Internet-delivered CBT effective for youths with social anxiety disorder

A 10-week course of internet-delivered cognitive behavioural therapy (ICBT) is an efficacious and cost-effective intervention for children and adolescents with social anxiety disorder (SAD) compared with internet-delivered supportive therapy (ISUPPORT), results of a recent randomized clinical study have shown.

“ICBT has the potential to overcome common treatment barriers and increase the availability of evidence-based psychological treatment for children and adolescents with SAD,” suggested the authors. [JAMA Psychiatry 2021;doi:10.1001/jamapsychiatry.2021.0469]

In the study, 103 youths (mean age, 14.1 years; female, 76.7 percent) with a principal diagnosis of SAD and their parents were randomized to receive 10 weeks of therapist-guided ICBT (n=51) or therapist-guided ISUPPORT (n=52). Patients were recruited at a clinical research unit within the Child and Adolescent Mental Health Services in Stockholm, Sweden, from September 2017 to October 2018. Both ICBT and ISUPPORT included 10 online modules, five separate parental modules and three video call sessions, with a therapist providing asynchronous support throughout the treatments.

ICBT was significantly more efficacious in reducing the severity of SAD symptoms than ISUPPORT. The mean Clinician Severity Rating (CSR) score, derived from the Anxiety Disorder Interview Schedule, for ICBT was reduced from 5.06 at baseline to 3.96 at 3-month follow up, compared with 4.94 and 4.48, respectively, for ISUPPORT.

A significant between-group effect size of d=0.67 (95 percent confidence interval [Cl] 0.21 to 1.12) in CSR score was demonstrated at 3-month follow-up, favouring ICBT.

Statistically significant between-group differences with small to large effect sizes were also shown in secondary outcomes, including masked assessor-rated diagnostic status of SAD and global functioning, child- and parent-reported social anxiety and depressive symptoms, and health-related costs, but not in child-rated quality of life as assessed by the Child Health Utility 9D score (β, -0.58; p=0.26).

Cost-effectiveness analysis indicated that ICBT was associated with total social cost savings while generating more participants free of SAD compared with ISUPPORT, with the main drivers of cost savings being lower medication costs (z=2.38; p=0.02) and increased school productivity (z=1.99; p=0.047) in the ICBT group.

There was one suicide attempt reported in the ISUPPORT group. No other serious adverse event occurred in either group.