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  • Nordh, MartinaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)

Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy vs Internet-Delivered Supportive Therapy for Children and Adolescents With Social Anxiety Disorder : A Randomized Clinical Trial

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • American Medical Association (AMA),2021
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:su-193986
  • https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-193986URI
  • https://doi.org/10.1001/jamapsychiatry.2021.0469DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-91807URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:146540817URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-175812URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Funding Agency:Region Stockholm 2017-0605 HNSV 14099
  • Funding Agencies|Swedish Research Council for Health, Working Life, and WelfareSwedish Research CouncilSwedish Research Council for Health Working Life & Welfare (Forte) [Forte 2014-4052]; Region Stockholm [2017-0605, HNSV 14099]
  • Importance  Social anxiety disorder (SAD) is a prevalent childhood-onset disorder associated with lifelong adversity and high costs for the individual and society at large. Cognitive behavioral therapy (CBT) is an established evidence-based treatment for SAD, but its availability is limited.Objective  To assess the efficacy and cost-effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (ICBT) for SAD in youths vs an active comparator, internet-delivered supportive therapy (ISUPPORT).Design, Setting, and Participants  This single-masked, superiority randomized clinical trial enrolled participants at a clinical research unit integrated within the child and adolescent mental health services in Stockholm, Sweden, from September 1, 2017, to October 31, 2018. The final participant reached the 3-month follow-up (primary end point) in May 2019. Children and adolescents 10 to 17 years of age with a principal diagnosis of SAD and their parents were included in the study.Interventions  ICBT and ISUPPORT, both including 10 online modules, 5 separate parental modules, and 3 video call sessions with a therapist.Main Outcomes and Measures  The Clinician Severity Rating (CSR), derived from the Anxiety Disorder Interview Schedule, rated by masked assessors 3 months after the end of treatment. The CSR ranges from 0 to 8, with scores of 4 or higher indicating caseness. Secondary outcomes included masked assessor–rated diagnostic status of SAD and global functioning, child- and parent-reported social anxiety and depressive symptoms, and health-related costs.Results  Of the 307 youths assessed for eligibility, 103 were randomized to 10 weeks of therapist-guided ICBT (n = 51) or therapist-guided ISUPPORT (n = 52) for SAD. The sample consisted of 103 youths (mean [SD] age, 14.1 [2.1] years; 79 [77%] female). Internet-delivered cognitive behavioral therapy was significantly more efficacious than ISUPPORT in reducing the severity of SAD symptoms. Mean (SD) CSR scores for ICBT at baseline and at the 3-month follow-up were 5.06 (0.95) and 3.96 (1.46), respectively, compared with 4.94 (0.94) and 4.48 (1.30) for ISUPPORT. There was a significant between-group effect size of d = 0.67 (95% CI, 0.21-1.12) at the 3-month follow-up. Similarly, all of the secondary outcome measures demonstrated significant differences with small to large effect sizes, except for child-rated quality of life (nonsignificant). The cost-effectiveness analyses indicated cost savings associated with ICBT compared with ISUPPORT, with the main drivers of the savings being lower medication costs (z = 2.38, P = .02) and increased school productivity (z = 1.99, P = .047) in the ICBT group. There was 1 suicide attempt in the ISUPPORT group; no other serious adverse events occurred in either group.Conclusions and Relevance  In this randomized clinical trial, internet-delivered cognitive behavioral therapy was an efficacious and cost-effective intervention for children and adolescents with SAD. Implementation in clinical practice could markedly increase the availability of effective interventions for SAD.Trial Registration  ClinicalTrials.gov Identifier: NCT03247075

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Wahlund, ToveKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Jolstedt, MaralKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Sahlin, HannaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Bjureberg, JohanKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Ahlen, JohanKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Karolinska Inst, Sweden (author)
  • Lalouni, MariaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Karolinska Inst, Sweden (author)
  • Salomonsson, SigridKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Vigerland, SarahCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Lavner, MalinCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Öst, Lars-GöranStockholms universitet,Klinisk psykologi,Department of Psychology, Stockholm University, Stockholm, Sweden,Stockholm Univ, Sweden(Swepub:su)ost (author)
  • Lenhard, FabianKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Hesser, Hugo,1982-Linköpings universitet,Örebro universitet,Institutionen för juridik, psykologi och socialt arbete,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden,Center for Health and Medical Psychology,Psykologi,Filosofiska fakulteten,Orebro Univ, Sweden(Swepub:liu)hughe47 (author)
  • Mataix-Cols, DavidKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Högström, JensKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Serlachius, EvaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (author)
  • Karolinska InstitutetKarolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden (creator_code:org_t)

Related titles

  • In:JAMA psychiatry: American Medical Association (AMA)78:7, s. 705-7132168-62382168-622X

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