Delivering cognitive therapy for adolescent social anxiety disorder in NHS CAMHS: A clinical and cost analysis
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Abstract Background: Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed. Aims: Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment? Method: CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training. Results: Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 ( SD = £1003) per adolescent treated, of which £1861 ( SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment. Conclusions: This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.
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Cognitive therapy was found to be effective in adult SAD as well as promising in adolescent SAD, whether delivered in person or remotely.
“Cognitive therapy was found to be effective in adult SAD [70] as well as promising in adolescent SAD, whether when delivered in person [71,72] or remotely [73].”
From The Prevalence of Adolescent Social Fears and Social Anxiety Disorder in School Contexts (2022) · cites this paper as [72]
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- Authors
- Leigh, E., Creswell, C., Stallard, P., Waite, P., Violato, M., Pearcey, S., Brooks, E., Taylor, L., Warnock-Parkes, E., & Clark, D. M.
- Affiliations
- University of Oxford (GB)
- Oxford Health NHS Foundation Trust (GB)
- University of Reading (GB)
- Warneford Hospital (GB)
- Corresponding author
- Leigh, Eleanor
- ORCID
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-03-01
- Volume
- 49
- Issue
- 4
- Pages
- 385-397
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W3128574682
- Cited by
- 11
- References
- 36
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 3 · 2022: 2 · 2021: 2
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CentAUR (University of Reading) (submittedVersion)
- Funders
- Wellcome Trust (200796/Z/16/Z)
- National Institute for Health and Care Research (RP_2014-04-018, 14/170/01, NIHR201370)
- Department of Health and Social Care
- Oxford Health NHS Foundation Trust
- NIHR Oxford Biomedical Research Centre
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive therapy, social anxiety disorder, adolescents, child and adolescent mental health services, therapist training, treatment costs, supervised practice, general anxiety, depression, National Health Service
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