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Therapist-Guided In...
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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 ...
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American Medical Association (AMA),2021
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:su-193986
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https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-193986URI
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https://doi.org/10.1001/jamapsychiatry.2021.0469DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-91807URI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:146540817URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-175812URI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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Funding Agency:Region Stockholm 2017-0605 HNSV 14099
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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]
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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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Wahlund, ToveKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Jolstedt, MaralKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Sahlin, HannaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Bjureberg, JohanKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Ahlen, JohanKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Karolinska Inst, Sweden
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Lalouni, MariaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Karolinska Inst, Sweden
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Salomonsson, SigridKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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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
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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
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Öst, Lars-GöranStockholms universitet,Klinisk psykologi,Department of Psychology, Stockholm University, Stockholm, Sweden,Stockholm Univ, Sweden(Swepub:su)ost
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Lenhard, FabianKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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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
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Mataix-Cols, DavidKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Högström, JensKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Serlachius, EvaKarolinska Institutet,Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
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Karolinska InstitutetKarolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden
(creator_code:org_t)
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In:JAMA psychiatry: American Medical Association (AMA)78:7, s. 705-7132168-62382168-622X
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Nordh, Martina
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Wahlund, Tove
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Jolstedt, Maral
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Sahlin, Hanna
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Bjureberg, Johan
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Ahlen, Johan
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Lalouni, Maria
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Salomonsson, Sig ...
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Vigerland, Sarah
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Lavner, Malin
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Öst, Lars-Göran
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Lenhard, Fabian
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Hesser, Hugo, 19 ...
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Mataix-Cols, Dav ...
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Högström, Jens
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Serlachius, Eva
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Stockholm University
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