School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Department of Experimental Psychology, University of Oxford, Oxford, UK.
Health Technol Assess. 2021 Mar;25(20):1-94. doi: 10.3310/hta25200.
Social anxiety disorder (SAD) is common, typically starts in adolescence and has a low natural recovery rate. Existing psychological treatments for adolescent SAD are only moderately effective. It is possible that recovery rates for adolescents could be substantially improved by adapting a psychological therapy that is highly effective among adults with SAD.
To train child and adolescent mental health services (CAMHS) therapists to deliver cognitive therapy for SAD in adolescents (CT-SAD-A) and assess therapist competence. To estimate the costs to the NHS of training therapists to deliver CT-SAD-A and the mean cost per adolescent treated. To examine the feasibility of a randomised controlled trial (RCT) to compare CT-SAD-A with the general form of cognitive-behavioural therapy that is more commonly used.
During the training phase of the study, it became clear that the RCT would not be feasible because of high staff turnover and unfilled posts within CAMHS and changes in the nature of referrals, which meant that few young people with primary SAD were accessing some of the participating services. The study design was altered to comprise the following: a training case series of CT-SAD-A delivered in routine CAMHS, an estimate of the cost to the NHS of training therapists to deliver CT-SAD-A and of the mean cost per adolescent treated, and qualitative interviews with participating young people, parents, therapists and service managers/leads.
Five CAMHS teams within Berkshire Healthcare and Oxford Health NHS Foundation Trusts.
Eight therapists received training in CT-SAD-A. Twelve young people received CT-SAD-A, delivered by six therapists. Six young people, six parents, seven therapists and three managers participated in qualitative interviews.
Cognitive therapy for social anxiety disorder in adolescents (CT-SAD-A).
Measured outcomes included social anxiety symptoms and diagnostic status, comorbid symptoms of anxiety and depression, social and general functioning, concentration in class and treatment acceptability. Patient level utilisation of the intervention was collected using clinicians' logs.
Nine out of 12 participants achieved good outcomes across measures ( ≥ 0.60 across social anxiety measures). The estimated cost of delivering CT-SAD-A was £1861 (standard deviation £358) per person. Qualitative interviews indicated that the treatment was acceptable to young people, parents and therapists, but therapists and managers experienced challenges when implementing the training and treatment within the current CAMHS context.
Findings were based on a small, homogeneous sample and there was no comparison arm.
CT-SAD-A is a promising treatment for young people with SAD, but the current CAMHS context presents challenges for its implementation.
Further work is needed to ensure that CAMHS can incorporate and test CT-SAD-A. Alternatively, CT-SAD-A should be delivered and tested in other settings that are better configured to treat young people whose lives are held back by SAD. The new schools Mental Health Support Teams envisaged in the 2017 Children's Mental Health Green Paper may provide such an opportunity.
The National Institute for Health Research (NIHR) Health Technology Assessment programme. Individual funding was also provided for Cathy Creswell, David M Clark and Eleanor Leigh as follows: NIHR Research Professorship (Cathy Creswell); Wellcome Senior Investigator Award (Anke Ehlers and David M Clark); and the Wellcome Clinical Research Training Fellowship (Eleanor Leigh).
社交焦虑障碍（SAD）很常见，通常始于青少年时期，且自然康复率较低。现有的青少年 SAD 心理治疗方法只有中等疗效。如果将针对成人 SAD 非常有效的心理疗法加以改编，应用于青少年，那么青少年的康复率可能会大大提高。
培训儿童和青少年心理健康服务机构（CAMHS）治疗师，为青少年提供认知治疗社交焦虑障碍（CT-SAD-A），并评估治疗师的能力。估算 NHS 培训治疗师提供 CT-SAD-A 的成本，以及每位接受治疗的青少年的平均成本。考察一项随机对照试验（RCT）的可行性，该试验旨在比较 CT-SAD-A 与更常用的认知行为疗法的一般形式。
在研究的培训阶段，由于 CAMHS 中的人员流动率高、职位空缺以及转诊性质的变化，导致只有少数患有原发性 SAD 的年轻人能够接受部分参与服务，因此 RCT 无法进行。研究设计改为以下内容：在常规 CAMHS 中进行 CT-SAD-A 的培训案例系列，估算 NHS 培训治疗师提供 CT-SAD-A 的成本，以及每位接受治疗的青少年的平均成本，并对参与的年轻人、父母、治疗师和服务经理/负责人进行定性访谈。
伯克希尔医疗保健和牛津健康 NHS 基金会信托的五个 CAMHS 团队。
八名治疗师接受了 CT-SAD-A 的培训。十二名青少年接受了六名治疗师提供的 CT-SAD-A。六名青少年、六名父母、七名治疗师和三名经理参加了定性访谈。
青少年社交焦虑障碍的认知治疗（CT-SAD-A）。
衡量结果包括社交焦虑症状和诊断状况、焦虑和抑郁共病症状、社交和一般功能、课堂注意力和治疗可接受性。使用临床医生的日志记录患者对干预措施的使用情况。
12 名参与者中有 9 名在各项测量中均取得了良好的结果（社交焦虑测量中≥0.60）。提供 CT-SAD-A 的估计成本为每人 1861 英镑（标准差 358 英镑）。定性访谈表明，该治疗方法得到了年轻人、父母和治疗师的认可，但治疗师和管理人员在当前的 CAMHS 背景下实施培训和治疗时遇到了挑战。
研究结果基于一个小型的同质样本，没有对照组。
CT-SAD-A 是一种有前途的青少年 SAD 治疗方法，但当前的 CAMHS 环境对其实施提出了挑战。
需要进一步努力确保 CAMHS 能够实施并测试 CT-SAD-A。或者，应在其他更适合治疗因 SAD 而生活受到影响的年轻人的环境中提供和测试 CT-SAD-A。2017 年儿童心理健康绿皮书设想的新学校心理健康支持团队可能提供了这样的机会。
英国国家健康研究所（NIHR）健康技术评估计划。为 Cathy Creswell、David M Clark 和 Eleanor Leigh 提供了单独的资金：NIHR 研究教授（Cathy Creswell）；惠康高级研究员奖（Anke Ehlers 和 David M Clark）；以及惠康临床研究培训奖学金（Eleanor Leigh）。
