Internet‐delivered therapist‐assisted cognitive therapy for adolescent social anxiety disorder (OSCA): a randomised controlled trial addressing preliminary efficacy and mechanisms of action

Abstract

Background: Cognitive therapy for SAD (CT-SAD) is a first-line recommended treatment for adult social anxiety disorder (SAD) and shows considerable promise for youth. However, the high prevalence of adolescent SAD and limited number of therapists presents an implementation challenge. Delivery of CT-SAD via the Internet may offer part of the solution. Method: Forty-three youth (14-18 years) with SAD recruited through schools were randomly allocated to therapist-assisted Internet-delivered CT-SAD (called OSCA) or waitlist for 14 weeks (ISRCTN15079139).Results: OSCA outperformed waitlist on all measures and was associated with large effects that were maintained at 6-month follow-up. In the OSCA arm, 77% of adolescents lost their SAD diagnosis at post (vs. 14% in the waitlist arm), increasing to 91% at 6-months. Beneficial effects of OSCA were mediated through changes in cognitions and safety behaviours as predicted by cognitive models of SAD. OSCA was associated with high credibility and therapeutic alliance. Conclusions: This preliminary trial suggests OSCA holds promise as an effective, accessible treatment for adolescent SAD. Future definitive trials could compare OSCA to active comparators to examine specificity of effects.

Remotely delivered cognitive therapy for social anxiety disorder in adolescence: Preliminary efficacy evidence based on changes throughout treatment

“…Though this research project included a wait-list control group, participants in that group were not asked to weekly report on their social anxiety symptoms or how they had been changing; likewise, no therapist weekly evaluated their symptoms or change thereof. As such, we are not able to compare that control group with the current intervention group concerning change throughout treatment, unlike what was done in this respect by Leigh and Clark (2022). Such comparison might be accomplished in the future by using a psychological placebo intervention, which would allow for a more conclusive understanding of the benefits of CT on the naturally unremitting course of SAD (Goldin et al, 2014;Stein et al, 2017) and/or in comparison with alternative intervention conditions (e.g., attention control as used by Warner et al, 2007).…”

“…Furthermore, findings generally concur with previous evidence on the applicability of CT to adolescents ( Leigh and Clark, 2018a , b ) and of its efficacy indicators ( Leigh and Clark, 2016 ; Leigh et al, 2021 ). The continuous change throughout treatment for SAD had been advanced before for adults receiving cognitive-behavioral individual therapy ( Goldin et al, 2014 ) and for adolescents receiving internet-delivered CT ( Leigh and Clark, 2022 ). Current findings also add evidence to the progressive and wholistic nature of CT, in which previously learnt skills (e.g., flexibility in attention allocation) may support successful experiences later in therapy (e.g., behavioral experiments).…”

“…More recently, Leigh and Clark (2022) found internet-delivered CT-SAD for adolescents to outperform a waitlist condition concerning several symptoms associated with social anxiety and in relation to remission of SAD diagnosis for 77% of participants at postintervention. This form of delivered is based on an online platform that adolescents use to go through core intervention models.…”

“…The present work aimed to explore preliminary efficacy data regarding self and therapists’ reports on the change of social anxiety symptoms across an online 10-session manualized CT program (CT@TeenSAD) applied to adolescents with generalized SAD. Based on previous promising findings for the CT-SAD for adolescents ( Leigh and Clark, 2016 ; Leigh et al, 2021 ) and on findings that point to social anxiety symptoms progressively diminishing during the course of cognitive-behavioral treatment ( Zaider et al, 2003 ; Hayes et al, 2008 ) and of internet-delivered CT ( Leigh and Clark, 2022 ), we expected both self and therapists’ ratings of social anxiety symptoms to decrease as intervention progresses (see Intervention section below). As secondary goals, we aimed to explore the effect that other relevant variables may have on change throughout the intervention, namely gender and therapist.…”

Study of the psychomotor abilities of athletes in cyclic sports, martial arts and esports

“…In esports, both specific and general components of motor activity play an important role. Experienced video game players outperform amateurs on a variety of cognitive and perceptual tasks, including visual selective attention (Leigh & Clark, 2022), visual stimulus detection, visual search efficiency, contrast sensitivity, cognitive flexibility, visual conciseness (Bediou et al, 2018), and attention switching and multisensory integration (Di Luzio et al, 2021).…”