CBT for Social Anxiety Disorder Delivered by School Counselors

描述(申请人提供)：理由：青少年社交焦虑障碍与多种障碍有关，并稳定到成年。尽管临床治疗前景看好，但大多数社交焦虑的青少年身份不明，没有得到治疗。通过在学校提供干预措施，治疗的可及性得到了优化。我们开发了为期12周的认知行为、以学校为基础的团体干预、社交和学习成功技能(SASS)。两个对照试验支持临床心理学家实施的SASS的有效性，与1)不治疗的情况和2)注意力控制的情况相比。SASS优势在治疗后6个月保持(Masia Warner等人，2005年；Masia Warner等人，2007年)。为促进学校推行社会保障计划的持续发展，我们建议评估学校人员推行的社会保障制度。目的：这项为期5年的研究通过由训练有素的学校辅导员(SC-SASS)提供的SASS测试来解决社交恐惧症青少年的未得到满足的需求，并与非特定的学校咨询计划--生活技能(SFL)进行比较。第二个目标是提供由心理学家(专家-SASS)提供的与SFL相比的SASS有效性的进一步检验。假设：SC-SASS和Expert-Sass在降低社交焦虑障碍的严重程度和发生率，以及在治疗后立即和六个月后改善整体和学校功能方面都优于SFL。方法：受试者。两所公立高中的126名9至11年级学生(年龄14-17岁)将接受标准社交焦虑量表的筛查。那些得分在前15%的学生的父母将被召唤。被报告为社交焦虑的青少年将由独立评估员进行系统评估。那些符合社交焦虑症标准的人将被录取。治疗。参与者将随机接受三种治疗之一：1)由学校辅导员提供的SASS(SC-SASS)，2)由心理学家提供的SASS(专家-SASS)，或3)非特定的学校咨询计划(SFL)。家长和青少年在基线、干预后和6个月后进行的评估将包括诊断、疾病严重程度、社交焦虑和抑郁的量表评级、临床总体改善以及总体和学校功能。数据分析。结果将使用线性和广义线性混合模型进行分析。意义：这项研究具有很高的公共卫生意义，因为1)青少年对社交焦虑的认识和治疗不足；2)学校作为主要心理健康服务提供者的角色；以及3)对学校满足学生情绪需求的需求增加。它将提供有关培训循证治疗前线专业人员的价值的信息，并可作为促进对服务不足的青少年进行有效护理的典范。

DESCRIPTION (provided by applicant): Rationale: Social anxiety disorder in adolescents is associated with multiple impairments, and is stable into adulthood. Despite promising clinical treatments, most socially anxious adolescents are unidentified and untreated. By delivering interventions in school, treatment accessibility is optimized. We have developed a 12- week cognitive-behavioral, school-based group intervention, Skills for Social and Academic Success (SASS). Two controlled trials support the efficacy of SASS implemented by clinical psychologists, compared to 1) a no- treatment condition, and 2) an attention control. SASS superiority was maintained six months post-treatment (Masia Warner et al., 2005; Masia Warner et al., 2007). To promote SASS's sustainability in schools, we propose to evaluate SASS implemented by school personnel. Objective: This 5-year study addresses the unmet needs of adolescents with social phobia through the testing of SASS delivered by trained school counselors (SC-SASS), compared to a nonspecific school counseling program, Skills for Living (SFL). A secondary goal is to provide further examination of the efficacy of SASS delivered by psychologists (Expert- SASS), compared to SFL. Hypotheses: Both SC-SASS and Expert-SASS will be superior to SFL in reducing the severity and rate of social anxiety disorder and in improving overall and school functioning, immediately following treatment and six months after. Methods: Subjects. One hundred twenty-six 9th through 11th graders (ages 14-17), in two public high schools, will be screened with standard social anxiety scales. Parents of those scoring in the top 15% will be called. Adolescents who are reported to be socially anxious will be systematically evaluated by independent evaluators. Those who meet criteria for social anxiety disorder will be enrolled. Treatments. Participants will be randomized to one of three treatments: 1) SASS delivered by school counselors (SC-SASS), 2) SASS delivered by psychologists (Expert-SASS), or 3) a nonspecific school counseling program (SFL). Assessments with parents and adolescents, at baseline, post-intervention, and 6 months later, will include diagnosis, illness severity, scale ratings of social anxiety and depression, clinical global improvement, and overall and school function. Data analyses. Outcomes will be analyzed using linear and generalized linear mixed models. Significance: The study has high public health significance given 1) the under-recognition and treatment of social anxiety in adolescents; 2) schools' role as primary mental health services providers, and 3) increased demand for schools to address students' emotional needs. It will provide information on the value of training frontline professionals in evidence-based therapy, and can serve as a model for promoting efficacious care to underserved youth.