Title
School-Based Intervention for Adolescents with Social Anxiety Disorder
Authors
Carrie Masia-Warner, Rachel G. Klein, Paige H. Fisher, Jose Alvir, and Anne M. Albano
New York University Child Study Center, NYU School of Medicine, New York
Heather C. Dent
Psychology Department, University of Denver, Denver, Colorado
Mary Guardino
Freedom from Fear, Staten Island, New York.
Author note
Carrie Masia-Warner, Rachel G. Klein, Paige H. Fisher, Jose Alvir, and Anne M. Albano, New York University Child Study Centre, NYU School of Medicine; Heather C. Dent, Psychology Department, University of Denver; Mary Guardino, Freedom from Fear, Staten Island.
This research was supported by the Anxiety Disorders Association of America and the Lowenstein Foundation. The authors thank Dr. Deborah Beidel for her consultation on this study, and Ben Adams, Joseph Capobianco, Nisha Patel, Eric Storch, and Jonathan Tobkes for their assistance in conducting the study.
Correspondence concerning this article should be addressed to Carrie Masia-Warner, NYU Child Study Centre, 215 Lexington Avenue, 13th floor, New York, 10016. E-mail: carrie.masia@med.nyu.edu.
The social anxiety disorder, which mostly happened in adolescences, was often neglected by teachers and parents for the symptoms mainly being quiet and compliant (Masia, Klein, Storch, & Corda, 2001; Pandey et al., 2003). The authors wanted to raise the awareness of identifying the social anxiety disorders of the adolescences, and conducted a research to see if the school-based intervention would effectively facilitate the treatment for socially anxious teenagers. In addition, previous research suggested that the treatment offered by the community centres or public health centres was resistant by the majority of adolescences (Weist, 1999; Weisz, Donenberg, Han, & Weiss, 1995), the authors wanted to find out if the school-based treatment worked better.
Methods
Participants
The participants were adolescences and their parents. The adolescences’ mean age was 14.8 years. The majority of them were female (74.3%), and their ethnicity was 82.9% Caucasian, 8.6% African American, 2.9% Asian American, 2.9% Latin American, and 2.9% other.
Sampling Procedures
At the beginning, 1521 participants were recruited. The participants were adolescences in grades 9 through 11 from two parochial high schools in New York City, and their parents who indicated social anxiety associated with impairment in functioning. Then, 475 students, who scored in the top 15% through self-rated instruments or were nominated by teachers, were selected for further screening. At last, 80 students and their parents agreed to participate.
Measures and Intervention
First of all, the participants were interviewed separately by the same evaluator using the Anxiety Disorders Interview Schedule for DSM-IV: Parent and Child Versions (Silverman & Albano, 1996). In the meanwhile, students were diagnosed in various ways to find out if they were unqualified or not. Among those interviewed, 42 students met study criteria and rated the subject’s social anxiety at a subclinical level.
This study was conducted as a between-subjects design because the 42 adolescences were randomly assigned to different conditions including the SASS intervention and wait-list control condition. The SASS (Skills for Academic and Social Success) intervention was developed with the goal of adapting clinic-based procedures to be practical for delivery in high schools (Masia et al., 1999). This intervention included school group sessions, individual meetings, social events, peer assistants, parent meetings, teacher meetings, and booster sessions (Masia et al., 2005).
The participants were evaluated at pre-intervention and post-intervention. In addition, the wait-list control group was provided with treatment following post-assessment evaluations, while the SASS group participated in 9-month follow-up assessments. The pre-assessments, the dichotomous outcomes, and post-intervention comorbidity rates were compared between the two groups.
Results
In terms of pre-assessment comparisons, there was no obvious difference on any demographic variable between the two groups. On the other hand, the outcome measures of the two groups at pre-intervention and post-intervention appeared distinctively. Although the data of pre-intervention of the two groups did not have much difference, the data of post-intervention of the SASS group were lower than that of the control group. The results of the comorbidity comparison showed that there was no intervention group participant were diagnosed a new comorbidity, whereas 22.2% wait-listed participants did.
Conclusions
This study has shown that the school-based intervention could effectively get access to the treatment of adolescents with social anxiety disorder. The treated students clearly got better during the treatment and still kept a healthy status 9 months later. Not only has this study extended opportunities available for clinicians, but also the school-based intervention could be adopted as a long-term approach to diagnosing the social anxiety disorder and facilitating the treatment.
Personal comments
This study is closely related to my research question “How to effectively help the students in the elementary school (or post-secondary school) manage their anxiety disorders and academic performance at the same time”. I am very impressed by the sustainability of the school-based intervention, which is successfully proved in the study. Although the authors mainly analyze how to treat social anxiety disorders, they have successfully demonstrated that the school-based intervention is a more effective approach to help the students in the school manage their anxiety disorders. And I could resort to this intervention to find out if the other anxiety disorders can be treated equally well. In addition, this article has not mentioned any correlation between anxiety disorders and academic performance. Therefore, it still needs me to explore more and to discover other useful evidence or approach that can strongly support my research question.
References
Masia, C., Beidel, D. C., Albano, A. M., Rapee, R. M., Turner, S. M., Morris, T. L., et al.(1999). Skills for Academic and Social Success. Available from Carrie Masia-Warner, PhD, New York University School of Medicine, Child Study Centre, 215 Lexington Avenue, 13th floor, New York 10016.
Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., & Guardino,(2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of abnormal child psychology, 33(6), 707-722.
Masia, C. L., Klein, R. G., Storch, E., & Corda, B. (2001). School-based behavioral treatment for social anxiety disorder in adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 780–786.
Pandey, P., Han, S., Fisher, P. H., Ferrante, D., Selinger, A., Cho, L.YJ., et al. (2003). Barriers to referral of socially anxious students: Teacher perspectives of why they go unnoticed. Poster presented at the 37th Annual Convention of the Association for the Advancement of Behavior Therapy, Boston, MA.
Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions. San Antonio, TX: Graywind, A Division of the Psychological Corporation.
Weist, M. D. (1999). Challenges and opportunities in expanded school mental health. Clinical Psychology Review, 19, 131–135.
Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688–701.