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Social AnxietyNCT03711513

Facing Fears by Focussing on Behaviour, Body, or Mind?

A study testing Cognitive behavioral therapy in people with Social Anxiety, run by University of Groningen at 4 sites in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Anxiety problems are a major concern of youth mental health given that the prevalence of anxiety disorders in Dutch adolescents aged 12 to 18 is approximately 10 percent. In this group, social phobia like speech or performance anxiety are among the most common. Read more about this study

Who is it for?
Ages 12 to 15 years
Conditions the study is for
Social Anxiety
What is being tested?
Cognitive behavioral therapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
65 participants
Where
4 sitesNetherlands
Study dates
6 Nov 2017to 31 Jan 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 to 15 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Adolescents are aged between 12-15 years old
  • Sufficient knowledge of the Dutch language
  • Subclinical or higher level of the fear of performance/public speaking subtype of social phobia (SPAI-C PPF score >6 (MEAN + 1 SD); Beidel, 1996)

Who cannot join

  • Absence of permission of legal guardian(s)
  • Currently in treatment or receiving medication for anxiety
  • Received CBT for anxiety in the past 12 months
  • Past or current diagnosis of ASS/ADHD
  • Different or more urgent request for help
  • (Risk of) suicidality or suicidal ideation (as evidenced by checking CDI item 9 score >1 and confirmation in the ADIS interview)

Trial locations and contacts

4 sites in 1 country.

Netherlands4 sites

  • Gomarus College

    Groningen, 9721 LX

  • CSG Augustinus

    Groningen, 9726 GP

  • RSG De Borgen Lindenborg

    Leek, Provincie Groningen, 9351 HC

  • Greijdanus College

    Zwolle, Overijssel, 8017 CB

Other trials in Netherlands

About this study

Official title: Core Elements of Cognitive Behavioural Therapy in Treating Speech Anxiety in Youth: Facing Fears by Focussing on Behaviour, Body, or Mind?

Anxiety problems are a major concern of youth mental health given that the prevalence of anxiety disorders in Dutch adolescents aged 12 to 18 is approximately 10 percent. In this group, social phobia like speech or performance anxiety are among the most common. Intervention programs based on the principles of exposure-based Cognitive Behavioral Therapy (CBT) have proven to be the most effective and most applied in therapy for social anxiety among adolescents. Thus far, research has mainly focused on effectiveness of "intervention packages" consisting of multiple CBT elements (i.e., exposure plus cognitive restructuring and relaxation exercises). The most common CBT element in current intervention packages for anxiety in youth is exposure, which is often only applied after providing the child with cognitive restructuring (CR) and relaxation exercises (RE) as preparation for exposure. However, although most empirical evidence supports the value of the use of exposure, there is hardly empirical evidence for the additional value of CR or RE. In addition, it is unclear whether the combination of these elements with exposure is counterproductive compared to the use of exposure only. After all, without lengthening the treatment, the addition of CR and/or RE will leave the therapist and child with less time to spend on exposure exercises.This study proposes to evaluate the effectiveness of these three different types of CBT-elements in the treatment of speech/performance anxiety among adolescents.

Read the detailed description

Objective: The primary goal of this study is to evaluate which elements add to the effectiveness of current CBT programs. Second, it will be investigated whether the effect of exposure is reduced by the addition of cognitive restructuring and relaxation exercises. In addition, it will be explored how a given element is effective (i.e., mediation), by investigating which dimension of anxiety (approach/avoidance behavior, cognitions or bodily tension) is changed by which specific element, in a group of adolescents with the performance/public speaking subtype of social phobia.

Study design: Randomized Controlled Trial with three parallel groups (intervention versus intervention versus intervention).

Study population: Adolescents aged 12 to 15 years with subclinical or higher levels of the fear of performance/public speaking subtype of social phobia.

Intervention: Adolescents will be randomly assigned to one of the three conditions based on their age, gender and severity of the social phobia. All adolescents will be offered a psycho-education session on anxiety, social phobia and exposure. Following this session either four exposure sessions (condition A) or two exposure session and two additional sessions are offered. The additional session are either two cognitive restructuring sessions (condition B) or two relaxation sessions (condition C). Each session will be given in groups consisting of five to eight participants. Every session will take up to an hour and is implemented by a psychologist assisted by a master student in psychology, who will receive training and supervision by a certified CBT therapist.

Main study parameters/endpoints (see outcome measures paragraph): The main study parameter is level of fear of performance/public speaking symptoms. Secondary study parameters are subjective level of fear, fearful cognitions, bodily tension, avoidance, coping (possible mediator variables), social phobia diagnosis, speech behavior, and self-efficacy. Tertiary study parameters are healthcare costs and quality of life (cost-effectiveness), note: cost-effectiveness is assessed for another study. Other study parameters are social phobia severity, comorbid anxiety and depression, and demographic variables (possible moderator variables); and credibility and expectancy of the treatment, treatment satisfaction, and treatment compliance (treatment characteristics).

Conditions
Social Anxiety

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cognitive behavioral therapyBehavioural

    All conditions start with a psycho-education session (PE). Subsequently, participants in condition A follow four exposure sessions (EX). Participants in condition B follow two cognitive restructuring (CR) followed by two exposure sessions. Participants in condition C follow two relaxation exercises sessions (RE) followed by two exposure sessions. All sessions will take place at their school in a group of five to eight adolescents (week 9,10,11,12,13,14). The sessions will be provided by a psychologist who receives training and supervision by a certified CBT therapist. The psychologist is assisted by a master student in psychology.

Study groups in NCT03711513
Study groupRoleWhat they receive
Exposure onlyExperimentalPsycho-education (PE) (plus homework) + 4 x Exposure (EX) (plus homework): 20 participants will receive four exposure group sessions after the psycho-education session. In the four sessions they will move up in their fear hierarchy by practicing public speaking/performance tasks.
Receives: Behavioral: Cognitive behavioral therapy
Cognitive restructuring plus exposureExperimentalPE (plus homework) + Cognitive Restructuring (CR) (plus homework) + CR (plus homework) + EX (plus homework) + EX: 20 participants will receive two cognitive restructuring group sessions after the psycho-education session. In these two session they will practice identifying dysfunctional cognitions and formulating more functional (alternative/helping) cognitions. After the cognitive sessions they will receive two exposure group sessions. In these two sessions they will move up in their fear hierarchy by practicing public speaking/performance tasks.
Receives: Behavioral: Cognitive behavioral therapy
Relaxation plus exposureExperimentalPE (plus homework) + Relaxation (RE) (plus homework) + RE (plus homework) + EX (plus homework) + EX: 20 participants will receive two relaxation exercises group sessions after the psycho-education session. In these two session they will practice muscle relaxation and breathing exercises. After the relaxation sessions they will receive two exposure group sessions. In these two sessions they will move up in their fear hierarchy by practicing public speaking/performance tasks.
Receives: Behavioral: Cognitive behavioral therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in fear of performance/public speaking symptoms

    • Fear of performance/public speaking symptoms will be measured by the Public Performance Factor (PPF) scale of the Social Phobia and Anxiety Inventory for Children (SPAI-C), which evaluates the somatic, cognitive and behavioural aspects of social phobia in children. This questionnaire contains 26 questions all rated on a 3-point interval scale. The PPF scale consists of 7 items. The SPAI-C has sufficient test-retest reliability and good construct, convergent and discriminative validity.

    Measured: At screening (T0), 6 weeks later at pre-intervention assessment (T1), 6 weeks later at post-intervention assessment (T7), and 6 weeks later at follow-up assessment (T8)

Secondary outcomes (4)

  1. Change in level of anxiety

    • Level of anxiety compromised of subjective level of fear, fearful cognitions, bodily tension, avoidance and coping will be measured by Visual Analogue Scales (VAS) ranging from 0-100 (ratio scale) on which the adolescent rates the following aspects of the goal situation as set in the PE session:
    • Subjective level of fear: 'I am not frightened' (0) - 'I am completely frightened' (100)
    • Fearful cognitions: 'I do not believe this at all' (0) - 'I completely believe this' (100), in which the credibility of the cognition about the feared situation as set in the PE session is rated.
    • Bodily tension: 'My body feels not tense at all' (0) - 'My body feels completely tense' (100)
    • Avoidance: 'I would never avoid this situation if I could' (0) - 'I would always avoid this situation if I could' (100)
    • Coping: 'I cannot cope with this situation at all when I encounter it' (0) - 'I can completely cope with this situation when I encounter it' (100)

    Measured: Weekly during the five intervention weeks (T2, T3, T4, T5, T6), and one week after the last intervention sessies at post-intervention assessment (T7), and then six weeks later at follow-up assessment (T8)

  2. Change in social phobia diagnosis

    • Social phobia diagnosis in adolescents will be measured with a clinical semi-structured interview using the Anxiety Disorder Interview Schedule for Children (ADIS-IV-C). The study will only include the section of social phobia. All items offer three possible answers: yes, no or other on a nominal scale (which is chosen when the adolescent answers 'I don't know' or 'sometimes'). If the adolescent meets all three criteria for social phobia as set in the ADIS-IV, he or she will receive the social phobia diagnosis. The ADIS-IV has good test-retest reliability and concurrent validity.

    Measured: at pre-intervention assessment (T1), 6 weeks later at post-intervention assessment (T7), and 6 weeks later at follow-up assessment (T8)

  3. Change in speech behavior

    • Speech behaviour will be measured by three situational Behavioural Approach Tests (BAT) for feared and avoided situations. The test consists of a number of increasingly difficult steps in which adolescents are asked to approach a phobic situation, but are told they can stop the test at any time they wish to do so. During the BAT, individuals are asked to provide "subjective unit of disturbance scale" (SUDS 0-100 ratio scale) ratings immediately after encountering the phobic situation.

    Measured: at pre-intervention assessment (T1), 6 weeks later at post-intervention assessment (T7), and 6 weeks later at follow-up assessment (T8)

  4. Change in self-efficacy

    • Self-efficacy will be measured by the Self Efficacy Questionnaire for Children (SEQ-C). This questionnaire contains 24 questions regarding academic, social and emotional self-efficacy. Items are rated on a 5-point interval scale from 'not at all' (1) to 'very well' (5). The SEQ-C is proven to be a valid instrument with sufficient reliability.

    Measured: at pre-intervention assessment (T1), 6 weeks later at post-intervention assessment (T7), and 6 weeks later at follow-up assessment (T8)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Oct 2018
  2. Study start6 Nov 2017
  3. Primary completion31 Jan 2019
  4. Study completion31 Jan 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
65 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03711513
Sponsor's protocol ID
NL60377.042.16
Status last verified
May 2019
First submitted
30 Jul 2018
Last updated
30 May 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Reynolds S, Wilson C, Austin J, Hooper L. Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2012 Jun;32(4):251-62. doi: 10.1016/j.cpr.2012.01.005. Epub 2012 Feb 13.

    PubMed 22459788

  • Storch EA, Masia-Warner C, Dent HC, Roberti JW, Fisher PH. Psychometric evaluation of the Social Anxiety Scale for Adolescents and the Social Phobia and Anxiety Inventory for Children: construct validity and normative data. J Anxiety Disord. 2004;18(5):665-79. doi: 10.1016/j.janxdis.2003.09.002.

    PubMed 15275945

  • Silverman WK, Saavedra LM, Pina AA. Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry. 2001 Aug;40(8):937-44. doi: 10.1097/00004583-200108000-00016.

    PubMed 11501694

  • Wood JJ, Piacentini JC, Bergman RL, McCracken J, Barrios V. Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Clin Child Adolesc Psychol. 2002 Sep;31(3):335-42. doi: 10.1207/S15374424JCCP3103_05.

    PubMed 12149971

  • Koopmanschap MA. PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies. Expert Rev Pharmacoecon Outcomes Res. 2005 Feb;5(1):23-8. doi: 10.1586/14737167.5.1.23.

    PubMed 19807557

  • EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199-208. doi: 10.1016/0168-8510(90)90421-9.

    PubMed 10109801

  • Brady EU, Kendall PC. Comorbidity of anxiety and depression in children and adolescents. Psychol Bull. 1992 Mar;111(2):244-55. doi: 10.1037/0033-2909.111.2.244.

    PubMed 1557475

  • Chorpita BF, Moffitt CE, Gray J. Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behav Res Ther. 2005 Mar;43(3):309-22. doi: 10.1016/j.brat.2004.02.004.

    PubMed 15680928

  • Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000 Jun;31(2):73-86. doi: 10.1016/s0005-7916(00)00012-4.

    PubMed 11132119

Questions about this trial

What is this clinical trial studying?

A study testing Cognitive behavioral therapy in people with Social Anxiety, run by University of Groningen at 4 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 May 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in fear of performance/public speaking symptoms (time frame: At screening (T0), 6 weeks later at pre-intervention assessment (T1), 6 weeks later at post-intervention assessment (T7), and 6 weeks later at follow-up assessment (T8)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03711513, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 May 2019.

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