Outcomes from a brief group behavior therapy approach for social anxiety disorder in adolescence: An exploratory clinical trial


  • Mariluz Barata
  • Ana Ferreira
  • Paula Vagos Universidade Portucalense Infante D. Henrique




Adolescence, Social anxiety disorder, Behavioral therapy, Change outcomes


Social anxiety disorder (SAD) usually develops in adolescence and is maintained by avoidance and safety seeking behaviors, which are the focus of behavioral therapy (BT). This work explored the outcomes of a brief group BT for SAD in adolescence, combining exposure with skills training. Fourteen adolescents (aged 14-18 years old) diagnosed with SAD received the intervention. BT was compared to a waiting list condition (n = 10) from pre- to post-intervention; how change in avoidance and safety behaviors predicted post-intervention social anxiety was also tested. Significant improvement was limited to anxiety and avoidance when interacting in new social situations, which may be due to skills training having been focused on general interaction. Only change in avoidance predicted post-intervention social anxiety. Though exploratory, current findings suggest BT to be a relevant approach to SAD. As such, it may inform future more robust studies on interventions tailored to specific core social fears.


Não há dados estatísticos.


Alves, F., Figueiredo, D., & Vagos, P. (2022). The prevalence of social anxiety disorder in school contexts. Int. J. Environ. Res. Public Health, 19(19), 12458. https://doi.org/10.3390/ijerph191912458

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). (5.a ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

Anderson, P. L., Edwards, S. M., & Goodnight, J. R. (2017). Virtual reality and exposure group therapy for social anxiety disorder: Results from a 4–6 Year Follow-Up. Cognitive Therapy and Research, 41(2), 230–236. https://doi.org/10.1007/s10608-016-9820-y

Beidel, D. C., Alfano, C. A., Kofler, M. J., Rao, P. A., Scharfstein, L., & Wong, N. (2014). The impact of social skills training for social anxiety disorder: A randomized controlled trial. Journal of Anxiety Disorders, 28(8), 908–918. https://doi.org/10.1016/j.janxdis.2014.09.016

Beidel, D. C., Turner, S. M., Sallee, F. R., Ammerman, R. T., Crosby, L. A., & Pathak, S. (2007). SET-C versus fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 46(12), 1622–1632. https://doi.org/10.1097/chi.0b013e318154bb57

Blöte, A. W., & Westenberg, P. M. (2007). Socially anxious adolescents’ perception of treatment by classmates. Behaviour Research and Therapy, 45(2), 189–198. https://doi.org/10.1016/j.brat.2006.02.002

Burstein, M., He, J.-P., Kattan, G., Albano, A. M., Avenevoli, S., & Merikangas, K. R. (2011). Social phobia and subtypes in the national comorbidity survey-adolescent supplement: Prevalence, correlates, and comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry, 50(9), 870–880. https://doi.org/10.1016/j.jaac.2011.06.005

Craske, M. G., Treanor, M., Conway, C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Ttherapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006

Cunha, M., Gouveia, J. P., & do Céu Salvador, M. (2008). Social fears in adolescence: The Social Anxiety and Avoidance Scale for Adolescents. European Psychologist, 13(3), 197–213. https://doi.org/10.1027/1016-9040.13.3.197

Cunha, M., Gouveia, J. P., Alegre, S., & do Céu Salvador, M. (2004). n. Psychologica, 35, 245–263.

Gallagher, H. M., Rabian, B. A., & McCloskey, M. S. (2004). A brief group cognitive-behavioral intervention for social phobia in childhood. Journal of Anxiety Disorders, 18(4), 459–479. https://doi.org/10.1016/S0887-6185(03)00027-6

Griffiths, K. M. (2013). Towards a framework for increasing help-seeking for social anxiety disorder. The Australian and New Zealand Journal of Psychiatry, 47(10), 899–903. https://doi.org/10.1177/0004867413493335

Halldorsson, B., & Creswell, C. (2017). Social anxiety in pre-adolescent children: What do we know about maintenance? Behaviour Research and Therapy, 99, 19–36. https://doi.org/10.1016/j.brat.2017.08.013

Halliburton, A. E., & Cooper, L. D. (2015). Applications and adaptations of acceptance and commitment Therapy (ACT) for adolescents. Journal of Contextual Behavioral Science, 4(1), 1–11. https://doi.org/10.1016/j.jcbs.2015.01.002

Helbig-Lang, S., & Petermann, F. (2010). Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice, 17(3), 218–233. https://doi.org/10.1111/j.1468-2850.2010.01213.x

Inderbitzen-Nolan, H. M., Anderson, E. R., & Johnson, H. S. (2007). Subjective versus objective behavioral ratings following two analogue tasks: A comparison of socially phobic and non-anxious adolescents. Journal of Anxiety Disorders, 21(1), 76–90. https://doi.org/10.1016/j.janxdis.2006.03.013

Keller, M. B. (2006). Social anxiety disorder clinical course and outcome: Review of Harvard/Brown Anxiety Research Project (HARP) findings. The Journal of Clinical Psychiatry, 67 (Suppl 12), 14–19.

Kodal, A., Bjelland, I., Gjestad, R., Wergeland, G. J., Havik, O. E., Heiervang, E. R., & Fjermestad, K. (2017). Subtyping social anxiety in youth. Journal of Anxiety Disorders, 49, 40–47. https://doi.org/10.1016/j.janxdis.2017.03.009

La Greca, A. M., & Lopez, N. (1998). Social anxiety among adolescents: Linkages with peer relations and friendships. Journal of Abnormal Child Psychology, 26(2), 83–94. https://doi.org/10.1023/A:1022684520514

Levitan, M. N., & Nardi, A. E. (2009). Social skill deficits in socially anxious subjects. The World Journal of Biological Psychiatry: The Official Journal of the World Federation of Societies of Biological Psychiatry, 10(4 Pt 3), 702–709. https://doi.org/10.1080/15622970802255919

Masia, C. L., Klein, R. G., Storch, E. A., & Corda, B. (2001). School-based behavioral treatment for social anxiety disorder in adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7), 780–786. https://doi.org/10.1097/00004583-200107000-00012

McManus, F., Sacadura, C., & Clark, D. M. (2008). Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39(2), 147–161. https://doi.org/10.1016/j.jbtep.2006.12.002

McNeil, D. W., Lejuez, C. W., & Sorrell, J. T. (2010). Chapter 13—Basic Behavioral Mechanisms and Processes in Social Anxieties and Social Anxiety Disorders. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social Anxiety (Second Edition) (pp. 347–372). Academic Press. https://doi.org/10.1016/B978-0-12-375096-9.00013-4

Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017

Mesa, F., Beidel, D. C., & Bunnell, B. E. (2014). An examination of psychopathology and daily impairment in adolescents with social anxiety disorder. PLOS ONE, 9(4), e93668. https://doi.org/10.1371/journal.pone.0093668

Meulders, A., Van Daele, T., Volders, S., & Vlaeyen, J. W. S. (2016). The use of safety-seeking behavior in exposure-based treatments for fear and anxiety: Benefit or burden? A meta-analytic review. Clinical Psychology Review, 45, 144–156. https://doi.org/10.1016/j.cpr.2016.02.002

Miers, A. C., Blöte, A. W., & Westenberg, P. M. (2010). Peer perceptions of social skills in socially anxious and nonanxious adolescents. Journal of Abnormal Child Psychology, 38(1), 33–41. https://doi.org/10.1007/s10802-009-9345-x

Miers, A. C., Blöte, A. W., de Rooij, M., Bokhorst, C. L., & Westenberg, P. M. (2013). Trajectories of social anxiety during adolescence and relations with cognition, social competence, and temperament. Journal of Abnormal Child Psychology, 41(1), 97–110. https://doi.org/10.1007/s10802-012-9651-6

Olivares, J., García-López, L.-J., Beidel, D. C., Turner, S. M., Albano, A. M., & Hidalgo, M. D. (2002). Results at long-term among three psychological treatments for adolescents with generalized social phobia (I): Statistical significance. Behavioral Psychology, 10(1), 147-164.

Piccirillo, M. L., Taylor Dryman, M., & Heimberg, R. G. (2016). Safety behaviors in adults with social anxiety: Review and future directions. Behavior Therapy, 47(5), 675–687. https://doi.org/10.1016/j.beth.2015.11.005

Plasencia, M. L., Alden, L. E., & Taylor, C. T. (2011). Differential effects of safety behaviour subtypes in social anxiety disorder. Behaviour Research and Therapy, 49(10), 665–675. https://doi.org/10.1016/j.brat.2011.07.005

Rao, P. A., Beidel, D. C., Turner, S. M., Ammerman, R. T., Crosby, L. E., & Sallee, F. R. (2007). Social anxiety disorder in childhood and adolescence: Descriptive psychopathology. Behaviour Research and Therapy, 45(6), 1181–1191. https://doi.org/10.1016/j.brat.2006.07.015

Rijo, D., Brazão, N., Barroso, R., da Silva, D. R., Vagos, P., Vieira, A., Lavado, A., & Macedo, A. M. (2016). Mental health problems in male young offenders in custodial versus community based-interventions: Implications for juvenile justice interventions. Child and Adolescent Psychiatry and Mental Health, 10, 40. https://doi.org/10.1186/s13034-016-0131-6

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. https://doi.org/10.1016/j.janxdis.2016.05.008

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G.C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Sup20), 22–33.

Silva, S., Salvador, M. C., & Pinto-Gouveia, J. (2011). Escala de Comportamentos de Segurança em Situações Sociais para Adolescentes (ECSSSA): Características psicométricas [Poster presentation]. Poster apresentado nas I Jornadas de Iniciação à Investigação em Psicologia, Coimbra, Portugal.

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. https://doi.org/10.1111/1469-7610.00659

Vagos, P., Pereira, A., & Cunha, M. (2014). Evaluating social fears in late adolescence: Study with a Portuguese sample. European Journal of Developmental Psychology, 11(3), 373-385. https://doi.org/10.1080/17405629.2013.841093

Warner, C. M., Fisher, P. H., Shrout, P. E., Rathor, S., & Klein, R. G. (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry, 48(7), 676–686. https://doi.org/10.1111/j.1469-7610.2007.01737.x



Como Citar

Barata, M., Ferreira, A., & Vagos, P. (2022). Outcomes from a brief group behavior therapy approach for social anxiety disorder in adolescence: An exploratory clinical trial. PSICOLOGIA, 36(2), 88–98. https://doi.org/10.17575/psicologia.1786