Psy-Q: What are the benefits of using Internet-based CBT to treat social anxiety disorder in youth? Martina Nordh, PhD, answers.

Martina Nordh, PhD (credit: Stefan Zimmerman)

Martina Nordh, PhD (photographer: Stefan Zimmerman)

Answer: According to a recent study, Internet-based CBT (ICBT) was found to be efficacious and cost-effective for treating social anxiety disorder (SAD) in children and adolescents. The study’s lead author, Martina Nordh, PhD, a licensed psychologist at the Department of Clinical Neuroscience at the Karolinska Institutet in Stockholm, shares more details with Psycom Pro.

Psycom Pro: Your team wrote that to your knowledge, no other previous study had used an active comparator when evaluating ICBT for SAD. Can you talk about why it was important to have an active comparator, in this case internet-delivered supportive therapy (ISUPPORT), as part of your study design?

Dr. Nordh: Our aim was to capture the effect of ICBT beyond the effect of general components in psychosocial interventions. Such general components include validation of the patient’s experiences and challenges, giving information about the disorder and asking the patient to report about his/her mental health symptoms. Even though such components can be important in terms of supporting the patient and providing hope, we wanted to evaluate the effect of CBT specific components, such as exposure to social situations and social interaction, that are thought to constitute the “active substance” in ICBT treatment.

Psycom Pro: Were the core findings surprising to your team?

Dr. Nordh: A couple of previous studies had showed that ICBT for SAD in young persons was more efficacious than a waitlist control. However, ICBT for SAD was not evaluated against an active comparator previously, nor were there any studies on the cost-effectiveness of ICBT for SAD. So even though our hypothesis was that ICBT would be superior, we actually did not know how the results would come out. The finding that ICBT was effective for not only social anxiety, but also for functional impairment, general anxiety, as well as for depression among the patients, came as something of a surprise for us.

See also, how dialectical behavioral therapy (DBT) may be helpful in treating adolescent depression and suicidal ideation.

Psycom Pro: How important was parental involvement in the effectiveness of the ICBT or ISUPPORT treatments?

Dr. Nordh: The study was not designed to formally test the impact of parental support on the treatment outcomes. However, our clinical experience from the current and previous ICBT trials is that parents can play an important role as “co-therapists” in the treatment, both in terms of supporting the youths to complete and engage with the online material and in terms of implementing the strategies in everyday life. Also, the parental material in the ICBT program provided the parents with strategies to reduce accommodation to the child’s anxiety and encouraged parents to support brave behaviors in the children. In that sense, we believe that it is important to involve parents to increase the youth’s adherence and compliance to the treatment.

Psycom Pro: What should therapists keep in mind when considering using ICBT with children and adolescents with a social anxiety disorder?

Dr. Nordh: ICBT as a treatment format is easily accessible and can be seen as a low-intensity treatment that could for instance be deployed as a first-step intervention for SAD in young people. From our current and previous trials, we can conclude that ICBT, in addition to being efficacious, is acceptable, feasible, and quite engaging for children and adolescents. However, the initial assessment of patients should aim to identify those who are suitable for a low-intensity treatment like ICBT and those who might need more intensive treatment. In terms of preparatory work, ICBT needs to be provided from an online platform that holds sufficient safety standards in line with local legislation.

Last Updated: Sep 9, 2021