CBT for Social Anxiety Disorder Delivered by School Counselors

描述（由申请人提供）：理由：青少年社交焦虑障碍与多种障碍相关，并稳定进入成年。尽管临床治疗很有希望，但大多数社交焦虑的青少年都没有得到确诊和治疗。通过在学校提供干预措施，优化了治疗的可及性。我们已经开发了一个为期12周的认知行为，以学校为基础的团体干预，社会和学业成功技能（SASS）。两项对照试验支持临床心理学家实施的SASS的有效性，与1)无治疗条件和2)注意控制相比。SASS的优势在治疗后6个月仍然保持（Masia Warner et al., 2005; Masia Warner et al., 2007）。为了促进SASS在学校的可持续性，我们建议对学校人员实施的SASS进行评估。目的：这项为期5年的研究通过训练有素的学校辅导员（SC-SASS）提供的SASS测试来解决患有社交恐惧症的青少年未满足的需求，并与非特定的学校咨询项目“生活技能”（SFL）进行比较。第二个目标是进一步检验心理学家（专家- SASS）提供的SASS与SFL的疗效。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改善整体和学校功能方面均优于SFL，在治疗后立即和治疗后6个月。方法:对象。两所公立高中的126名9年级至11年级学生（14-17岁）将接受标准社交焦虑量表的筛查。分数在前15%的学生的家长将会接到电话。被报告为社交焦虑的青少年将由独立的评估者进行系统的评估。那些符合社交焦虑障碍标准的人将被纳入研究。治疗方法。参与者将被随机分配到三种治疗中的一种：1)由学校辅导员提供的SASS （SC-SASS), 2)由心理学家提供的SASS (Expert-SASS)，或3）非特定学校咨询计划（SFL）。在基线、干预后和6个月后，对家长和青少年的评估将包括诊断、疾病严重程度、社交焦虑和抑郁的量表评分、临床总体改善以及整体和学校功能。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：考虑到青少年社交焦虑的认知和治疗不足，本研究具有较高的公共卫生意义；2)学校作为初级心理健康服务提供者的角色；3)学校解决学生情感需求的需求增加。它将提供关于在循证治疗方面培训一线专业人员的价值的信息，并可作为促进向得不到充分服务的青年提供有效护理的模式。公共卫生相关性：该研究调查了由学校辅导员提供的基于学校的CBT治疗社交焦虑障碍是否有效。鉴于患有精神疾病的青年对心理健康服务的利用不足，以及对学校服务的需求增加，以提高治疗的可及性，这一努力尤其重要。这一应用具有相当大的公共卫生相关性，因为它将提供关于在循证治疗方面培训一线专业人员的价值的信息，并有可能成为促进对患有社交焦虑障碍和其他精神障碍的得不到充分服务的青年进行有效护理的模式。

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. Public Health Relevance: The study investigates whether school-based CBT for social anxiety disorder, delivered by school counselors, is effective. This effort is particularly significant given the underutilization of mental health services by youth with psychiatric disorders, and the increased demand for school services to enhance treatment accessibility. This application has considerable public health relevance since it will provide information on the value of training frontline professionals in evidence-based treatments, and potentially serve as a model for promoting efficacious care for underserved youth with social anxiety disorder, as well as other psychiatric disorders.