Behavioral and Cognitive-Behavioral Treatments for Youth with Social Phobia

Pediatric social phobia (SP) is characterized by a pervasive pattern of social timidity. SP is most often diagnosed in mid- to- late adolescence, affecting approximately 3–5% of youth. This article reviews behavioral (BT) and cognitive-behavioral treatments (CBT) for youth with SP and outlines several limitations in the current literature. Although these treatments are all presumed to be efficacious for youth with SP and are often the treatment of choice, examination of outcome often occurs in samples with mixed anxiety disorders (AD) (including generalized anxiety disorder and separation anxiety disorder). Outcome is often assessed without considering diagnostic status, obfuscating important treatment distinctions. Further, SP often accounts for only a small portion of the samples in controlled treatment trials that include different diagnostic categories. When outcomes are examined by diagnosis, recovery rates for SP often are lower in comparison with other ADs, suggesting that factors unique to SP youth are not being adequately addressed with some forms of CBT. In contrast, interventions that include social skills training result in outcome rates for SP that are equivalent to the overall rates for BT/CBT for mixed diagnostic groups. The critical role of assessment and treatment of skills deficits in youth with SP is highlighted.