Examining two of the ingredients of Cognitive therapy for adolescent social anxiety disorder: Back-translation from a treatment trial

Background

Cognitive Therapy for Social Anxiety Disorder (CT-SAD) based on the Clark & Wells model is a complex intervention comprised of a series of therapeutic elements. Two of the key ingredients are the self-focused attention and safety behaviour experiment and video feedback. The present study examined the effects of these two therapeutic procedures in adolescents with SAD, as well as common themes of the young people's social fears and negative self-images.

Method

35 participants with a diagnosis of SAD completed internet-delivered CT-SAD as part of a randomised controlled trial. We conducted a series of paired samples t-tests to evaluate the effects of the self-focused attention and safety behaviour experiment and video feedback. We applied Latent Dirichlet Allocation to identify latent topics based on participants' description of their social fears and negative self-images that were elicited during the course of these therapy procedures.

Results

Participants reported lower anxiety and more positive self-appraisals when focusing externally and dropping safety behaviours, compared to when focusing internally and using safety behaviours (ps < 0.0025). After they watched the videos compared to before, they reported more positive appraisals of their appearance and performance (ps < 0.0025). The differences in these outcomes were significantly larger when they focused internally and used safety behaviours, compared to focusing externally and dropping safety behaviours (ps < 0.0025). Topic modelling identified six social fear topics and five negative self-image topics.

Conclusions

Self-focused attention, safety behaviours, and negative self-imagery are modifiable with the ‘self-focused attention and safety behaviour experiment’ and ‘video feedback’ as part of internet delivered CT-SAD.