist to spend more time on more problematic areas in the child with SAD. This may lead to better outcomes. Including mindfulness in CBT treatment for SAD may also be useful as there are six change mechanisms of attentional processes training in SAD:

• Reducing hypervigilance by focusing on broader aspects of self and environment.
• Increasing mindfulness to counter mindless ruminating.
• Increasing attention control.
• Increasing self-esteem through enhanced concentration.
• Reducing self-focused attention.
• Reducing attentional avoidance.

A relatively short modular CBT is effective for 50% of the youth with SAD (i.e. they were free of diagnosis) and for 80% at a 10-week follow-up. Children receiving modular treatment showed faster improvements than youth in usual care. It is not clear whether the personalization by the therapists to the individual client or the inclusion of mindfulness led to the results.