School Intervention for Youth with Social Anxiety Disorder

Article summary provided by Hillary Greene

THE MAIN POINT:

Social anxiety disorder affects a large number of adolescents and often causes personal distress and difficulties in functioning. However, these youth often do not receive available treatment for their social anxiety. In order to help increase treatment accessibility for this vulnerable population, recent research has examined the effects of a school-based intervention for youth with social anxiety disorder. This treatment program, Skills for Social and Academic Success (SASS), has been shown to be an effective option for treating social anxiety within a school system. Key aspects of this treatment are the involvement of real life social situations and involvement from multiple levels of the youth’s environment through working with parents, teachers, and peers. See details below, which reflect information described in recent studies (Masia-Warner, Fisher, Shrout, Rathor, & Klein, 2007; Masia-Warner et al., 2005; Ryan & Masia-Warner, 2012).

THE DETAILS:

What are some of the issues with social anxiety disorder and treatment among youth?

Although as many as 12% of adolescents have social anxiety disorder, very few of these youth receive referrals for treatment or pursue treatment for their social anxiety. This gap between a high need for treatment and low rates of receiving treatment is common among youth with mental health difficulties. To address the strong need for research-supported treatments for social anxiety disorder in youth, several child and adolescent treatment programs have been developed and tested. These treatments usually rely on youth being treated at a mental health center in the community. However, these centers often have long waitlists, adolescents often are unwilling to participate in treatment in a mental health setting, and those youth who begin treatment often do not complete treatment (Masia-Warner et al., 2007; Masia-Warner et al., 2005; Ryan & Masia-Warner, 2012).

How might school-based interventions for social anxiety disorder be helpful?

In order to increase availability and use of mental health care for youth with social anxiety disorder, researchers suggest conducting structured treatment programs within school settings (Masia-Warner et al., 2005). This idea is consistent with government recommendations (U.S. Department of Health and Human Services, 1999) that describe schools as being a key location for recognizing need for and providing mental health care for youth. These researchers argue that schools provide a good environment for treating social anxiety disorder for several reasons. Adolescents might be more likely to engage in treatment at school versus at a mental health center. Schools allow for practicing skills and facing social fears in real-life situations. Students at school can be treated in small groups to maximize time and resources and to increase positive social interactions with actual peers. Parents, teachers, and peers are more readily available to become involved with treatment efforts, to broaden their knowledge regarding social anxiety disorder characteristics, and to learn useful approaches for supporting persons with social anxiety (Masia-Warner et al., 2007; Masia-Warner et al., 2005; Ryan & Masia-Warner, 2012).

What is the Skills for Social and Academic Success (SASS) program?

The Skills for Social and Academic Success (SASS) program is a school-based intervention designed to treat youth with social anxiety disorder. The SASS treatment program was adapted from a similar treatment for children with social anxiety called Social Effectiveness Therapy for Children (SET-C), which had strong research support when used in clinical settings.
The SASS program consists of the following components (Ryan & Masia-Warner, 2012):

• 12 weekly small group sessions in school (40 minutes) where leaders work with students in five areas:
o Psychoeducation: learning about social anxiety disorder, who it affects, and how it affects multiple areas of your functioning (i.e., thoughts, feelings, behaviors, and physical symptoms).
o Realistic thinking: learning to recognize and challenge your problematic negative thinking that leads to or worsens your anxiety.
o Social skills training: learning ways to engage effectively in conversations, maintain positive social interactions, and build relationships.
o Exposure: learning how to cope with anxiety in real life social situations that cause anxiety or fear until you can function well in those situations.
o Relapse prevention: learning how anxiety can come back sometimes and how to keep social anxiety from becoming problematic.

• Two small group follow-up sessions for support 1 and 2 months after treatment.

• Two brief individual sessions (20 minutes) to address goals and concerns.

• Four weekend social outings (90 minutes) with peers and leaders (e.g., bowling).

• Parents are asked to attend two group meetings to learn more about social anxiety disorder and how best to support their children.

• Teachers often are provided educational meetings about social anxiety disorder.

• Positive peer mentors are recruited to help with sessions and social outings.

What does the research say about the Skills for Social and Academic Success program?

Research studies have compared the SASS treatment for youth with social anxiety disorder to other treatment options. One study compared the SASS program to a wait-list control condition, which is a way of comparing the treatment to the effects of having no treatment while controlling for the passage of the same amount of time (Masia-Warner et al., 2005). This study found that the SASS program led to decreased symptoms of social anxiety and increased overall functioning for adolescents compared to those who received no treatment. Another study compared the SASS program to an educational and supportive control condition, which means that these adolescents received the same amount of time and attention as those in the SASS program but were not given the key parts of the treatment (Masia-Warner et al., 2007). This research design allows for comparing the effects of the treatment components thought to be most therapeutic versus the general effects of receiving help and attention from a professional. This study found that the SASS program led to greater decreases in social anxiety symptoms than the control condition, with the benefits lasting at least six months after treatment. Overall, these studies support the idea of using a school-based intervention for social anxiety disorder in youth, but more research still needs to be done to confirm these findings.

How might families and supporters use this research to help youth with social anxiety disorder?

Families who have youth suffering from social anxiety disorder should be encouraged by this research to pursue multiple possible treatment options for their adolescents, whether through mental health care settings or through school-based options. Parents also should consider using this research to advocate in their children’s schools for better identification and treatment of mental health problems, especially through programs such as SASS that have been shown to be helpful for a common youth mental health problem. For parents and teachers especially, these studies should serve to increase awareness regarding the severity of social anxiety struggles among youth and the need for intervention efforts at multiple levels of these children’s environments, at home, at school, and in community settings.

Where can families and supporters learn more about this research?

The studies discussed here are available at these links:
http://www.ncbi.nlm.nih.gov/pubmed/17593148
http://www.ncbi.nlm.nih.gov/pubmed/16328746
http://www.ncbi.nlm.nih.gov/pubmed/22137815

REFERENCES

Masia-Warner, C., Fisher, P. H., Shrout, P. E., Rathor, S., & Klein, R. G. (2007). Treating Adolescents with Social Anxiety Disorder in school: an attention control trial. Journal of Child Psychology and Psychiatry, 48(7), 676-686.
Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., & Guardino, M. (2005). School-Based Intervention for Adolescents with Social Anxiety Disorder: Results of a Controlled Study. Journal of Abnormal Child Psychology, 33(6), 707-722.
Ryan, J. L., & Masia-Warner, C. (2012). Treating Adolescents with Social Anxiety Disorder in Schools. Child and Adolescent Psychiatric Clinics of North America 21(1), 105-118.