Cognitive behavioral therapy for youth with social anxiety: Differential short and long-term treatment outcomes

This study examined social anxiety symptoms and/or diagnosis as a predictor of differential short- and long-term cognitive-behavioral treatment (CBT) outcomes. Ninety-one anxiety-disordered youth participated in a randomized clinical trial of CBT. Semi-structured interviews provided dimensional clinical severity ratings (CSRs) for children's principal anxiety disorder at pretreatment, posttreatment, 1-year and 7.4-year follow-up assessments for youth with versus without pretreatment social anxiety. Thirty-nine youth presented with either principal (n = 17), secondary (n = 11), or tertiary social phobia diagnoses (n = 7) or subclinical social anxiety symptoms (n = 4). Hierarchal linear modeling (HLM) indicated that youth made similar gains from pretreatment to posttreatment and 1-year follow-up regardless of their social anxiety symptoms or diagnosis; however, youth with social anxiety symptoms or diagnosis were significantly less improved at 7.4-year follow-up. This pattern was distinct from that of youth with the most severe (CSR = 4) principal anxiety disorders at pretreatment. Though initially responsive to CBT, children who present with social anxiety diagnoses or symptoms may require an enhanced or extended treatment to maintain their gains into young adulthood whether or not social anxiety is considered their principal childhood difficulty.

► Anxious youth with versus without social anxiety have more severe pretreatment anxiety.
► Youth with social anxiety treated with CBT show a similar rate of improvement.
► Youth with social anxiety maintain gains similarly 1 year after treatment.
► But, youth with social anxiety show less maintenance at 7.4-year follow-up.
► This difference in treatment maintenance is not due to greater initial anxiety.