Social Anxiety and Social Phobia in Youth: Characteristics, Assessment, and Psychological Treatment Edition 1 by Christopher Kearney

Author:Christopher Kearney
Language: rus
Format: mobi
ISBN: 9781441935526
Publisher: Springer US
Published: 2010-12-05T22:00:00+00:00

CHAPTER 6

pre-treatment levels of child internalizing symptoms, maternal depression,

and older child age (Southam-Gerow, Kendall, & Weersing, 2001).

Second, Barrett, Dadds, and Rapee (1996) compared cognitive-

behavioral treatment (CBT), CBT with family-based treatment, and no

treatment for youths aged 7–14 years with various anxiety disorders, in-

cluding social phobia. Child-based treatment was similar to Kendall’s ap-

proach (Coping Koala Workbook). Family-based treatment consisted of

parent training to reinforce approach behaviors and extinguish anxiety-

based behaviors, to address parent-based anxiety responses and model

appropriate responses to anxiety, and to improve family communication

and problem-solving skills. Results from 12-sesssion treatment indicated

that both groups improved significantly on various dependent measures

compared to controls. In addition, family-based treatment substantially

enhanced the effects of CBT alone. For example, elimination of anxiety

diagnoses at posttreatment was 57% for the CBT group and 84% for the

CBT plus family treatment approach. Subsequent studies have generally

supported these treatment approaches as well (Barrett, Duffy, Dadds, &

Rapee, 2001; Cobham et al., 1998; Dadds et al., 1999; Dadds, Spence, Hol-

land, Barrett, & Laurens, 1997).

Finally, Silverman and colleagues (1999a, 1999b) conducted two treat-

ment outcome studies of youths aged 6-16 years with various anxiety disor-

ders, including social phobia. The first study consisted of group CBT with

parent-based contingency management procedures (GCBT), and the sec-

ond study consisted of 10-session exposure-based cognitive self-control

(SC) procedures versus exposure-based contingency management (CM).

All treatments except CM were substantially more effective than control

conditions. Elimination of anxiety diagnoses at posttreatment was 64% for

GCBT, 88% for SC, and 56% for CM. Poorer treatment outcome seems best

predicted by levels of child depression and trait anxiety and by parental de-

pression, hostility, and paranoia (Berman, Weems, Silverman, & Kurtines,

2000).

A consensus has thus formed that child-based and parent/family-

based cognitive-behavioral procedures are effective for treating youths

with anxiety disorders, and may even inform prevention efforts (e.g.,

Albano & Kendall, 2002; Barrett, 2000; Essau & Petermann, 2001; Hudson,

Kendall, Coles, Robin, & Webb, 2002; Nauta, Scholing, Emmelkamp, &

Minderaa, 2003; Ollendick & March, 2004; Silverman & Treffers, 2001;

Toren et al., 2000). Practice parameters for treating this population also

concentrate heavily on education, exposure-based procedures, family in-

terventions, and pharmacotherapy (American Academy of Child and Ado-

lescent Psychiatry, 1997). Applying these procedures to youths with specific

anxiety disorders such as social phobia has thus begun in earnest.

THE TREATMENT OF SOCIAL ANXIETY AND SOCIAL PHOBIA IN YOUTHS

117

TREATMENT OUTCOME STUDIES FOR YOUTHS WITH

SOCIAL PHOBIA

Several treatment outcome studies have been conducted specifically

for youths with social phobia. Albano and colleagues (1995), for example,

evaluated a 16-session group treatment protocol for five adolescents with

social phobia. Uncontrolled treatment consisted of psychoeducation about

the nature of social anxiety, rationale for treatment, skills building with

modeling, role play, and shaping (i.e., social and problem-solving skills,

assertiveness training, and cognitive therapy), and in-session and external

in vivo exposures to feared social situations. Parents also received psychoe-

ducation and treatment rationales and were prepared for exposure-based

sessions. At three-month follow-up, 4 of 5 participants no longer met for-

mal diagnostic criteria for social phobia.

This cognitive-behavioral group treatment approach has been ex-

panded and refined with time (Albano, 1995; Albano & Barlow, 1996;

Albano et al., 1999). The primary structure of this treatment consists of

two, 8-session phases, the first of which includes psychoeducation, skills

building, and snack time practice.

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