2 - (IOP 15) Prevention and Treatment of Social Anxiety Disorder in Adolescents: Results of a Mixed Method Randomised Controlled Trial of a Guided Self-help Online Intervention

Background: Social anxiety disorder (SAD) and subclinical social anxiety are highly prevalent in adolescents and negatively impact their social and academic functioning. Effective low-threshold interventions like online interventions are needed to address the care gap, which is especially pronounced in adolescents. This study aimed to evaluate the efficacy of the guided online intervention SOPHIE for adolescents with SAD (i.e., treatment) or subclinical social anxiety (i.e., indicated prevention) and to qualitatively analyse their experiences of using the intervention.

Methods: 133 adolescents (11 – 17 years) were randomised to the SOPHIE intervention or a care-as-usual control condition. Assessments were conducted at baseline, mid-intervention (4 weeks), post-intervention (8 weeks) and follow-up (5 months after randomisation). Intervention effects on the primary outcome, social anxiety post-intervention, and secondary outcomes (i.e., psychosocial functioning, depression, social fears and avoidance behaviour, anxiety, self-esteem, and quality of life) were analysed by linear mixed-effect models. Qualitative interviews were conducted post-intervention via phone with adolescents in the intervention group and transcribed verbatim.

Results: The intervention did not significantly reduce social anxiety symptoms post-intervention but showed a significant medium to large between-group effect at follow-up (d=0.67, 95%CI [0.32; 1.02]). Separate analyses by diagnostic condition (SAD vs. subclinical social anxiety) showed significant between-group effects at follow-up in the subclinical (d=1.07, 95%CI [1.74; 0.41]) but not in the clinical condition. Social functioning significantly improved at post-intervention and follow-up, with medium to large effects (post: d=-0.73, 95%CI [-1.08; -0.37]; follow-up: d=-0.32, 95%CI [-0.66; 0.02]). Qualitative analyses showed that young people generally found the content of the intervention helpful and interesting. Some had difficulties with the implementation of exposure exercises and wished for additional support. Very heterogeneous needs emerged regarding the guidance provided during the programme.

Discussion: The primary aim of the RCT was to evaluate the efficacy of the online intervention SOPHIE in reducing social anxiety in adolescents. The online intervention SOPHIE for adolescents with SAD or social anxiety symptoms was effective after 5 months, especially when used as an indicated prevention approach. This study adds to previous evidence on the efficacy of disorder-specific online interventions for social anxiety based on conceptual models such as the cognitive model (Clark & Wells, 1995) and supports the longer-term efficacy of online interventions for social anxiety, particularly for subclinical social anxiety. It further suggests new avenues to personalise future interventions.