The Role of Comorbid Mood Disorders in Cognitive Behavioral Therapy for Childhood Social Anxiety

Background: Children with a social anxiety disorder have worse treatment outcomes after Cognitive Behavior Therapy (CBT) than children with other anxiety disorders. Anxiety disorders and mood disorders are strongly related and especially social anxiety is related to high comorbidity rates with mood disorders. The aim of the study was to investigate how comorbid mood disorders are related to treatment outcomes after CBT and whether this can explain the worse outcomes for childhood social anxiety. Methods: Participants were 152 referred clinically children (7–18 years) with either a social anxiety disorder (n = 52) or another anxiety disorder (n = 100) of whom 24.3% (n = 37) had a comorbid mood disorder. Child anxiety, internalizing symptoms, and quality of life were measured pre-treatment, post-treatment, 3 months and 1 year after treatment, using child and both parents’ report. Results: Children with a primary social anxiety disorder more often had a comorbid mood disorder than children with another primary anxiety disorder. Children with a mood disorder had more severe anxiety problems before treatment. Comorbid mood disorders were related to greater anxiety reductions after treatment. The worse outcomes for children with a primary social anxiety disorder remained after controlling for comorbid mood disorders. Conclusions: Findings stress the importance of future studies examining why the presence of a comorbid mood disorder is associated with greater anxiety reductions, and other factors that explain the worse treatment outcomes found for childhood social anxiety disorder.</p

Social anxiety and perceptions of likeability by peers in children

The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children

Childhood social anxiety: What’s next?: Exploring the role of cognitions, depression, parents, and peers

The overall aim of this dissertation was to investigate treatment outcomes after Cognitive Behavioral Therapy (CBT) for childhood social anxiety, to investigate what predicts these treatment outcomes, and to investigate which factors are related to social anxiety and may be important to consider in optimizing treatment outcomes. More specifically, the first aim was to study the relations between child and parental anxiety symptoms at a symptom level. The second aim was to investigate outcomes after CBT for social anxiety disorder compared to other anxiety disorders in children and to study if comorbid depression and/or parental anxiety could explain differences in treatment outcomes. In sum, results showed that children with a primary social anxiety disorder improved less after CBT. Comorbidity with mood disorders was high in the social anxiety group, but did not explain why children with a social anxiety disorder had worse outcomes. There are clear and specific relations between children’s and parents’ anxiety symptoms and parent’s anxiety symptoms decrease slightly when their children receive an anxiety treatment. Parent’s anxiety symptoms were associated with treatment outcomes, but did not explain why children with a social anxiety disorder were worse off. The third aim of the dissertation was to study relations between social anxiety symptoms, social relations according to peers, and perception accuracy of these social relations. It was found that social anxiety symptoms in children and young adolescents are related to negative perceptions of one’s likeability by peers. On average, children with higher levels of social anxiety have greater chances of underestimating their likeability by peers (cognitive bias), but avoiding or scoring high on depressive symptoms is related to actual disliking and thus having a more accurate perception. Furthermore, the tendency to avoid is related to having less friendships in adolescents