Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy and Internet-Delivered Support Therapy for Children and Adolescents with Social Anxiety Disorder
In this randomized clinical trial, cognitive behavioral therapy delivered over the Internet was an effective and cost-effective intervention for children and adolescents with SAD. Its implementation in clinical practice may significantly increase the availability of effective interventions for SAD.
Nordh M, Wahlund T, Jolstedt M, et al. Therapist-guided Internet-delivered cognitive behavioral therapy and Internet-delivered support therapy for children and adolescents with social anxiety disorder: a randomized clinical trial. JAMA Psychiatry. Published online May 12, 2021. doi: 10.1001 / jamapsychiatry.2021.0469
Commentary
One of the most common childhood disorders is social anxiety disorder (SAD), which is characterized by symptoms of life adversity and social disorganization, and for which cognitive behavioral therapy (CBT) may be indicated as a treatment. This treatment is supported by scientific evidence of effectiveness, but is limited in its conditions. This study was designed to evaluate the effectiveness and cost-effectiveness of Internet-delivered cognitive-behavioral therapy (ICBT) and active comparator Internet-delivered supportive therapy (ISUPPORT) by therapists for clients.
As a result, of the 307 adolescents assessed, 103 were randomly assigned to 10 weeks of therapist-led ICBT (n = 51) or therapist-led ISUPPORT (n = 52) for SAD. The age of participants was 14.1 [2.1] years and 77% were female.
Internet-delivered cognitive behavioral therapy was found to be significantly more effective than ISUPPORT in reducing symptom severity. Furthermore, secondary outcome measures showed significant differences in effect sizes from small to large, except for quality of life, which was assessed by children.
The cost-effectiveness analysis also showed cost savings for ICBT, with savings factors such as reduced medication use and resumption of school attendance. However, while one suicide attempt was reported in the ISUPPORT group, no other serious adverse events were reported in either group.
The intervention consisted of three 20-30 minute video call sessions at weeks 3, 5, and 7, which were available for parents to view in parallel.
Based on this effectiveness, we feel that the use of online CBT may become more widespread.
