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有关，并且在成年后保持稳定。尽管有希望的临床治疗，大多数社交焦虑的青少年是身份不明，未经治疗。通过在学校提供干预措施，最大限度地提高了治疗的可及性。我们已经开发了一个为期12周的认知行为，以学校为基础的小组干预，社交和学术成功的技能（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）注意力控制相比。治疗后6个月，SASS优势得以维持（Masia Warner等人，2005; Masia Warner等人，2007年）。为促进学校的持续发展，我们建议评估学校人员实施的SASS。目的：这项为期5年的研究解决了未满足的需求，青少年与社交恐惧症通过测试SASS提供的训练有素的学校辅导员（SC-SASS），相比，一个非特定的学校咨询计划，生活技能（SFL）。第二个目标是提供进一步检查的有效性SASS提供的心理学家（专家- SASS）相比，SFL。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上级SFL，治疗后立即和6个月后。方法：受试者。在两所公立高中，将对126名9至11年级学生（年龄14-17岁）进行标准社交焦虑量表筛查。得分在前15%的父母将被称为。据报告有社交焦虑的青少年将由独立评估人员进行系统评估。那些符合社交焦虑障碍标准的人将被招募。治疗。参与者将被随机分配到以下三种治疗中的一种：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）非特定的学校咨询计划（SFL）。在基线、干预后和6个月后，对父母和青少年的评估将包括诊断、疾病严重程度、社交焦虑和抑郁量表评分、临床总体改善以及总体和学校功能。数据分析。将使用线性和广义线性混合模型分析结局。重要性：这项研究具有很高的公共卫生意义，因为1）青少年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作用; 3）对学校解决学生情感需求的需求增加。它将提供关于培训循证治疗一线专业人员的价值的信息，并可以作为促进对服务不足的青年进行有效护理的模式。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社交焦虑症CBT是否有效。鉴于患有精神疾病的青年对精神保健服务利用不足，以及对学校服务的需求增加，以提高治疗的可及性，这一努力尤为重要。该应用程序具有相当大的公共卫生相关性，因为它将提供有关培训一线专业人员循证治疗的价值的信息，并可能作为一种模式，促进有效的护理服务不足的青年社交焦虑症，以及其他精神疾病。

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.