Metacognitive Therapy for Social Anxiety in Youth
Condition: Social Anxiety Disorder; Social Anxiety; Social Phobia
MeSH terms: Anxiety Disorders; Phobia, Social
Study type: Interventional

Summary: 
      Social anxiety disorder (SAD) is a fear of social situations that involve interacting with
      other people. Although it can be very upsetting, there are ways to help people deal with it.
      This study aims to explore the use of a new treatment called Metacognitive Therapy (MCT) for
      social anxiety in children and teenagers. MCT is a one-to-one talking therapy which works by
      changing people's patterns of attention and thinking in social situations. By doing this,
      people with SAD can begin to feel more confident and less anxious when interacting with
      others.

      Findings suggests that MCT works well when treating adults who have social anxiety. However,
      this treatment has not yet been used with young people. This study hopes to explore whether
      MCT can help treat SAD in children and teenagers. This information will help us to plan
      larger studies in the future.

      People who would like to take part in this study will be asked to fill in some questionnaires
      once a week for at least 2 weeks and return these to the researcher in the post. Following
      this, they will be offered 8 weekly sessions of MCT at their local Child and Adolescent
      Mental Health Service. Each session will last for about 1 hour. This will involve talking to
      a clinician about how they think and feel when in social situations, and filling in some more
      questionnaires. This will allow us to see how their social anxiety changes week-by-week and
      whether this has improved by the end of treatment (week 8).

      1-months after people have had their last session of MCT, they will be asked to complete and
      return a final set of questionnaires through the post. This will allow us to get a final
      measure of their social anxiety and see whether any changes in SAD have been maintained.

      Primary Questions:

        -  Is MCT a feasible and acceptable treatment for social anxiety disorder within a child
           and adolescent population?

        -  Is MCT associated with improvements in SAD symptoms and functioning?

      Secondary Questions:

        -  Are benefits associated with MCT replicable across subtypes of social anxiety disorder
           (general and specific)?

        -  Are any gains associated with MCT for social anxiety disorder maintained at 1 month
           follow up?
    

Detailed description: 
      A systematic case replication series utilising an A-B design with 1-month follow-up will be
      used within this study to replicate MCT intervention across SAD subtypes. (A = no treatment
      baseline; B = 8 weekly one-one sessions of MCT). This design was chosen as MCT is a
      relatively novel approach to SAD, particularly within a child and adolescent population.

      Recruitment:

      Potential participants will be identified by CAMHS Clinicians during routine clinical
      practice. If the Anxiety Disorders Interview Schedule-IV Child/Parent Version indicates
      clinical severity of SAD, individuals will be invited to participate in the full study.

      This study aims to recruit 5 participants experiencing social anxiety disorder. Participants
      who drop out of the study during the baseline phase (i.e. before receiving any sessions of
      MCT intervention) will be replaced by another eligible participant who will be recruited in
      their place. However, any participants who drop out during the intervention phase of the
      study will not be replaced.

      Phase 1 (Baseline):

      During the initial phase of the study, participants will be asked to complete baseline
      measures once a week for a minimum of 2 weeks (with at least 3 data-points) until stability
      of scores is achieved. Stability of scores will be defined as 3 consecutive data points
      showing an increasing or horizontal trend on the primary outcome measure. If the last data
      point is decreasing, baseline will be extended until stable trends can be plotted, although
      if stability of scores is not achieved by 6 weeks (i.e. 6 data points) then intervention will
      be introduced at this point regardless.

      Phase 2 (Intervention):

      Participants will be invited to attend 8 weekly sessions of MCT at their local CAMHS. Each
      session will last approximately 1 hour. Participants will be asked to complete sessional
      measures to allow for monitoring of SAD symptoms and metacognitive beliefs, as well as
      measures of treatment acceptability.

      Phase 3 (Follow-up):

      Follow-up will be conducted between 4-6 weeks after the final treatment session. Participants
      will be asked to complete and return a final set of measures via the post. This will provide
      a final measure of SAD symptoms and metacognitions and see whether any benefits of receiving
      MCT have been maintained.

      Phase 4 (Exit Interviews):

      Participants will be invited to complete an optional, semi-structured exit interview to
      gather descriptive level information regarding how they found the intervention. This will
      examine factors such as which components of the intervention were well received.
    

Intervention name(s): Metacognitive Therapy for Social Anxiety
Intervention type(s): Other
Intervention description(s): The transdiagnostic Metacognitive model posits that psychological disorder stems from the activation of a perseverative thinking style called the CAS (Cognitive Attentional Syndrome). This has 3 key elements: worry/rumination, threat-focussed attention and unhelpful coping behaviours. Each of these elements results in extended cognitive responses to negative thoughts, prolonging negative emotions and maintaining an individual's sense of threat. The CAS arises from an individual's positive and negative metacognitive beliefs (beliefs about cognition). Metacognitive Therapy (MCT) aims to bring the CAS under control by modifying metacognitive beliefs and enabling individuals to develop new reactions to negative thoughts.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Metacognitive Therapy