Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and acceptability of psychological interventions for social anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Social anxiety disorder (SAD) is highly prevalent and persistent in children and adolescents. However, evidence for the efficacy and acceptability of psychological interventions for SAD in children and adolescents remains unclear. Seven electronic databases (PubMed, CENTRAL, Embase, Web of Science, PsycINFO, CINAHL, and ProQuest) were searched. Randomized controlled trials (RCTs) that compared psychological interventions for SAD with control conditions in children and adolescents were included. Primary outcomes were the efficacy (mean change in anxiety symptom scores) and acceptability (dropouts for all reasons). Secondary outcomes were remission, quality of life/functional improvement, and depressive symptoms measures. Seventeen RCTs were included in this meta-analysis. Psychological interventions (including cognitive behavioral therapy and behavioral therapy) were significantly more effective than control conditions, with a standardized mean difference (SMD) of − 1.13, and remission with a risk ratio (RR) of 8.99, the number needed to treat was 3.3. There was no statistically significant difference between psychological interventions and control conditions for all-cause dropouts (RR = 1.00). Psychological interventions were superior to control conditions in improving quality of life/functioning (SMD = 0.79) and reducing depressive symptoms (SMD = − 0.39). Given considerable heterogeneity of primary efficacy outcome, a series of subgroup analyses of different variables were conducted. Psychological interventions are probably efficacious in the treatment of SAD among children and adolescents, and may markedly improve quality of life and functioning in this population. However, this finding should be interpreted with caution because of the high heterogeneity of trials and low literature quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wittchen HU, Stein MB, Kessler RC (1999) Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med 29:309–323

    Article  CAS  Google Scholar 

  2. Burstein M, He JP, Kattan G, Albano AM, Avenevoli S, Merikangas KR (2011) Social phobia and subtypes in the national comorbidity survey-adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry 50:870–880

    Article  Google Scholar 

  3. Davidson JR, Hughes DC, George LK, Blazer DG (1994) The boundary of social phobia. Exploring the threshold. Arch Gen Psychiatry 51:975–983

    Article  CAS  Google Scholar 

  4. National Institute for Health and Clinical Excellence (2013) Social anxiety disorder: recognition, assessment and intervention. National Institute for Health and Clinical Excellence, London

    Google Scholar 

  5. Nikolić M, Colonnesi C, de Vente W, Bögels SM (2016) Blushing in early childhood: feeling coy or socially anxious? Emotion 16:475–487

    Article  Google Scholar 

  6. Hidalgo RB, Barnett SD, Davidson JR (2001) Social anxiety disorder in review: two decades of progress. Int J Neuropsychopharmacol 4:279–298

    Article  CAS  Google Scholar 

  7. Garcia-Lopez LJ, Bonilla N, Muela-Martinez JA (2016) Considering comorbidity in adolescents with social anxiety disorder. Psychiatry Investig 13:574–576

    Article  Google Scholar 

  8. Gensthaler A, Maichrowitz V, Kaess M, Ligges M, Freitag CM, Schwenck C (2016) Selective mutism: the fraternal twin of childhood social phobia. Psychopathology 49:95–107

    Article  Google Scholar 

  9. Katzelnick DJ, Kobak KA, DeLeire T, Henk HJ, Greist JH, Davidson JR, Schneier FR, Stein MB, Helstad CP (2001) Impact of generalized social anxiety disorder in managed care. Am J Psychiatry 158:1999–2007

    Article  CAS  Google Scholar 

  10. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT (2016) Long-term disability in anxiety disorders. BMC Psychiatry 16:248

    Article  Google Scholar 

  11. Barrett PM, Rapee RM, Dadds MM, Ryan SM (1996) Family enhancement of cognitive style in anxious and aggressive children. J Abnorm Child Psychol 24:187–203

    Article  CAS  Google Scholar 

  12. Barrett PM (1998) Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. J Clin Child Psychol 27:459–468

    Article  CAS  Google Scholar 

  13. Scaini S, Belotti R, Ogliari A, Battaglia M (2016) A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disorder in children and adolescents. J Anxiety Disord 42:105–112

    Article  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  Google Scholar 

  15. Stangier U (2016) New developments in cognitive-behavioral therapy for social anxiety disorder. Curr Psychiatry Rep 18:25

    Article  Google Scholar 

  16. Beidel DC, Turner SM, Morris TL (1995) A new instrument to assess childhood social anxiety and phobia: the Social Phobia and Anxiety Inventory for Children. Psychol Assess 7:73–79

    Article  Google Scholar 

  17. La Greca AM, López N (1998) Social anxiety among adolescents: linkages with peer relations and friendships. J Abnorm Child Psychol 26:83–94

    Article  Google Scholar 

  18. Spence SH (1997) Structure of anxiety symptoms amongst children: a confirmatory factor-analytic study. J Abnorm Psychol 106:280–297

    Article  CAS  Google Scholar 

  19. Gren-Landell M, Björklind A, Tillfors M, Furmark T, Svedin CG, Andersson G (2009) Evaluation of the psychometric properties of a modified version of the Social Phobia Screening Questionnaire for use in adolescents. Child Adolesc Psychiatry Ment Health 3:36

    Article  Google Scholar 

  20. James AC, James G, Cowdrey FA, Soler A, Choke A (2015) Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 18:CD004690

    Google Scholar 

  21. Cuijpers P (2016) Meta-analyses in mental health research. A practical guide. https://indd.adobe.com/view/5fc8f9a0-bf1e-49d3-bf5f-a40bfe5409e0. Accessed 5 Sept 2017

  22. Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration, Oxford. https://www.cochrane-handbook.org. Accessed 16 Jul 2017

  23. Cipriani A, Zhou XY, del Giovane C, Hetrick SE, Qin B, Whittington C, Coghill D, Zhang YQ, Hazell P, Leucht S, Cuijpers P, Pu JC, Cohen D, Ravindran AV, Liu YY, Michael KD, Yang LN, Liu LX, Xie P (2016) Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet 388:881–890

    Article  CAS  Google Scholar 

  24. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–187

    Article  CAS  Google Scholar 

  25. Riley RD, Higgins JP, Deeks JJ (2011) Interpretation of random effects meta-analyses. BMJ 342:d549

    Article  Google Scholar 

  26. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  Google Scholar 

  27. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  Google Scholar 

  28. Beidel DC, Turner SM, Morris TL (2000) Behavioral treatment of childhood social phobia. J Consult Clin Psychol 68:1072–1080

    Article  CAS  Google Scholar 

  29. Hayward C, Varady S, Albano AM, Thienemann M, Henderson L, Schatzberg AF (2000) Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study. J Am Acad Child Adolesc Psychiatry 39:721–726

    Article  CAS  Google Scholar 

  30. Spence SH, Donovan C, Brechman-Toussaint M (2000) The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. J Child Psychol Psychiatry 41:713–726

    Article  CAS  Google Scholar 

  31. Baer S, Garland EJ (2005) Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. J Am Acad Child Adolesc Psychiatry 44:258–264

    Article  Google Scholar 

  32. Masia-Warner C, Klein RG, Dent HC, Fisher PH, Alvir J, Albano AM, Guardino M (2005) School-based intervention for adolescents with social anxiety disorder: results of a controlled study. J Abnorm Child Psychol 33:707–722

    Article  Google Scholar 

  33. Olivares J, Rosa-Alcázar AI, Piqueras JA (2005) Early detection and treatment of adolescents with generalized social phobia. Psicothema 17:1–8

    Google Scholar 

  34. Masia-Warner C, Fisher PH, Shrout PE, Rathor S, Klein RG (2007) Treating adolescents with social anxiety disorder in school: an attention control trial. J Child Psychol Psychiatry 48:676–686

    Article  Google Scholar 

  35. Rosa-Alcázar AI, Olivares-Olivares PJ, Olivares J (2009) The role of non-specific effects in the psychological treatment of adolescents with social phobia. Anales De Psicología 40:43–61

    Google Scholar 

  36. Herbert JD, Gaudiano BA, Rheingold AA, Moitra E, Myers VH, Dalrymple KL, Brandsma LL (2009) Cognitive behavior therapy for generalized social anxiety disorder in adolescents: a randomized controlled trial. J Anxiety Disord 23:167–177

    Article  Google Scholar 

  37. Sánchez-García R, Olivares J (2009) Effectiveness of a program for early detection/intervention in children/adolescents with generalized social phobia. Anales De Psicología 25:241–249

    Google Scholar 

  38. Melfsen S, Kühnemund M, Schwieger J, Warnke A, Stadler C, Poustka F, Stangier U (2011) Cognitive behavioral therapy of socially phobic children focusing on cognition: a randomised wait-list control study. Child Adolesc Psychiatry Ment Health 5:5

    Article  Google Scholar 

  39. Tillfors M, Andersson G, Ekselius L, Furmark T, Lewenhaupt S, Karlsson A, Carlbring P (2011) A randomized trial of Internet-delivered treatment for social anxiety disorder in high school students. Cogn Behav Ther 40:147–157

    Article  Google Scholar 

  40. Ingul JM, Aune T, Nordahl HM (2014) A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. Psychother Psychosom 83:54–61

    Article  Google Scholar 

  41. Olivares J, Olivares-Olivares PJ, Rosa-Alcázar AI, Montesinos L, Macià D (2014) The contribution of the therapist’s competence in the treatment of adolescents with generalized social phobia. Psicothema 26:483–489

    PubMed  Google Scholar 

  42. Öst LG, Cederlund R, Reuterskiöld L (2015) Behavioral treatment of social phobia in youth: does parent education training improve the outcome? Behav Res Ther 67:19–29

    Article  Google Scholar 

  43. Masia-Warner C, Colognori D, Brice C, Herzig K, Mufson L, Lynch C, Reiss PT, Petkova E, Fox J, Moceri DC, Ryan J, Klein RG (2016) Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial. J Child Psychol Psychiatry 57:1229–1238

    Article  Google Scholar 

  44. Spence SH, Donovan CL, March S, Kenardy JA, Hearn CS (2017) Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: a randomized controlled trial using internet delivery. Behav Res Ther 90:41–57

    Article  Google Scholar 

  45. Weisz JR, Kuppens S, Ng MY, Eckshtain D, Ugueto AM, Vaughn-Coaxum R, Jensen-Doss A, Hawley KM, Krumholz Marchette LS, Chu BC, Weersing VR, Fordwood SR (2017) What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice. Am Psychol 72:79–117

    Article  Google Scholar 

  46. Zhou XY, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, Cohen D, del Giovane C, Liu YY, Michael KD, Zhang YQ, Weisz JR, Xie P (2015) Comparative efficacy and acceptability of psychological interventions for depression in children and adolescents: a systematic review and network meta-analysis. World Psychiatry 14:207–222

    Article  Google Scholar 

  47. Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS (2013) A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry 58:376–385

    Article  Google Scholar 

  48. Cuijpers P, Cristea IA, Weitz E, Gentili C, Berking M (2016) The effects of cognitive and behavioural therapies for anxiety disorders on depression: a meta-analysis. Psychol Med 46:3451–3462

    Article  CAS  Google Scholar 

  49. Ougrin D (2011) Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry 11:200

    Article  Google Scholar 

  50. Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, Ades AE, Pilling S (2014) Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 1:368–376

    Article  Google Scholar 

  51. Barkowski S, Schwartze D, Strauss B, Burlingame GM, Barth J, Rosendahl J (2016) Efficacy of group psychotherapy for social anxiety disorder: a meta-analysis of randomized-controlled trials. J Anxiety Disord 39:44–64

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People’s Republic of China

    Lining Yang, Juncai Pu, Lanxiang Liu, Yuqing Zhang, Hanping Zhang, Shuai Yuan, Teng Teng, Lu Tian & Peng Xie

  2. Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China

    Xinyu Zhou

  3. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands

    Pim Cuijpers

Authors
  1. Lining Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinyu Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juncai Pu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lanxiang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pim Cuijpers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuqing Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hanping Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shuai Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Teng Teng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lu Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Peng Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LY and JP conceived the study. LY and JP drafted the manuscript. XZ and YZ assisted in the design and revision. LL and HZ participated in the search strategy development. SY and XJ designed the statistical analysis; PX and PC are the guarantors. The first four authors contributed equally to this study. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Pim Cuijpers or Peng Xie.

Ethics declarations

Conflict of interest

The authors have declared that they have no conflicts of interest regarding the content of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 3422 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, L., Zhou, X., Pu, J. et al. Efficacy and acceptability of psychological interventions for social anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials. Eur Child Adolesc Psychiatry 28, 79–89 (2019). https://doi.org/10.1007/s00787-018-1189-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-018-1189-x

Keywords

Search

Navigation