Schools-based digital therapy for adolescent social anxiety disorder.

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Many everyday activities, like walking in a busy area and speaking on the phone, are anxiety-provoking for people with social anxiety disorder (SAD). SAD is common: almost 1 in 10 people will be affected by it in their lifetime and it is characterised by an intense fear of being watched and judged by others. SAD interferes with relationships and work and can lead to other serious mental health problems such as depression. For adults with SAD, powerful and accessible treatment is available: cognitive therapy for SAD (CT-SAD) is the leading treatment and recommended for the NHS. An internet-version (iCT-SAD) achieves similar large effects as face-to-face treatment with 70% less therapist time. This means that trained therapists can treat around three times as many patients as they can when offering traditional face-to-face therapy. But SAD nearly always starts before adulthood and so effective and accessible interventions are needed in adolescence. The standard treatment for adolescent SAD is a psychological therapy (exposure-based CBT) that is used to treat all anxiety problems. However, adolescents with SAD do much less well with this treatment than those with other anxiety problems. My recent research has shown that with minimal adaptations to the adult treatment, iCT-SAD is a promising treatment for adolescents. This suggests that iCT-SAD could improve outcomes for adolescents with SAD, while saving therapist time so more people can be treated with existing resources. In the fellowship I aim to ensure iCT-SAD meets the needs of socially anxious adolescents and test out its use in routine services. To realise this aim, two key issues need to be addressed: First iCT-SAD needs to be adapted further to enhance its effectiveness and acceptability for adolescents. The way that socially anxious adolescents behave in classroom settings and with their peers keeps social anxiety going and is linked to academic and relationship problems. Based on clinical and experimental knowledge, I will develop new modules to target these two adolescent-specific factors ('Social Anxiety in the Classroom' and 'Peer Problems'). Experiments will compare the effect of each module vs. no module amongst socially anxious adolescent participants. Those who received a module will give feedback to identify any further refinements to be made before the modules are integrated into iCT-SAD. Adolescents and families have told us that they also want to be able to access iCT-SAD via a smartphone application (app). Young people explained that this would make it easier to use therapy skills 'in the moment' and keep on top of learning, and parents want to learn how to support their child in treatment and access this information on their phones. An adolescent app that complements iCT-SAD and a separate parent app will be co-developed with adolescents, families, and software developers. Second is that so far iCT-SAD has been delivered by highly trained clinical psychologists working in specialist research settings, but adolescents with SAD are seen by practitioners with relatively little training working in school mental health services. Consultation with service leads, practitioners, and training providers will identify any refinements needed to iCT-SAD to make it easy to deliver in these services. A feasibility trial of internet CT-SAD compared to standard care will look at whether treatment and trial procedures are practical and whether they are acceptable to young people, families, and practitioners.The research will produce a digital treatment for adolescents with SAD that can be delivered in routine services. If a larger study confirms that it is helpful, then clinical services would benefit from fewer onward referrals to CAMHS and later adult services, and it would improve the lives of young people and their families: after treatment one young person told us, "I am about to start uni. I could never have imagined being able to do that before".