Prevention of Social Anxiety in Older Children and Young

1 The Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)The Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)The Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)

Prevention of Social Anxiety in Older Children and Young Adolescents


3 The Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)

Anxiety disorders

• Impoverishing disorder

• Occurs in early childhood

• Prevalence rates 5 – 21%

• Crucial that parents, teachers, and health promoters discover anxiety disorders among children.


Anxiety disorders cont. (2/2)

• Evolution->Survival mechanism

• Fear reaction

• Development of the brain

• Attention

• Perception -> is controlled





Social anxiety disorder (DSM-IV criteria, APA,1994)

• As a marked an persistent fear of one or more social performance situations.

• Fear of social failure and negative evaluation

• These situations are either avoided or endured under extreme distress or anxiety.

• The individual recognize that the fear is excessive

• Causes significant interference in the persons life

• Duration of symptoms has to last for at least 6 months.


Phenomenology of Social anxiety disorder in children and young adolescents.• Fear of negative evaluation, being rejected.

• Often anticipatory anxiety, create vicious cycles

• Performance situations such as speaking, reading, writing and eating in public.

• Interactions situations like parties, social gathering and conversations.

• In youths, prevent dating, participating in sport etc.

• Assumptions (dumb, rare, boring)

• Cognitions (I am a failure, looks nervous, etc.)


Why is it important to prevent development of social anxiety disorder?

– High prevalence rates (Furmark, 2002)

– Majority of children and adolescents do not receive treatment (Wittchen et al., 1999)

– Proper treatment is not available (Greenberg et al., 2000)

– Reported treatment efficacy is about 50-60% (Cartwright-Hatton et al., 2006).

– Primary diagnosis (Kessler et al., 2005)

– Strong predictor of mental health problems in adulthood (Van Os & Jones, 1999)

– Serious individual and societal burdens (Beidel et. al.

2000)


Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)

Risk and Protective factors


Norwegian Universal Preventive program for Social Anxiety (NUPP-SA)

– Based on a cognitive behavioral format.

– Multi component target all pupills from 6th to 9th grade, parents/guardians, teachers, school staff and county healthworkers.


Chronological overview of the interventions

– Two phases (Active intervention, & consolidation)




– One day of psychoeducative information was given to public and school helath nurses.




– One day of psychoeducative information was given to public and school helath nurses.

– Two booklets- one aimed at the pupils and the other designed for the parents/guardians and community health and welfear workers


IntervensjonHva gjør vi i èn kommune?

• Two phases (Active intervention, & consolidation)- One day of psychoeducative information was given to public and school helath nurses.- Two booklets; one aimed at the pupils and the other designed for the parents/guardians and community health and welfear workers

• Website: www.beskjedenhet.no

http://www.beskjedenhet.no/



• Two phases (Active intervention, & consolidation)- One day of psychoeducative information was given to public and school helath nurses.-Two booklets; one aimed at the pupils and the other designed for the parents/guardians and community health and welfear workers

• Egen web-side: www.beskjedenhet.no

• Parents/guardians 60 min psychoeduacative lecture

• Teachers and community health and welfare workers and primary physicians




Two phases (Active intervention, & consolidation)- One day of psychoeducative information was given to public and school helath nurses.-Two booklets; one aimed at the pupils and the other designed for the parents/guardians and community health and welfear workers

• Egen web-side: www.beskjedenhet.no

• Parents/guardians 60 min psychoeduacative lecture

• Community health and welfare workers and primary physicians

• Use of the local newspaper



Intervention – Pupils – 3 X 45 min.

• Pupils- received a 45 min lecture that provided education about anxiety, emphasizing the normalcy and commonness of feeling anxious in various situations, and how anxious thoughts, affects, and somatic symptoms can be recognized to avoid misinterpretations of symptoms



• Pupils- received a 45 min lecture about anxiety.

• Hand-out, pupils worked for

45 min.




- Pupils-> received a 45 min lecture

-Handout – >going to a birthdaypart

-Booklet –> aimed specifically towardsthe pupils.



Pupils-> received a 45 min le

Handout –> going to a birthdayparty

Booklet -> Twowards the pupils

Essay -> Three text introductions


Effects of memory rescripting on memory distress, images and social anxiety.

• “Story writing”

–Peter/Ann don’t like to work in groups. What may be the reason? Write and tell what thoughts Peter/Ann may have about themselves. As a friend, how could you give support to Peter/Ann.


Method

• Randomized two communities/municipalities to an intervention or a control condition.

• Subjects

– N=2148, 6-9th graders living in the two counties of Steinkjer and Levanger.

– 1748 returned written consents (856 M, 892 FM)

– The cohort was assessed twice in a 12 month intervall

- 1633 pupils participated at both assessment points.

- 1439 (692 M, 747 FM) valid SPAI-C scores


Method cont.Measures

• Primary outcome measure

– SPAI-C (Social Phobia and Anxiety Inventory for Children).

– Secondary outcome measures;

• SCARED (The Screen for Child Anxiety-Related Emotional Disorders)

• SDQ (Strengths and Difficulties Questionnaires)

• SMFQ (Short Mood and Feeling questionnaire)

Potential confounding effects were assessd by measuring Stressful Life Events and bullying


Hypotheses

– Hypothesis 1: Following the preventive program, the intervention group should demonstrate a significantly lower level of social anxiety.

– Hypothesis 2: Compared to the control group significantly fewer subjects in the intervention group should develop syndromal social anxiety following the intervention.


Results

• The two groups did not differ on any demographic variables measured at the first assessment point.

• A significant reduction in social anxiety was observed among the subjects in the intervention group, and compared to the controll group.


Mean S

PAI-

C s

core

6

6,5

7

7,5

8

8,5

9

9,5

10

Pre Post

Time

Intervention municipality

Control municipality


Results cont.

• The NUPP-SA showed a possible specific preventive effect as well as a possible specific treatment effect. The effect size for the total sample was .20 while the effect size for those with syndromal social anxiety was .83.

• Significantly more subjects in the intervention group with syndromal social anxiety had shifted from syndromal to subsyndromal category,and fewer subjects had switched from subsyndromal to syndromal category during the intervention period. (Aune, T., & Stiles, T. C., JCCP, 2009).


c

6

6,5

7

7,5

8

8,5

9

9,5

10

Pre Post One-year follow-up

Time

Intervention municipality

Control municipality

Mean S

PAI-

C s

core


Prevention interventionPrimary or secondary problems/disorders

Mean age of onset

Social Phobia13 years of age

Substance abuse20 years of age

Major depressive dis.30 years of age

10%

15%

5%

Lifetime prevalence in percent %

12.1% 13.2%

16.6%

Kessler et al., 2005



Mean age of onset




10%

15%

5%


12.1% 13.2%

16.6%

Prevention intervention



Mean age of onset




10%

15%

5%


12.1% 13.2%

16.6%

Prevention Intervention


Thanks for your attention

Documents

Prevention of Social Anxiety in Older Children and Young