Childhood social anxiety: What’s next? Exploring the role of cognitions, depression, parents, and peers

The overall aim of this dissertation was to investigate treatment outcomes after Cognitive Behavioral Therapy (CBT) for childhood social anxiety, to investigate what predicts these treatment outcomes, and to investigate which factors are related to social anxiety and may be important to consider in optimizing treatment outcomes. More specifically, the first aim was to study the relations between child and parental anxiety symptoms at a symptom level. The second aim was to investigate outcomes after CBT for social anxiety disorder compared to other anxiety disorders in children and to study if comorbid depression and/or parental anxiety could explain differences in treatment outcomes. In sum, results showed that children with a primary social anxiety disorder improved less after CBT. Comorbidity with mood disorders was high in the social anxiety group, but did not explain why children with a social anxiety disorder had worse outcomes. There are clear and specific relations between children’s and parents’ anxiety symptoms and parent’s anxiety symptoms decrease slightly when their children receive an anxiety treatment. Parent’s anxiety symptoms were associated with treatment outcomes, but did not explain why children with a social anxiety disorder were worse off. The third aim of the dissertation was to study relations between social anxiety symptoms, social relations according to peers, and perception accuracy of these social relations. It was found that social anxiety symptoms in children and young adolescents are related to negative perceptions of one’s likeability by peers. On average, children with higher levels of social anxiety have greater chances of underestimating their likeability by peers (cognitive bias), but avoiding or scoring high on depressive symptoms is related to actual disliking and thus having a more accurate perception. Furthermore, the tendency to avoid is related to having less friendships in adolescents.