Title: Specific versus generic psychological therapy for adolescents with social anxiety disorder: A comparison of Clark & Wells’ condition-specific cognitive therapy adapted for adolescents, with the generic cognitive behaviour therapy that is currently used in adolescent services
Funder: Department of Health and Social Care

Abstract: The project has four primary aims: (i) to adapt and manualise Cognitive Therapy (CT) for social anxiety disorder for use with adolescents; (ii) to train CAMHS clinicians to deliver this treatment and to assess therapist competency using an adapted scale; (iii) to determine clinical and economic outcomes that are meaningful to patients; and (iv) to establish the feasibility of a randomised controlled trial to compare the adapted treatment to CAMHS usual treatment. Setting NHS CAMHS in Berkshire Healthcare and Oxford Health NHS Foundation Trusts. Target population We will include adolescents (aged 11- 17.5 years at intake) with a primary diagnosis of social anxiety disorder. If young people have been prescribed psychotropic medication this must have been at a stable dosage for two months. We will exclude young people who have previously received any form of CT or CBT for social anxiety disorder and those with established autistic spectrum disorders, learning disabilities, suicidal intent, recurrent self-harm, or who have been identified by social services as currently ‘at risk’ due to child protection concerns. Health technology being assessed Specific CT for social anxiety disorder in adolescents as an alternative to usual treatment within CAMHS (generic CBT for anxiety disorders; The C.A.T. Project). Both treatments will involve up to fourteen weekly sessions. Measurement of costs and outcomes in the feasibility trial Clinical outcomes will include change in social anxiety symptoms and disorder, social functioning, school/college attendance, concentration in class, quality of life, comorbid symptoms of anxiety and depression, and other outcomes determined by patients as clinically meaningful. A societal perspective for costs will be adopted and patient level resource use and productivity-loss data for patients and their parents will be collected using resource use diaries. Contribution to routine datasets Routine CYP-IAPT outcomes will be collected and will be included in NHS England’s monitoring of the outcomes achieved in CYP-IAPT services. Participants will be invited to consent to long-term follow-up beyond the term of this project. Sample size of feasibility trial 48 participants will be randomised across two treatment arms in order to establish the feasibility of the adapted treatment and the trial procedures. Treatment will be delivered by up to 10 CAMHS clinicians trained to deliver either adapted CT or the ‘C.A.T. project’. Project timetable (see flow chart) Develop treatment manual and therapist competency scale (mths 1-6) Develop training programme, train clinicians and assess competence (mths 1-16) Determine clinical outcome and economic measures for a definitive trial (mths 1-32) Conduct feasibility trial (mths 13-32) Team expertise (and below) The team comprises international experts in the development of psychological treatments for anxiety disorders, child and adolescent mental health, the experience of psychological therapies and all aspects of clinical trials (including health economics, statistics, assessing patient experience, and quality assurance).

Lay abstract: Aims We will adapt a highly effective psychological therapy for social anxiety disorder in adults (‘Cognitive Therapy’) so that it is suitable and acceptable for adolescents and can be delivered in NHS Child and Adolescent Mental Health Services (CAMHS). We will conduct a feasibility trial to establish how many young people will take part in a trial and what outcomes are relevant and appropriate for a full trial. Background Social anxiety disorder is the most common anxiety disorder and third most common of all types of mental health difficulties, with lifetime prevalence rates in Europe of 6.7% (range 3.9-13.7%). People with social anxiety disorder are extremely scared of social situations because they fear embarrassing themselves or being humiliated. Social anxiety disorder usually starts around the age of 13 years, and typically does not go away without treatment. People with social anxiety disorder are more likely to develop other mental health difficulties (for example, depression and drug and alcohol abuse), underachieve at school, have less well-paid jobs, fewer friends, and be less likely to get married than those without these difficulties. Clark & Wells’ Cognitive Therapy (CT) is a talking therapy for adults with social anxiety disorder which produces excellent outcomes. The treatment is not currently being used with adolescents. Instead, in CAMHS young people with social anxiety disorder usually receive a type of Cognitive Behaviour Therapy (CBT) that was developed for all anxiety problems. CBT is effective for anxiety disorders in young people, but unfortunately those with social anxiety disorder do not do as well as those with other anxiety disorders from this general type of CBT and achieve only modest outcomes. We have good reason to think that CT based on the Clark & Wells' model might be suitable for young people as well as adults. Members of our team have begun to adapt the treatment with excellent results. This recent work suggests that CT that specifically targets social anxiety disorder has great promise for use in NHS CAMHS. Design and methods used We will adapt CT for social anxiety disorder for young people, train a group of CAMHS clinicians to deliver it and assess their competency, and examine the feasibility of a trial comparing CT to current practice (CBT). We will explore how many young people take part in our study, what they think of CT and what outcomes we should assess in a full trial. Patient and public involvement One of our team (GS) is a past patient and will work with young people and their carers to develop materials, make sure that CT and the trial processes are acceptable, and identify what outcomes are important to them. He will also work with young people and their carers to ensure that the study findings are communicated to patients and the public in a useful way. Dissemination We will share our results with professionals, young people and their carers through journals, talks at conferences, newsletters, and online information.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH