The state of psychological treatments for social anxiety disorder in children and adolescentsAn Umbrella Review

  1. Mª del Mar Diaz-Castela 1
  2. Jose Antonio Muela-Martinez 1
  3. Luis Joaquín Garcia-López 1
  4. Lourdes Espinosa-Fernández 1
  1. 1 Jaén University, Spain.
Revista de Psicología Clínica con Niños y Adolescentes

ISSN: 2340-8340

Year of publication: 2023

Issue Title: Estado de los tratamientos psicológicos infanto-juveniles

Volume: 10

Issue: 1

Type: Article

More publications in: Revista de Psicología Clínica con Niños y Adolescentes


Social Anxiety Disorder (SAD) is a very common disorder in childhood and adolescence. Many studies have examined various types of Cognitive Behavioral Therapy (CBT), meaning there is a need for a study exploring the efficacy of CBT. The objectives of this study are to determine what treatments and factors can improve treatment outcomes for SAD. We performed an umbrella review of the effectiveness of psychological interventions in treating SAD in children and adolescents. Nine databases were searched using a combination of keywords. Risk of bias was assessed using AMSTAR-2. Six systematic reviews and meta-analysis were selected and reported. All of those studies assessed the efficacy of CBT in children and adolescents with SAD, demonstrating its short- and long-term effectiveness. The components that seem to be most effective are exposure in any modality and social skills training. Other considerations to take into account are addressed in the discussion.

Bibliographic References

  • Amir, N., Bomyea, J., & Beard, C. (2010). The effect of single-session interpretation modification on attention bias in socially anxious individuals. Journal of Anxiety Disorders, 24, 178–182. janxdis.2009.10.005.
  • Antona, C. J., & Garcia-Lopez, L. J. (2008). Repercusión de la exposición y reestructuración cognitiva sobre la fobia social. Revista Latinoamericana de Psicología, 40(2), 281-292. php?script=sci_arttext&pid=S0120-05342008000200006&lng=en&tlng=.
  • Baker, H. J., Lawrence, P. J., Karalus, J., Creswell, C., & Waite, P. (2021). The Effectiveness of Psychological Therapies for Anxiety Disorders in Adolescents: A Meta-Analysis. Clinical Child and Family Psychology Review, 24, 765–782
  • Ballesteros, F., & Labrador, F. J. (2018). Análisis de las técnicas psicológicas utilizadas en el trastorno de fobia social en un centro sanitario de psicología. Clínica y Salud, 29(2), 71-80.
  • Beidel, D. C., & Turner, S. M. (1998). Shy children, phobic adults: Nature and treatment of social phobia. American Psychological Association. https://
  • Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood Social phobia. Journal of Consulting and Clinical Psychology, 68(6), 1072–1080.
  • Biagianti, B., Conelea, C., Brambilla, P., & Bernstein, G. (2020). A systematic review of treatments targeting cognitive biases in socially anxious adolescents. Journal of Affective Disorders, 264, 543–551. https://doi. org/10.1016/j.jad.2019.12.002
  • Bublatzky, F., & Alpers, G. W. (2017). Facing two faces: Defense activation varies as a function of personal relevance. Biological Psychology, 125, 64-69.
  • Caletti, E., Massimo, C., Magliocca, S., Moltrasio, C., Brambilla, P., & Delvecchio, G. (2022). The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review, Journal of Anxiety Disorders, 310, 174-182.
  • Carlucci, L., Saggino, A., & Balsamo, M. (2021). On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clinical Psychology Review, 87, 101999
  • Cordier, R., Speyer, R., Mahoney, N., Arnesen, A., Mjelve, L. H., & Nyborg, G. (2021). Effects of interventions for social anxiety and shyness in schoolaged children: A systematic review and meta-analysis. PLoS ONE, 16(7): e0254117.
  • Cristea, I. A., Mogoașe, C., David, D., & Cuijpers, P. (2015). Practitioner review: cognitive bias modification for mental health problems in children and adolescents: a metaanalysis. The Journal of Child Psychology and Psychiatry, 56, 723–734.
  • Crozier, W. R. (2014). Children’s shyness: A suitable case for treatment? Education Psychology in Practice, 30(2),156–66. 7363.2014.895934
  • Davis III, T. E., May, A., & Whiting, S. E. (2011). Evidence-based treatment of anxiety and phobia in children and adolescents: Current status and effects on the emotional response. Clinical Psychology Review, 31, 592–602.
  • Evans, R., Clark, D., & Leigh, E. (2021). Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 49(3), 352–369.
  • Garcia-Lopez, L. J. (2000). Un estudio de la eficacia entre tres modalidades de tratamiento para población adolescente con fobia social. Mimeographed manuscript: Faculty of Psychology, University of Murcia.
  • Garcia-Lopez, L. J., Díaz-Castela, M. M., Muela-Martinez, J. A., & Espinosa-Fernandez, L. (2014). Can parent training for parents with high levels of expressed emotion have a positive effect on their child’s social anxiety improvement? Journal of Anxiety Disorders, 28, 812-822. https://doi. org/10.1016/j.janxdis.2014.09.001
  • Garcia-Lopez, L. J., Olivares, J., Beidel, D., Albano, A. M., Turner, S., & Rosa, A. I. (2006). Efficacy of three treatment protocols for adolescents with social anxiety disorder: a 5-year follow-up assessment. Journal of Anxiety Disorders, 20(2), 175–191.
  • Khalid-Khan, S., Santibanez, M-P., McMicken, C., & Rynn, M. A. (2007). Social anxiety disorder in children and adolescents. Pediatry Drugs, 9, 227–237.
  • Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76(2), 282–297. http://dx.doi. org/10.1037/0022-006X.76.2.282
  • Kessler, R. C., Avenevoli, S., Costello, E. J., Georgiades, K., Green, J. G., Gruber, M. J., He, J., Koretz, D., McLaughlin, K. A., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Merikangas, K. R. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 69(4), 372–380.
  • Kley, H., Heinrichs, N., Bender, C., & Tuschen-Caffier, B. (2012). Predictors of outcome in a cognitive-behavioral group program for children and adolescents with social anxiety disorder. Journal of Anxiety Disorders, 26(1), 79–87.
  • Masia, C., Klein, R., Storch, E., & Corda, B. (2001). School-based behavioral treatment for social anxiety disorder in adolescents: results of a pilot study. Journal American Academic Child Adolescence Psychiatry, 40, 780-786.
  • Mohammadi, M. R., Salehi, M., Khaleghi, A., Hooshyari, Z., Mostafavi, S. A., Ahmadi, N., Hojjat, S. K., Safavi, P., & Amanat, M. (2020). Social anxiety disorder among children and adolescents: a nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities. Journal of Affective Disorders, 263, 450–457. jad.2019.12.015
  • Moher, D., Liberati, A., Tetzlaff, J., & Altman, D.G., The PRISMA Group, 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(6), e1000097 https://doi. org/10.1371/journal.pmed1000097.
  • Mychailszyn, M. P, Cohen, J. S., Edmunds, M., & Kendall, P. C. (2010). Treating social anxiety in youth. In: K. H. Rubin, R. J. Coplan, The development of shyness and social withdrawal. The Guilford Press.
  • National Institute for Health and Care Excellence (NICE) (2013). Social anxiety disorder: recognition, assessment and treatment of social anxiety disorder (Clinical guideline 159). The British Psychological Society and The Royal College of Psychiatrists,
  • Olivares, J., Rosa-Alcázar, A. I., Caballo, V. E., Garcia-Lopez, L-J., Orgilés, M., & López-Gollonet, C. (2003). El tratamiento de la Fobia Social en niños y adolescentes: una revisión meta-analítica. Psicología Conductual, 11(3), 599-622. meta-analitica_Treatment_of_social_phobia_in_children_and_adolescents_a_meta-analytic_review
  • Olivares, J., Ruiz, J., Hidalgo, M. D., Garcia-Lopez, L. J., Rosa-Alcázar, A. I., & Piqueras, J. A. (2005). Social anxiety scale for adolescents (SAS-A): psychometric properties in a Spanish-speaking population. International Journal of Clinical and Health Psychology, 5, 85–97. https://www.redalyc. org/articulo.oa?id=33701005
  • Rosa-Alcázar, A. I., Olivares-Olivares, P. J., & Iniesta, M. (2009). Los tratamientos psicológicos en la fobia social infantil y adolescente: una revisión cualitativa. Anuario de Psicología, 40(1), 23-42. php/AnuarioPsicologia/article/view/135245.
  • Scaini, S., Belotti, R., Ogliari, A., & Battaglia, M. (2016). A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disorder in children and adolescents. Journal of Anxiety Disorders, 42, 105–112.
  • Segool, N. K., & Carlson, J. S. (2008). Efficacy of cognitive-behavioral and pharmacological treatments for children with social anxiety. Depression and Anxiety, 0, 1-12.
  • Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 37(1),105- 30.
  • Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41(6), 713–726.
  • Stein, D. J., Lim, C. C. W., Roest, A. M., Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E. J., Bruffaerts, R., Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Harris, M., Él, Y., Hínkov, H., Horiguchi, I., Hu, C., … WHO World Mental Health Survey Collaborators (2017). The cross-national epidemiology of social anxiety disorder: data from the World Mental Health Survey Initiative. BMC Medicine, 15, 143.
  • Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. The Lancet, 371 (9618), 1115–1125.
  • Wright, E. C., Hostinar, C. E., & Trainor, B. C. (2020). Anxious to see you: neuroendocrine mechanisms of social vigilance and anxiety during adolescence. European Journal of Neuroscience, 52, 2516–2529. https://doi. org/10.1111/ejn.14628