European Child & Adolescent Psychiatry

, Volume 28, Issue 1, pp 79–89 | Cite as

Efficacy and acceptability of psychological interventions for social anxiety disorder in children and adolescents: a meta-analysis of randomized controlled trials

  • Lining Yang
  • Xinyu Zhou
  • Juncai Pu
  • Lanxiang Liu
  • Pim CuijpersEmail author
  • Yuqing Zhang
  • Hanping Zhang
  • Shuai Yuan
  • Teng Teng
  • Lu Tian
  • Peng XieEmail author
Original Contribution


Social anxiety disorder (SAD) is highly prevalent and persistent in children and adolescents. However, evidence for the efficacy and acceptability of psychological interventions for SAD in children and adolescents remains unclear. Seven electronic databases (PubMed, CENTRAL, Embase, Web of Science, PsycINFO, CINAHL, and ProQuest) were searched. Randomized controlled trials (RCTs) that compared psychological interventions for SAD with control conditions in children and adolescents were included. Primary outcomes were the efficacy (mean change in anxiety symptom scores) and acceptability (dropouts for all reasons). Secondary outcomes were remission, quality of life/functional improvement, and depressive symptoms measures. Seventeen RCTs were included in this meta-analysis. Psychological interventions (including cognitive behavioral therapy and behavioral therapy) were significantly more effective than control conditions, with a standardized mean difference (SMD) of − 1.13, and remission with a risk ratio (RR) of 8.99, the number needed to treat was 3.3. There was no statistically significant difference between psychological interventions and control conditions for all-cause dropouts (RR = 1.00). Psychological interventions were superior to control conditions in improving quality of life/functioning (SMD = 0.79) and reducing depressive symptoms (SMD = − 0.39). Given considerable heterogeneity of primary efficacy outcome, a series of subgroup analyses of different variables were conducted. Psychological interventions are probably efficacious in the treatment of SAD among children and adolescents, and may markedly improve quality of life and functioning in this population. However, this finding should be interpreted with caution because of the high heterogeneity of trials and low literature quality.


Child Adolescent Psychological intervention Meta-analysis Social anxiety disorder 


Author contributions

LY and JP conceived the study. LY and JP drafted the manuscript. XZ and YZ assisted in the design and revision. LL and HZ participated in the search strategy development. SY and XJ designed the statistical analysis; PX and PC are the guarantors. The first four authors contributed equally to this study. All authors read and approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors have declared that they have no conflicts of interest regarding the content of this article.

Supplementary material

787_2018_1189_MOESM1_ESM.docx (3.3 mb)
Supplementary material 1 (DOCX 3422 kb)


  1. 1.
    Wittchen HU, Stein MB, Kessler RC (1999) Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity. Psychol Med 29:309–323Google Scholar
  2. 2.
    Burstein M, He JP, Kattan G, Albano AM, Avenevoli S, Merikangas KR (2011) Social phobia and subtypes in the national comorbidity survey-adolescent supplement: prevalence, correlates, and comorbidity. J Am Acad Child Adolesc Psychiatry 50:870–880Google Scholar
  3. 3.
    Davidson JR, Hughes DC, George LK, Blazer DG (1994) The boundary of social phobia. Exploring the threshold. Arch Gen Psychiatry 51:975–983Google Scholar
  4. 4.
    National Institute for Health and Clinical Excellence (2013) Social anxiety disorder: recognition, assessment and intervention. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
  5. 5.
    Nikolić M, Colonnesi C, de Vente W, Bögels SM (2016) Blushing in early childhood: feeling coy or socially anxious? Emotion 16:475–487Google Scholar
  6. 6.
    Hidalgo RB, Barnett SD, Davidson JR (2001) Social anxiety disorder in review: two decades of progress. Int J Neuropsychopharmacol 4:279–298Google Scholar
  7. 7.
    Garcia-Lopez LJ, Bonilla N, Muela-Martinez JA (2016) Considering comorbidity in adolescents with social anxiety disorder. Psychiatry Investig 13:574–576Google Scholar
  8. 8.
    Gensthaler A, Maichrowitz V, Kaess M, Ligges M, Freitag CM, Schwenck C (2016) Selective mutism: the fraternal twin of childhood social phobia. Psychopathology 49:95–107Google Scholar
  9. 9.
    Katzelnick DJ, Kobak KA, DeLeire T, Henk HJ, Greist JH, Davidson JR, Schneier FR, Stein MB, Helstad CP (2001) Impact of generalized social anxiety disorder in managed care. Am J Psychiatry 158:1999–2007Google Scholar
  10. 10.
    Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, Penninx BW, Beekman AT (2016) Long-term disability in anxiety disorders. BMC Psychiatry 16:248Google Scholar
  11. 11.
    Barrett PM, Rapee RM, Dadds MM, Ryan SM (1996) Family enhancement of cognitive style in anxious and aggressive children. J Abnorm Child Psychol 24:187–203Google Scholar
  12. 12.
    Barrett PM (1998) Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. J Clin Child Psychol 27:459–468Google Scholar
  13. 13.
    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. J Anxiety Disord 42:105–112Google Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535Google Scholar
  15. 15.
    Stangier U (2016) New developments in cognitive-behavioral therapy for social anxiety disorder. Curr Psychiatry Rep 18:25Google Scholar
  16. 16.
    Beidel DC, Turner SM, Morris TL (1995) A new instrument to assess childhood social anxiety and phobia: the Social Phobia and Anxiety Inventory for Children. Psychol Assess 7:73–79Google Scholar
  17. 17.
    La Greca AM, López N (1998) Social anxiety among adolescents: linkages with peer relations and friendships. J Abnorm Child Psychol 26:83–94Google Scholar
  18. 18.
    Spence SH (1997) Structure of anxiety symptoms amongst children: a confirmatory factor-analytic study. J Abnorm Psychol 106:280–297Google Scholar
  19. 19.
    Gren-Landell M, Björklind A, Tillfors M, Furmark T, Svedin CG, Andersson G (2009) Evaluation of the psychometric properties of a modified version of the Social Phobia Screening Questionnaire for use in adolescents. Child Adolesc Psychiatry Ment Health 3:36Google Scholar
  20. 20.
    James AC, James G, Cowdrey FA, Soler A, Choke A (2015) Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 18:CD004690Google Scholar
  21. 21.
    Cuijpers P (2016) Meta-analyses in mental health research. A practical guide. Accessed 5 Sept 2017
  22. 22.
    Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration, Oxford. Accessed 16 Jul 2017
  23. 23.
    Cipriani A, Zhou XY, del Giovane C, Hetrick SE, Qin B, Whittington C, Coghill D, Zhang YQ, Hazell P, Leucht S, Cuijpers P, Pu JC, Cohen D, Ravindran AV, Liu YY, Michael KD, Yang LN, Liu LX, Xie P (2016) Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet 388:881–890Google Scholar
  24. 24.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–187Google Scholar
  25. 25.
    Riley RD, Higgins JP, Deeks JJ (2011) Interpretation of random effects meta-analyses. BMJ 342:d549Google Scholar
  26. 26.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560Google Scholar
  27. 27.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634Google Scholar
  28. 28.
    Beidel DC, Turner SM, Morris TL (2000) Behavioral treatment of childhood social phobia. J Consult Clin Psychol 68:1072–1080Google Scholar
  29. 29.
    Hayward C, Varady S, Albano AM, Thienemann M, Henderson L, Schatzberg AF (2000) Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study. J Am Acad Child Adolesc Psychiatry 39:721–726Google Scholar
  30. 30.
    Spence SH, 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. J Child Psychol Psychiatry 41:713–726Google Scholar
  31. 31.
    Baer S, Garland EJ (2005) Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. J Am Acad Child Adolesc Psychiatry 44:258–264Google Scholar
  32. 32.
    Masia-Warner C, Klein RG, Dent HC, Fisher PH, Alvir J, Albano AM, Guardino M (2005) School-based intervention for adolescents with social anxiety disorder: results of a controlled study. J Abnorm Child Psychol 33:707–722Google Scholar
  33. 33.
    Olivares J, Rosa-Alcázar AI, Piqueras JA (2005) Early detection and treatment of adolescents with generalized social phobia. Psicothema 17:1–8Google Scholar
  34. 34.
    Masia-Warner C, Fisher PH, Shrout PE, Rathor S, Klein RG (2007) Treating adolescents with social anxiety disorder in school: an attention control trial. J Child Psychol Psychiatry 48:676–686Google Scholar
  35. 35.
    Rosa-Alcázar AI, Olivares-Olivares PJ, Olivares J (2009) The role of non-specific effects in the psychological treatment of adolescents with social phobia. Anales De Psicología 40:43–61Google Scholar
  36. 36.
    Herbert JD, Gaudiano BA, Rheingold AA, Moitra E, Myers VH, Dalrymple KL, Brandsma LL (2009) Cognitive behavior therapy for generalized social anxiety disorder in adolescents: a randomized controlled trial. J Anxiety Disord 23:167–177Google Scholar
  37. 37.
    Sánchez-García R, Olivares J (2009) Effectiveness of a program for early detection/intervention in children/adolescents with generalized social phobia. Anales De Psicología 25:241–249Google Scholar
  38. 38.
    Melfsen S, Kühnemund M, Schwieger J, Warnke A, Stadler C, Poustka F, Stangier U (2011) Cognitive behavioral therapy of socially phobic children focusing on cognition: a randomised wait-list control study. Child Adolesc Psychiatry Ment Health 5:5Google Scholar
  39. 39.
    Tillfors M, Andersson G, Ekselius L, Furmark T, Lewenhaupt S, Karlsson A, Carlbring P (2011) A randomized trial of Internet-delivered treatment for social anxiety disorder in high school students. Cogn Behav Ther 40:147–157Google Scholar
  40. 40.
    Ingul JM, Aune T, Nordahl HM (2014) A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. Psychother Psychosom 83:54–61Google Scholar
  41. 41.
    Olivares J, Olivares-Olivares PJ, Rosa-Alcázar AI, Montesinos L, Macià D (2014) The contribution of the therapist’s competence in the treatment of adolescents with generalized social phobia. Psicothema 26:483–489Google Scholar
  42. 42.
    Öst LG, Cederlund R, Reuterskiöld L (2015) Behavioral treatment of social phobia in youth: does parent education training improve the outcome? Behav Res Ther 67:19–29Google Scholar
  43. 43.
    Masia-Warner C, Colognori D, Brice C, Herzig K, Mufson L, Lynch C, Reiss PT, Petkova E, Fox J, Moceri DC, Ryan J, Klein RG (2016) Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial. J Child Psychol Psychiatry 57:1229–1238Google Scholar
  44. 44.
    Spence SH, Donovan CL, March S, Kenardy JA, Hearn CS (2017) Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: a randomized controlled trial using internet delivery. Behav Res Ther 90:41–57Google Scholar
  45. 45.
    Weisz JR, Kuppens S, Ng MY, Eckshtain D, Ugueto AM, Vaughn-Coaxum R, Jensen-Doss A, Hawley KM, Krumholz Marchette LS, Chu BC, Weersing VR, Fordwood SR (2017) What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice. Am Psychol 72:79–117Google Scholar
  46. 46.
    Zhou XY, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, Cohen D, del Giovane C, Liu YY, Michael KD, Zhang YQ, Weisz JR, Xie P (2015) Comparative efficacy and acceptability of psychological interventions for depression in children and adolescents: a systematic review and network meta-analysis. World Psychiatry 14:207–222Google Scholar
  47. 47.
    Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS (2013) A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry 58:376–385Google Scholar
  48. 48.
    Cuijpers P, Cristea IA, Weitz E, Gentili C, Berking M (2016) The effects of cognitive and behavioural therapies for anxiety disorders on depression: a meta-analysis. Psychol Med 46:3451–3462Google Scholar
  49. 49.
    Ougrin D (2011) Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry 11:200Google Scholar
  50. 50.
    Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, Ades AE, Pilling S (2014) Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 1:368–376Google Scholar
  51. 51.
    Barkowski S, Schwartze D, Strauss B, Burlingame GM, Barth J, Rosendahl J (2016) Efficacy of group psychotherapy for social anxiety disorder: a meta-analysis of randomized-controlled trials. J Anxiety Disord 39:44–64Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingPeople’s Republic of China
  2. 2.Department of PsychiatryThe First Affiliated Hospital of Chongqing Medical UniversityChongqingPeople’s Republic of China
  3. 3.Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands

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