Schools-based digital therapy for adolescent social anxiety disorder.

许多日常活动，比如在繁忙的地区散步和打电话，都会让社交焦虑症(SAD)患者感到焦虑。悲伤很常见：几乎十分之一的人在一生中都会受到悲伤的影响，其特点是强烈害怕被他人监视和评判。悲伤会干扰人际关系和工作，并可能导致其他严重的心理健康问题，如抑郁症。对于患有SAD的成年人，有强大且可获得的治疗方法：SAD的认知疗法(CT-SAD)是主要的治疗方法，并推荐给NHS。互联网版(ICT-SAD)与面对面的治疗效果相似，治疗师的时间减少了70%。这意味着训练有素的治疗师可以治疗的患者数量大约是提供传统面对面治疗时的三倍。但SAD几乎总是在成年前就开始了，所以在青春期需要有效和可获得的干预措施。青少年SAD的标准治疗方法是一种心理疗法(基于暴露的CBT)，用于治疗所有焦虑问题。然而，患有SAD的青少年在这种治疗下的表现比那些有其他焦虑问题的青少年要差得多。我最近的研究表明，由于对成人治疗的适应性很小，ICT-SAD对青少年来说是一种有希望的治疗方法。这表明ICT-SAD可以改善患有SAD的青少年的预后，同时节省治疗师的时间，以便更多的人可以利用现有的资源得到治疗。在奖学金中，我的目标是确保ICT-SAD满足社交焦虑青少年的需求，并在日常服务中测试其使用情况。为了实现这一目标，需要解决两个关键问题：第一，信息和通信技术-SAD需要进一步调整，以提高其效力和青少年的接受度。社交焦虑的青少年在课堂上和与同龄人相处时的行为方式使社交焦虑持续存在，并与学业和人际关系问题有关。基于临床和实验知识，我将开发新的模块来针对这两个青少年特有的因素(“课堂社交焦虑”和“同伴问题”)。实验将在社交焦虑的青少年参与者中比较每个模块和没有模块的效果。收到模块的人将提供反馈，以确定在模块纳入信息和通信技术可持续发展系统之前需要进一步改进的地方。青少年和家庭告诉我们，他们也希望能够通过智能手机应用程序(App)访问ICT-SAD。年轻人解释说，这将使使用治疗技能变得更容易，并保持在学习的领先地位，父母们想要学习如何在治疗中支持他们的孩子，并在他们的手机上访问这些信息。将与青少年、家庭和软件开发人员共同开发一款补充ICT-SAD的青少年应用程序和一个单独的家长应用程序。第二，到目前为止，ICT-SAD是由在专业研究环境中工作的训练有素的临床心理学家提供的，但患有SAD的青少年是由在学校心理健康服务工作中接受相对较少培训的从业者提供的。咨询服务负责人、从业者和培训提供商将确定ICT-SAD需要进行的任何改进，以便于在这些服务中提供。互联网CT-SAD与标准护理的可行性试验将考察治疗和试验程序是否可行，以及年轻人、家庭和医生是否可以接受。这项研究将为患有SAD的青少年提供一种可以在常规服务中提供的数字治疗。如果一项更大规模的研究证实这是有帮助的，那么临床服务将受益于更少的转诊到CAMHS以及后来的成人服务，这将改善年轻人及其家人的生活：治疗后，一名年轻人告诉我们，“我即将成立UNI。我以前从未想象过能够做到这一点。”

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".