Online Cognitive Therapy for Social Anxiety Disorder in Adolescence: A Clinical Case Study Using the CT@TeenSAD

Abstract

SAD is an intense fear or anxiety associated with past, current, or future social situations. The Clark and Wells (1995) cognitive model for SAD has been proved to be clinically effective in adults, and its developmentally sensitive adaptations for adolescents have recently shown promising results. Given this evidence and considering that adolescence is typically the age of onset for the first SAD symptoms and a critical developmental period for the delivery of evidence-based interventions, we adapted CT for adolescents for online intervention (CT@TeenSAD) encompassing 10 weekly, 90 min sessions, extended by two booster sessions. This work presents the first case study of that intervention as applied to Merida (M.; pseudonym; 17-year-old, girl). The estimated Reliable Change Index shows M.’s progress for most of her symptoms, from pre-to post-treatment (RCI-1 range: −.53 to −8.03), and the maintenance of benefits at 3 months follow-up (RCI-2 range: .00 to −2.25). A relapse in the adoption of safety behaviors was seen between post-treatment and follow-up, which might be explained by the life-changing challenges experienced by M. between session 10 and follow-up, concerning her transition from high school to college. M.’s case study offers a first glance on the promising results of CT@TeenSAD related to its efficacy and feasibility. Likewise, it offers the opportunity to critically appraise the limitations of the intervention as well as practical challenges and suggestions thought to be useful for therapists willing to implement CT@TeenSAD in the future.

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

“…The current work showed preliminary efficacy of synchronous and remotely CT delivered to adolescents with SAD; this online synchronous approach had been preliminarily shown feasible and useful using a case study approach ( Ganho-Ávila et al, 2022 ). Specifically, we found preliminary evidence that both adolescents and therapists perceived a continuous decrease/improvement in social anxiety symptoms throughout the course of 10-intervention sessions.…”

The Prevalence of Adolescent Social Fears and Social Anxiety Disorder in School Contexts

“…Specifically, on the one hand, it may be useful to consider not only those adolescents presenting with SAD but also those presenting with intense social fears, and how they may benefit from similar or specific intervention approaches. Cognitive therapy was found to be effective in adult SAD [70] as well as promising in adolescent SAD, whether when delivered in person [71,72] or remotely [73]. Other approaches are also showing potential and should be further explored (e.g., acceptance and commitment therapy [74]).…”

Serotonin-related Mechanisms in the Etiology and Pharmacotherapy of Social Phobia, A Review: Serotonin and Social Phobia

“…It is believed that symptoms including shame characterizing social phobia could hinder the proactive help request by patients with SAD [9]. In addition, proper management of SAD may be compromised in recurrent psychiatric comorbidity due to clinicians' focus on secondary complications including alcoholism [10,11]. Nevertheless, functional solutions have been proposed, including the definition of biomarkers that can distinguish between these diseases, which may contribute to both correct diagnosis and selection of appropriate therapy, and also it could play a role in tracking patient status [12,13].…”