Mediators and moderators of outcome in the behavioral treatment of childhood social phobia

Abstract

Objective: The current study examined mediators and moderators of treatment response among children and adolescents (ages 7-17 years) with a primary diagnosis of social phobia.

Method: Participants were 88 youths participating in one of two randomized controlled treatment trials of Social Effectiveness Therapy for Children. Potential mediators included changes in observer-rated social skill and child-reported loneliness after 12 weeks of Social Effectiveness Therapy for Children. Age and depressive symptoms were examined as potential moderators.

Results: Loneliness scores and social effectiveness during a role-play task predicted changes in social anxiety and overall functioning at posttreatment. Changes in social anxiety were mediated by child-reported loneliness. Outcomes were not moderated by age or depressive symptoms.

Conclusions: Findings support the role of loneliness as an important mechanism of change during treatment for childhood social phobia.

Figure 1

(a–c) excludes the covariates of pre treatment LS scores and social effectiveness ratings on the role play and read aloud tasks as well as the correlations among variables to avoid clutter, but these variables were included in tests of the model. Standardized effect coefficients for direct effects are shown. *p < .05; **p < .01; ***p < .001. ADIS-C/P CSR = Anxiety Disorders Interview Schedule for Children for DSM-IV Child and Parent Clinical Severity Ratings. SPAI-C = Social Phobia and Anxiety Inventory for Children. C-GAS = Children’s Global Assessment Scale.