The Effects of Developmentally Oriented Cognitive Therapy on Safety Behaviours of Adolescents with Social Anxiety Disorder: A Developmentally Oriented Cognitive Therapy - DOCT-SAD

Abstract

Introduction. Social anxiety disorder (SAD) is defined in the DSM-5 as an intensive and persistent fear of one or multiple social situations, that causes suffering and functional impairment for the individual. Adolescence is a particularly sensitive time for the onset of SAD, due to the increasing need for peer acceptance and support. In addition, the young person’s further evolving cognition and independence from their parents increases the risk of SAD. Left untreated, SAD can have multiple negative life-long impacts on one’s academic success, social relationships, and family life. According to the Cognitive Model of SAD by Clark and Wells (1995), primary maintaining factors of SAD are in-situation safety behaviours, increased attentional focus on oneself and bias negative cognitions related to self and others. A cognitive therapy treatment program focusing on these factors specified by the cognitive model of SAD has been found effective among adults in several studies. For adolescents, there is preliminary evidence on efficacy. An emerging need for more developmentally sensitive treatments for adolescents. A Developmentally Oriented Cognitive Therapy for Social Anxiety Disorder DOCT-SAD (in Finnish: Tosi Minä- treeni) was developed. The aim of this case series was to examine the effects of the DOCT-SAD -treatment on the symptoms of SAD and safety behaviours in the participants, and to further examine the different subscales of safety behaviours in the participants. Methods. Ten (n = 10) adolescents from upper secondary schools in Tampere participated in the treatment (13-15 years old, mean age = 13.8, SD = 0.92, one male, nine females). DOCT-SAD consists of 10 sessions: four individual sessions and six group sessions. In the first two individual sessions diagnostic assessments were made, interviewing the parent(s) and the adolescents face-to-face. In addition to the diagnostic assessment, the researchers evaluated the severity of SAD with CSRs. The participants were also given a set of self-report measures, including the SPIN and the SAFE measures. Pre- and post-treatment scores were collected from the participants, and the diagnostic remission and remission according to SPIN were calculated. Results. The mean difference between pre- and post-treatment scores were significantly different in SPIN (d = 1.614), SAFE (d = 1.614) and CSRs (d = 1.497). Six out of ten (60%) participants were in diagnostic remission and in remission according to SPIN. Conclusion. This study provides emerging evidence that the participants benefited from a short 10-session cognitive therapy. Further studies are needed, with larger sample sizes and control groups.